As we enter autumn and the weather turns cooler, it is important for asthma patients to pay more attention at this time of year because asthma may flare up or worsen when the seasons change and the temperature drops. However, some patients may be confused: Why is my asthma not well controlled even though I follow my doctor’s regimen of regular medication? These patients may have refractory asthma, which accounts for 5-10% of asthma cases. So, what is refractory asthma and what are the reasons why it is difficult to control? How should it be managed?
The definition of refractory asthma has not yet been fully unified at home and abroad. According to the consensus of domestic experts in 2010, it is defined as asthma that cannot be well controlled even after at least 6 months of standard treatment with two or more control medications including inhaled hormones and long-acting β2 agonists.
So, what are the manifestations of refractory asthma?
1. Hormone-dependent/hormone-resistant asthma, which means that these patients respond poorly to hormone therapy and require long-term reliance on high-dose inhaled hormones or even oral hormones.
2. Brittle asthma: These patients can have an asthma attack in a short period of time without any obvious trigger. It can be divided into 2 types. Type I is poorly controlled asthma after active and standardized treatment, with more than 50% of days with a daily PEF variability of 40%. Type II is usually well-controlled asthma, smooth symptoms, in a few minutes suddenly severe attacks, even life-threatening.
3, lethal asthma: this type of asthma attack is often accompanied by hypercapnia and requires mechanical ventilation to solve the problem.
What makes this part of asthma symptoms difficult to control?
1, patient compliance: some patients do not understand their condition and believe that as long as the attack is under control, they usually do not regulate the use of medication. There are also parents who are worried about the side effects of drugs, especially hormonal drugs, and are afraid that long-term hormone inhalation will affect their children’s growth as well as growth and development. In addition, there is another situation is not the correct use of drug inhalation device.
2, respiratory infections: Some patients may have the experience that asthma attacks often occur after a cold, and studies have shown that wheezing in children is associated with respiratory viral infections, while respiratory syncytial virus infections may lead to refractory asthma. In addition, Mycoplasma pneumoniae and Chlamydia infections can also cause asthma attacks.
3. Coexisting allergic rhinitis: Regarding the relationship between allergic rhinitis and asthma, a survey showed that 64% of asthma patients had allergic rhinitis first and 21% had both diseases. Studies have shown that the same person with allergic rhinitis often encounters asthma in time, and a significant number of patients have allergic rhinitis manifestations such as nasal itching, sneezing, and runny nose before an asthma attack. In view of the fact that allergic rhinitis and asthma are different manifestations of the same disease in the upper and lower respiratory tract, the concept of “the same respiratory tract and the same disease” has been proposed in recent years.
4, environmental asthma-causing factors: common inhalation allergens: dust mites, mold, pollen, cockroach insects, animal fur and secretions; food allergens: eggs, milk, meat products, soy products, seafood, etc.; environmental pollutants: nitrogen oxides, ozone, sulfur dioxide, nitrogen dioxide, particulate matter and smoke, etc.
5.Gastroesophageal reflux (GER): It is a symptom caused by reflux of gastric contents into the esophagus through the lower esophagus. If a patient has typical symptoms of GER, such as burning sensation behind the sternum, repeated episodes of choking, coughing and wheezing after eating acidic food or drinks and overeating, then GER should be highly suspected.
6. Smoke exposure: Whether smoking or passive smoking, asthma patients exposed to smoke have more severe symptoms, more attacks, and faster lung function decline than nonsmoking patients. Smoking not only triggers asthma attacks and is an important cause of refractory asthma, it is also the cause of treatment resistance in patients.
7, obesity: some studies have shown that pregnant mothers are obese before pregnancy, the risk of asthma in children within 3 years of age increased by 52%. Overweight children at birth and those who are overweight in childhood have an increased risk of asthma.
How is refractory asthma managed?
If your child’s asthma symptoms are not controlled after regular treatment, then you should see your doctor for a consultation to find out why the asthma is difficult to control and to change the treatment plan. For patients, the first step is to improve compliance and master the use of various inhalation devices. Secondly, various allergens should be avoided.
(1) House dust mites: Wash sheets and blankets weekly in hot water and dry them in a dryer or in the sun, paying particular attention to shaking the sheets after drying so that no dust mites remain. Use flooring in the home instead of carpet, especially in the bedroom. Also note that doing these treatments keeps the patient out of the home.
(2) Fur-bearing animals: Animals should not be left in the home, especially in the bedroom; bathe pets; use air filters.
(3) Pollen and mold: During the pollen transmission season, try not to go outside, stay at home, close doors and windows; wear masks appropriately when you go out.
(4) Indoor mold: reduce indoor humidity, open windows and ventilate, and clean moist areas frequently.
In addition, stay away from the air pollution environment, and wear a mask when necessary. Smokers should quit smoking. Obese people should control their weight. Again, some coexisting diseases, such as allergic rhinitis and gastroesophageal reflux, should be treated actively. In allergic rhinitis, medication should be standardized to control the symptoms and keep the nasal cavity clean. Steps such as nasal washing and nasal medication are indispensable to avoid asthma attacks due to rhinitis attacks. If there are symptoms of gastroesophageal reflux, they should be treated by the relevant specialist. The control of refractory asthma requires the joint efforts of patients and doctors, and we believe that with the active cooperation of patients, refractory asthma will no longer be “difficult to treat”.