The standardized and individualized treatment of bronchial asthma and the standardized combination of Chinese and Western medicine are very important in slowing down the progression of the disease, reducing mortality and improving the quality of life.
1. First, you have to assess your condition yourself, as follows.
Table 1 Asthma control test form
Question 1
In the past 4 weeks, how often has asthma prevented you from
to perform daily activities?
All the time 1 point
Most of the time 2 points
Some of the time 3 points
Rarely 4 points
No 5 points
Score
Question 2
In the past 4 weeks, how many times have you had difficulty breathing?
More than 1 time per day 1 point
1 time per day 2 points
3 to 6 times per week 3 points
1 to 2 times per week 4 points
Not at all 5 points
Score
Question 3
In the past 4 weeks, because of asthma symptoms (wheezing, coughing, difficulty breathing, chest tightness, or
pain), how many times did you wake up at night or earlier than usual in the morning?
4 or more nights per week 1 point
2 points for 2 to 3 nights per week
1 time per week 3 points
1 to 2 times 4 points
No 5 points
Score
Question 4
In the past 4 weeks, how many times did you use emergency medication (e.g., salbutamol)?
More than 3 times a day 1 point
1 to 2 times a day 2 points
2 to 3 times per week 3 points
1 time per week or less 4 points
No 5 points
Score
Question 5
How would you rate the control of your asthma in the past 4 weeks?
No control 1 point
Very poorly controlled 2 points
Somewhat controlled 3 points
Very well controlled 4 points
Fully controlled 5 points
Scores
Step 1: Record the exact score for each question; Step 2: Add up the scores for each question to get the total score; Step 3: Find the meaning of the total score (25 points: fully controlled; 20-24 points: partially
In addition, an acute asthma attack in any week is considered uncontrolled, and ≥1 attack in a year is considered partially controlled in that year.
2. Based on the assessment of the condition, a graded treatment plan was selected and developed as follows: (the aim was to achieve the level of complete control)
Table 2
Downgrading Treatment level Escalation
Level 1 Level 2 Level 3 Level 4 Level 5
Asthma education, environmental control
Short-acting as needed
B2-agonist Short-acting B2-agonist as needed
1 optional 1 optional 1 additional 1 or more additional 1 or 2
Low dose ICS Low dose ICS+ Medium to high dose ICS+ Oral low dose glucocorticoids
LABA LABA
Controlled medication
Leukotriene modulator Medium to high dose ICS Leukotriene modulator Anti-IgE therapy
Low-dose ICS+ slow-release theophylline
Leukotriene modulators
Low-dose ICS+
Slow-release theophylline
Description.
Long-term treatment regimens for patients with asthma are divided into 5 levels,
Tier 2 can be chosen for patients with previously untreated primary asthma, and Tier 3 should be chosen directly for patients with significant asthma symptoms. From level 2 to level 5, different asthma control medications are available. In each tier, relief medications should be used as needed to provide rapid relief of asthma symptoms. A single inhalation device containing formoterol and budesonide may be used as both a control and relief medication when used in combination.
If asthma control is not achieved with this tiered regimen, the regimen should be escalated until asthma control is achieved. When asthma is controlled and maintained for at least 3 months, the regimen may be considered for downgrading. The recommended dose reduction regimen is: (1) for patients on medium to high dose inhaled hormone alone, reduce the inhaled hormone dose by 50%; (2) for patients on low dose hormone alone, switch to once daily dosing; (3) for patients on combination inhaled hormone and LABA, reduce the inhaled hormone dose by approximately 50% and continue with the LABA combination. When a low dose of combination therapy is reached, it is optional to switch to once-daily combination therapy or to discontinue the LABA and treat with inhaled hormones alone. Patients are usually seen 2 to 4 weeks after the initial diagnosis and then every 1 to 3 months thereafter. Patients should be seen promptly in the event of an asthma attack, with a follow-up visit within 2 to 4 weeks after the attack.
Table 3 Daily dose and interchangeability of commonly used inhaled glucocorticoids (Lg)
Drug Low dose Medium dose High dose
Beclomethasone dipropionate 200~500 500~1000 > 1000~2000
Budesonide 200~ 400 400~ 800 > 800~ 1600
Fluticasone propionate 100~ 250 250~ 500 > 500~ 1000
Ciclesonide 80~ 160 160~ 320 > 320~ 1280
3.Commonly used drugs introduction
The drugs for asthma treatment can be divided into control drugs and relief drugs.
( 1) Control drugs: They are drugs that need to be used daily for a long time. These drugs are mainly used to maintain clinical control of asthma through anti-inflammatory effects, including inhaled glucocorticoids (hormones), systemic hormones, leukotriene modulators, long-acting B2-agonists (LABA, which must be combined with inhaled hormones), extended-release theophylline, sodium cromoglycate, anti-IgE antibodies and other drugs that help reduce the dose of systemic hormones;
( 2) Relieving drugs: These are drugs used on an as-needed basis. These drugs relieve asthma symptoms by rapidly relieving bronchospasm.
They include rapid-acting inhaled B2-agonists, systemic hormones, inhaled anticholinergics, short-acting theophylline, and short-acting oral B2-agonists. Short-acting B2-agonists (SABA): Commonly used drugs such as salbutamol (salbutamol) and terbutalin.
LABA: These B2-agonists have long side chains in their molecular structure and can maintain the effect of diastolic bronchial smooth muscle for more than 12 hours, such as salmeterol and formoterol:
These are the two types of inhaled LABA currently in clinical use in China. Compounding such as salmeterol (salmeterol + fluticasone).
4.Grading of the severity of the disease during the acute attack
Mild degree can be self-managed, but moderate degree and above go to hospital for consultation.
Table 3 Grading of severity in acute exacerbation of asthma
Clinical features Mild Moderate Severe Critical
Shortness of breath Walking up stairs with a little activity At rest C
Position May lie down Prefer sitting position Sitting breathing –
Speech Continuous sentences Single words Single words Cannot speak
Mental status may be anxious, quiet, sometimes anxious or irritable, often anxious, irritable, drowsy or unconscious
Sweating None Yes Sweating profusely –
Respiratory rate mildly increased increased often > 30 breaths/min C
Auxiliary respiratory muscle activity and trigeminal signs are often absent May be present Often present Paradoxical chest and abdominal movements
Rales are scattered, loud at the end of the breath, diffuse, diffuse, or even absent
Pulse rate (beats/m in) < 100 100~120 > 120 Slowed or irregular pulse rate
Odd pulse absent, < 10 mm H g possible, 10-25 mm H g frequent, > 25 mm H g (adults) absent, suggesting respiratory muscle fatigue
Initial bronchodilator treatment
PEF after initial bronchodilator treatment as expected or individual
Best % > 80% 60% to 80% < 60% or < 100 L/ m in
or duration of action < 2 h
-PaO2
PaO2 (inhaled air, mm H g) normal 60 < 60 < 60
PaCO2 (mm H g) < 45 ≤ 45 > 45 > 45
S aO2 ( inspiratory air, %) > 95 91~ 95 [ ≤ 90 ≤ 90
Decrease in pH value
Note: As long as certain indicators of a certain severity are met, but not all indicators need to be met, it can indicate an acute attack of that level; 1 mm H g = 0. 133 kPa; PEF: peak expiratory flow
5.Chinese herbal medicine and acupuncture
Asthma as a clinical chronic disease, Western medicine is effective in the treatment of acute exacerbation, while the treatment of non-acute exacerbation, the combination of Chinese and Western medicine often has greater advantages, through the dialectical treatment of Chinese medicine, acupuncture points, acupuncture and moxibustion, and other means, patients can also see the effect of asthma treatment. The treatment of chronic asthma with Chinese medicine is very individualized and should be based on the individual patient’s condition. It is more advantageous to combine the Western medical treatment with the Chinese medicine individual condition “diagnosis and treatment”, which can reduce the hormone dosage and enhance the efficacy.