The latest information shows that there are 300 million asthma patients worldwide and about 30 million asthma patients in China, and with urbanization and modernization of lifestyle, the number of asthma cases in China will increase significantly in the next 10 years. However, only about 30% of asthma patients are on the “right track” for treatment in outpatient clinics, while the remaining 70% are still wandering, trying to find the secret cure for asthma and “get rid of the root”. Many patients have the behavior of “believing in the witch but not in the doctor” and do not go to the regular hospital to see the doctor, blindly believing in some “ancestral secret recipes”, “Chinese medicine capsules” and other drugs without approved symbols. Inhalation therapy is the preferred treatment for asthma. In principle, the commonly used drugs for asthma in children can be divided into two categories: control drugs and rapid relief drugs. Asthma control drugs, also known as preventive drugs or maintenance drugs, are long-term and daily drugs to prevent or reduce asthma attacks, including glucocorticoids, long-acting β2 agonists, leukotriene modulators, slow-release theophylline and sodium cromoglycate, etc.; while relief drugs, also known as fast-relief drugs or emergency drugs, work quickly to relieve bronchospasm and are used as needed during attacks. The short-acting β2 agonists, theophylline and anticholinergic drugs are commonly used. In the past, asthma was thought to be caused by allergens causing bronchoconstriction, so bronchodilators were mainly used to treat asthma, but they could not solve the recurrent attacks and progressive deterioration of asthma. Recent studies have demonstrated that asthma is primarily a chronic inflammation of the airways and the resulting set of symptoms, so asthma should be treated primarily with anti-inflammatory therapy targeting chronic allergic inflammation of the airways. The most effective anti-inflammatory drug is glucocorticoids, which block all aspects of the inflammatory response in asthma and increase the role of β2 agonists in bronchodilation. Inhalation therapy is currently the first choice of treatment for asthma recommended by the World Health Organization, which has the characteristics of fast onset, less medication, less side effects and good therapeutic effect, and is generally divided into two categories: asthma calming and anti-inflammatory. Asthma medication is used during an asthma attack and can be effective in a few minutes. As the condition improves, it is used on an as-needed basis, and the fewer times it is used, the more stable the patient’s condition is. Anti-inflammatory drugs, namely inhaled hormones, are long-term control medications that are used during an attack and do not have an effect until 1 week later. However, it is an indispensable drug for repairing airway inflammation and should be used consistently for a long time. From a pharmacotherapeutic point of view, inhalation therapy for asthma is the most classical targeted treatment. Patients can use various inhalation devices to deliver drug components to the lesion site, so the onset of action is fast, the dose of medication is small, and the corresponding side effects are reduced. Only through regular inhalation of hormones can we achieve the goals of suppressing airway inflammation, maintaining the patient’s normal or approximately normal lung function, preventing asthma attacks, and ensuring the patient’s quality of life. Only by adhering to regular medication can the remission period of asthma be prolonged, the number of attacks be reduced as much as possible, and even if there is an acute attack, the attack can be made less severe. In short, asthma should be well controlled for a long time, which is what we usually call a permanent cure for a long time. Do I need to treat my asthma when it is not attacking on a daily basis? Asthma is a chronic allergic airway inflammation that is characterized by recurrent attacks. Although the symptoms of asthma are episodic, the airway inflammation persists over time. In the interval without attacks, the patient seems to have no problem, but in fact, he is like a “volcano” that is temporarily inactive, once stimulated by allergens, the “volcano” will immediately erupt and coughing and wheezing symptoms will appear. When the volcano erupts, it may lead to death. Current research on asthma confirms that with standardized treatment, 80% of asthma patients can achieve complete control or good control, no attacks, no additional medication, and no interference with school and life. However, there are still some misunderstandings in the treatment of asthma, and it is one of the important reasons for the current situation of asthma development in China. For example, many parents are particularly nervous when their children have asthma attacks and actively seek medical attention. But once the condition is under control and in remission, they relax their vigilance and even think that as long as they “don’t wheeze”, they are well and don’t need medication. Some families are afraid of the hassle and delay, some parents are afraid of spending money, and some parents have a fluke mentality. As a result, the chronic inflammation of the airways gets out of control and asthma is triggered by the slightest breeze. In fact, the control of airway inflammation in asthma needs a process, and the reduction of wheezing symptoms does not mean that the airway inflammation has been well controlled, and if the dose of inhaled hormone is hastily reduced at this time it is easy to have an asthma relapse. Currently, treatment protocols classify asthma patients into 4 levels of severity, each with corresponding treatment options, using individualized stepwise treatment norms, and achieving and sustaining control for at least 3 months before considering step-down treatment, which should continue to maintain asthma control after step-down. For a given asthma patient, it often takes a year or even years from the start of application of a larger inhaled dose to the application of a minimal maintenance dose. It is only by following the doctor’s instructions, reviewing the medication regularly, and adjusting the type and dose of medication strictly according to the asthma treatment guidelines under the doctor’s guidance that you can achieve good long-term control of asthma and truly “breathe healthy every day”. Will long-term hormone inhalation cause adverse effects? When it comes to hormones, people are afraid of talking about them and feel that they have many side effects. It is true that long-term systemic application can lead to centripetal obesity, full-moon face, elevated blood sugar, hypertension, osteoporosis and even femoral head necrosis. However, the side effects mentioned above refer to systemic application of hormones (oral or intravenous), and the first-line treatment we recommend for asthma treatment now is actually inhaled hormones. The pharmacology and pharmacokinetic characteristics of inhaled hormones are different from those of systemic hormones. The absorption ratio of inhaled hormones is very low, and we call these hormones local hormones, and the bioavailability of local hormones is particularly low. Some people have done this conversion, a breath of specially processed hormone, the weight of this breath is about 1/200 of a small grain of rice, so the inhaled hormone is very small, and therefore the side effects are greatly reduced. Secondly, when administered by inhalation, the drug enters the lower respiratory tract with the airflow, mainly acting directly on the airway mucosa, and the amount absorbed into the blood circulation through the mucosa is very small; although some drugs are deposited in the oropharynx and absorbed into the blood through the digestive tract, most of them are then inactivated by the liver, so the dose that really participates in the body’s metabolism is very small and will not bring about obvious systemic adverse reactions. Only a small percentage of patients (about 2-3%) may have mild reactions such as mouth ulcers, hoarseness, sore throat, etc. As long as attention is paid to rinsing the mouth after using the drug, the above reactions will be reduced or disappear. On the contrary, due to the lack of understanding of the characteristics of inhaled hormone therapy and excessive worry about the so-called “side effects”, no medication is used during the remission period, resulting in repeated asthma attacks, poor breathing and insufficient oxygen supply to the child, which will definitely affect the child’s growth and development, and over time, airway remodeling will occur, causing irreversible and serious damage to the child’s lung function. The best time for treatment is lost, and it will be too late to regret. What are the commonly used pediatric inhaled hormones? There are many types of inhaled glucocorticosteroids commonly used in pediatrics, including beclomethasone dipropionate (Bicodone), budesonide (Pulmicort) and fluticasone propionate (Co-codone); pharmacologically, the local efficacy of budesonide and fluticasone is stronger than that of beclomethasone dipropionate, while the systemic side effects are smaller. In terms of dosage form, there are quantitative aerosol (MDI), dry powder and nebulized liquid. Generally speaking, the use of dry powder inhalation device is more convenient than ordinary quantitative aerosol, which does not require the coordination of inhalation action and snap action, but requires higher inhalation flow rate and inhalation flow rate, and the amount of dry powder entering the airway and lung tissue is more than that of aerosol, while the drug staying in the oropharynx is less than that of aerosol, thus increasing the efficacy and reducing side effects such as fungal infection in the oropharynx. It does not contain Freon, which avoids environmental pollution, and the irritation of the throat is much less than that of aerosols. When nebulized inhalation with nebulizer solution, the drug mist is continuous and continuously inhaled into the lungs with the patient’s breathing, without the patient’s cooperation, with less irritation to the oropharynx, high amount of drug inhaled into the lungs, and better distribution, with better efficacy than other inhalation methods. It is mainly used for acute attacks of asthma in children. It has a rapid onset of action and can reduce the dosage of systemic hormones during severe asthma attacks. At present, the main varieties of inhaled hormones available in the domestic market are Bicodone Aerosol, Pulmicort Aerosol, Cozultone Aerosol, Pramipexole, Sulidexole Dry Powder (Fluticasone Propionate + Salmeterol), Cymbalexole (Budesonide + Formoterol) and Pramipexole. The combination of inhalation hormone and inhaled long-acting β2 agonist has synergistic anti-inflammatory and antiasthmatic effects, which can achieve efficacy equivalent to (or better than) inhaled doubled doses of hormone and avoid the potential systemic adverse effects of high doses of inhaled hormone. It is especially suitable for the long-term control treatment of children with moderate to severe asthma. Desensitization is a good way to keep asthma away for good “Can asthma be cured?” This is a common concern for many parents of children with asthma. It is true that asthma is a common allergic disease that is difficult to be cured and recurrent in clinical practice. However, with the continuous development of medical science, the understanding of the pathogenesis, rules and treatment of asthma has been greatly improved, and new effective drugs and measures are emerging. The World Health Organization clearly states in its guiding document on immune desensitization therapy that “desensitization therapy is the only radical treatment possible for the complete treatment of bronchial asthma”. Desensitization therapy improves the desensitization of the patient and is the only treatment that targets the cause of allergic asthma. For this reason, desensitization therapy is becoming increasingly popular among physicians and patients. Desensitization therapy, also called allergen vaccine therapy, is one of the important treatments for asthma. Through a specific method, an allergen is formulated into an agent that the patient uses and is able to gradually adapt to the allergen until antibodies are produced. When the patient is exposed to the substance again, the allergic reaction is not triggered and the symptoms caused by the allergy disappear or are significantly reduced for treatment purposes. Children who have difficulty avoiding allergens (such as dust mites) can be treated by this method with clear efficacy and fewer side effects. However, desensitization treatment takes longer (2 to 3 years) because asthma is a chronic and recurrent disease, and desensitization to reduce the body’s sensitivity to allergens cannot be rushed. At the beginning of desensitization treatment, if the child has allergic symptoms, it is still necessary to combine the use of symptomatic medications under the guidance of a doctor. The root cause of the symptoms of allergic diseases is often due to the accumulation of inflammation in the airways. Desensitization reduces and avoids the development of new inflammation by improving the body’s tolerance; medication is directed at the symptoms that have developed and controls the inflammation. Therefore, if symptoms persist, medication should still be administered according to medical advice and should not be stopped without authorization. The earlier desensitization treatment is carried out in children, the better the results will be, basically changing the allergy condition and achieving a cure. However, desensitization should be stopped during an asthma attack and resumed when the coughing and wheezing are under control. When doing desensitization treatment, the dose should be increased gradually according to a relatively clear regulation of the World Health Organization, and the dose should be increased gradually according to this method, otherwise it may sometimes induce asthma and even induce anaphylaxis. Commonly used desensitization methods include subcutaneous injection desensitization and sublingual desensitization. Subcutaneous desensitization is the traditional method of desensitization. Sublingual desensitization therapy is a new therapy advocated by the World Health Organization in recent years. Compared with subcutaneous injection desensitization therapy, sublingual desensitization therapy is convenient, not limited by time and place; the way of administration is warm, no need for injection, more suitable for long-term desensitization therapy, especially for children; the efficacy is commensurate with subcutaneous injection desensitization therapy; the safety is higher. After one to three years of sublingual desensitization, patients can significantly reduce the number and severity of asthma attacks, and some patients can achieve a completely symptom-free state. More importantly, patients can significantly reduce the number and dose of hormones used. Studies have shown that this therapy can alter the natural course of asthma and maintain its effectiveness for several years after treatment is stopped.