Little Bebe, who has just turned 1, is chubby and lively, and her family treats her like a jewel in the palm of their hands and spoils her. But this month, for some reason, she has been coughing all the time, especially at night or when she is having fun, and she wakes up with a coughing sound, and sometimes her throat makes a “swooshing” wheezing sound. After a month of medication and many antibiotics, her cough still didn’t go away and she kept feeling a lot of phlegm in her throat. After being referred to our pediatric department by a neighbor, I gave Bebe a detailed examination and considered it to be infantile asthma. Bebe’s mother was very nervous and could not accept that Bebe only had a cough, how could it be asthma? How to diagnose asthma in infants and children? Bronchial asthma (asthma) is a chronic inflammatory disease of the respiratory tract, which means that the airways are in a state of hypersensitivity (i.e., airway hyperresponsiveness) and clinically presents with symptoms such as recurrent coughing, wheezing, chest tightness or shortness of breath. These clinical symptoms have a temporal regularity and are often evident during weather changes, early morning or at night; they have an episodic character and can be exacerbated by the stimulation of triggering factors; and they are reversible and can resolve on their own or with bronchodilator treatment. The causes of asthma are complex and often related to viral infections, environmental and genetic factors. Children with allergic eczema on the skin and a history of allergic diseases (such as allergic rhinitis, urticaria, etc.) or asthma in both parents have a significantly higher chance of getting asthma. Children with asthma often start out with a recurrent cough, which is often misdiagnosed as “upper respiratory tract infection, bronchitis”. In general, a cough caused by a cold rarely lasts more than 2 weeks. If a recurrent cough lasts more than 2 weeks and is particularly pronounced at night or after exercise, especially when the weather changes, it is important to be alert to the presence of asthma. Asthma only has the typical clinical symptoms of chest tightness, shortness of breath, and wheezing sounds when breathing during an acute attack, and it is often at this time that it comes to the attention of parents. The clinical symptoms of asthma in infants and young children are often atypical, and because children are young and mostly inexpressive, the diagnosis of asthma in infants and young children is mainly based on the assessment of clinical symptoms and physical examination. Clinical symptoms are highly suggestive of asthma if the following are present: frequent episodes of wheezing more than once a month, activity-induced cough or wheezing, intermittent nocturnal cough or nocturnal awakening due to non-viral infections, wheezing without seasonal changes and wheezing symptoms lasting beyond 3 years of age. All of these require careful parental observation, a detailed medical history and comprehensive physician analysis and judgment. Physicians commonly use experimental treatment with inhaled rapid-acting bronchodilators and inhaled glucocorticoids to determine whether wheezing is asthma, and if clinical symptoms improve significantly after treatment and recur or worsen after discontinuation of the drug, the diagnosis of asthma is supported. Of course, episodes of wheezing and cough are common clinical symptoms, and not all wheezing in infants and children is bronchial asthma; therefore, some other diseases such as recurrent lower respiratory tract infections, bronchopulmonary dysplasia, airway foreign bodies, tuberculosis, etc. must also be ruled out in infants and children with recurrent wheezing. Pulmonary function tests are very important in the diagnosis and monitoring of asthma, and determination of airway responsiveness is highly sensitive for the diagnosis of asthma, but pulmonary function tests are not reliable in infants and children, and airway responsiveness measurements are difficult to perform in children of this age. In infants and children with asthma, allergen determination helps to identify the risk factors that contribute to asthma and also facilitates the recommendation of environmental control strategies for patients. How to prevent and treat asthma in infants and children? The occurrence, development and prognosis of asthma are closely related to the environment and genetics. Genetic constitution from parents is difficult to change, and about 80% of childhood asthma has allergic factors, so avoiding allergens and non-specific irritant exposure is the most fundamental and effective way to prevent asthma attacks or worsening with the nature of etiological treatment if allergens are clearly identified. If you are sensitive to house dust mites, it is advisable to wash bed sheets and pillow cases frequently, preferably every other week, and soak and scald them with hot water above 55℃ for 10-15 minutes or expose them to the sun for more than half an hour; keep room furnishings as simple as possible, do not use carpets and plush toys, too many decorations tend to accumulate dust; when cleaning the room, affected children should avoid it and try to wipe it with a wet cloth to avoid flying dust. Take comprehensive or specific measures to reduce the number of dust mites and minimize the exposure to allergens. For those allergic to animal fur, pets (cats, dogs) should not be kept indoors. Avoid second-hand smoke and some irritating smelling substances, such as mosquitoes, paints, mothballs, perfumes, etc. Active prevention and treatment of respiratory viral or bacterial infections in infants and children with asthma can prevent asthma attacks. For infant asthma, early diagnosis and early access to standardized treatment, many children can gradually reduce asthma symptoms as they grow older and stop having attacks by adolescence. Therefore, asthma treatment consists of two main parts: the use of fast-relieving drugs to control symptoms during asthma attacks; and a long-term, standardized and continuous preventive treatment program should be developed according to individualization during the remission period, and the dose of drugs can be slowly reduced after the symptoms have gradually stabilized for 3-6 months. However, the current misconception of many parents is that children need treatment only when they have wheezing, and they do not care if they take medicine for a few days after the symptoms improve, completely ignoring the importance of maintenance treatment and waiting for the next attack. As a result, the airways become more and more damaged due to chronic inflammation and wheezing becomes more and more severe, and an acute attack may cause irreversible results over time. Therefore, preventive treatment of asthma is very important. The main drugs for long-term control of asthma attacks are inhaled glucocorticoids (ICS) and leukotriene modifiers, which are currently the most effective anti-inflammatory drugs for asthma treatment, reducing the sensitivity of the airways and reducing acute attacks, and should be inhaled for a long period of time and gradually reduced only after the condition has stabilized. However, many parents are concerned about the side effects of glucocorticoids, worrying that long-term inhalation of hormones will affect the growth and development of their children, and also worrying that once they start inhaling the medication, they will not be able to leave it for the rest of their lives. This is actually a misconception. Inhaled glucocorticosteroids are not the same as the systemic glucocorticosteroids normally used. Systemic glucocorticosteroids have to pass through the gastrointestinal tract and blood circulation before reaching the lungs, the target organ for treatment, and therefore require larger doses of drugs. ICS, through some inhalation devices, does not go through the absorption of the gastrointestinal tract, blood circulation, the drug is inhaled directly to the treatment site – the lungs, so the required inhalation of a small dose can achieve the desired therapeutic effect, and residual drugs in the mouth can be cleared by rinsing, drinking water, a small amount of drugs into the gastrointestinal tract through the liver, kidney The small amount of drugs entering the gastrointestinal tract can be inactivated by the liver and kidneys and no longer enter the blood circulation, thus avoiding side effects of systemic hormones. Therefore, ICS is a very safe drug for asthma treatment, and physicians will adjust the dose of the drug according to whether the child’s condition can be controlled after treatment. Commonly used ICS include budesonide (trade name: Promethazine), fluticasone (trade name: Co-codone), beclomethasone dipropionate (trade name: Bicodone), etc. For infants and children with asthma, because of their young age and crying, inhalation medications are mainly inhaled using a suspension through an air-compressed nebulizer pump or an aerosol through a fog storage tank. It is important to master the correct method of inhalation, both to improve the efficacy of the drug and, more importantly, to reduce its side effects. Among the long-term control medications for asthma are also leukotriene modifiers (trade name: cisplatin). Because leukotrienes are one of the important inflammatory mediators in the development of asthma, the use of leukotriene modulators can reduce asthma attacks and achieve the purpose of asthma control, mostly for mild asthma, but the overall efficacy is often weaker than ICS, mostly used in the combination of moderate to severe asthma and ICS. The main drugs used for rapid relief of asthma symptoms are fast-acting bronchodilators, such as salbutamol (Ventolin), terbutaline (Bolicam), ipratropium bromide (Echolac), etc. These drugs relieve bronchospasm within 5 to 30 minutes after inhalation and can be used as emergency medication during acute asthma attacks. Every family with a child with asthma should have these medications for rapid relief of asthma attacks and know how to use them properly in an emergency. However, it is important to emphasize that bronchodilators are used only in emergency situations; long-term use of such medications alone has no anti-inflammatory effect, but masks the severity of asthma, causing parents to become paralyzed by the dangers of asthma and can increase the risk of death. In acute asthma attacks, oral or intravenous glucocorticoids are necessary treatment, primarily to reduce inflammation of the airway mucosa and the systemic inflammatory response, but the onset of action is late. If a child has an acute attack, the dose of oral corticosteroids required is much higher than the daily ICS dose. Therefore, it is recommended that children with asthma should cooperate with their physicians to inhale ICS properly to reduce the use of systemic hormones and side effects. In addition, for children with asthma whose attacks cannot be effectively controlled with inhaled medications and who have clear allergens, desensitization therapy (specific immunotherapy) can be considered, mainly for children over 5 years old, by injecting a low dose of allergen subcutaneously and then slowly increasing the dose so that the patient gradually develops a normal immune response to the allergen without an allergic reaction, which is a very effective cause-specific It is a very effective treatment for the cause of the disease. The disadvantage is the high cost and the long course of treatment, which takes about 2 to 3 years for the whole course of treatment. Early standardized treatment can bring asthma under complete control and promote the healthy growth and development of children. We wish all asthmatic children to breathe smoothly, get rid of asthma and live a completely relaxed life!