1.Concept It refers to the disappearance of treated or untreated symptoms and signs, and the recovery of lung function to the pre-acute attack level and maintenance for four weeks.
2.Prospect There is no cure yet, but through long-term treatment and management, complete control can be achieved so that patients can study, work and live normally.
3.Goals of long-term management
(1) Minimal (no) chronic symptoms, including nocturnal symptoms
(2) Minimal (infrequent) asthma exacerbations
(3) No need for emergency room visits
(4) Minimal (no) use of beta2 agonists
(5) Unrestricted daily activities (including exercise)
(6) Normal or near-normal lung function
(7) Minimal (no) adverse drug reactions
(8) Prevention of progression to irreversible airway obstruction
(9) Prevent the occurrence of sudden death
4. Key points of long-term management
(1) Partnership between patient and physician.
(2) Objective evaluation of the condition through symptom reporting and pulmonary function measurements.
(3) Avoidance and control of predisposing factors.
(4) Establishment of an individualized long-term management treatment plan.
(5) Develop a management plan for asthma exacerbations.
(6) Provide regular follow-up health care.
5.Grading and treatment of non-acute exacerbation of asthma
(1) Intermittent exacerbations: daytime symptoms < once a week, short-term exacerbations (one to several hours), nocturnal symptoms ≤ twice a month, no symptoms between exacerbations, normal lung function, PEF or FEV1 ≥ 80% of expected values, PEF variability 60%, 30%.
Treatment: daily application of long-term prophylactic medication: e.g. inhaled glucocorticoids (600-1000 μg/day), daily inhaled short-acting β2 agonists and/or long-acting bronchodilators (especially for nocturnal symptom control).
(2) Severe: frequent symptom attacks, frequent nocturnal asthma attacks, severe sleep disturbance, limited postural activity, PEF, FEV1 < 60% of expected values, PEF variability > 30%.
Treatment: daily with multiple long-term preventive medications, high-dose inhaled corticosteroids (>1000 μg/day), long-acting bronchodilators and/or long-term oral glucocorticoids.
6.Management of asthma in remission
Measure PEF regularly every day, monitor changes in the condition, and encourage the keeping of an asthma diary.
Pay attention to whether there is an aura of an attack, and add medication to reduce the symptoms of an attack once detected.
According to the patient’s specific triggers and attack pattern, study together with the patient and propose and take practical preventive measures.
Specific immunotherapy: desensitization therapy.
7.Prevention of asthma
The prevention of bronchial asthma attacks is an important part of the treatment in remission. In terms of the mechanism of occurrence, a more effective approach than anti-inflammatory treatment in remission is to try to avoid the various factors that cause asthma attacks. These factors include allergens (such as dust mites, molds, pollen, animal fur, allergic foods, etc.), various irritants (such as noxious gases, dry and cold air, smoke, etc.), respiratory infections (such as viruses, bacteria, etc.), and psychological disorders.