1.What is asthma a disease?
Asthma is a chronic inflammatory disease of the airways involving a variety of cells and cytokines (phagocytes, mast cells, T lymphocytes). This inflammation leads to airway hyperresponsiveness, causing reversible airway narrowing and increased resistance, manifesting recurrent episodes of coughing, wheezing, chest tightness, and dyspnea. The above symptoms often worsen in the early morning, at night or after activity, and most patients can relieve themselves or with treatment.
A few explanations.
The “root” of asthma is chronic airway inflammation, and this inflammation is not that inflammation, but rather allergic allergic inflammation. Therefore, antibiotics are not effective.
”The narrowing of asthma is reversible, especially in children, which means that the symptoms of asthma can be relieved by themselves or by treatment. So don’t be pessimistic about your child’s asthma, and work actively with your doctor.
Another characteristic of “airway hyperresponsiveness” asthma is that the airways are highly sensitive to various stimuli, and the same stimulus can be unresponsive to the general population but highly reactive to asthmatics, thus inducing an asthma attack. This hypersensitivity to irritants is often referred to as airway hyperresponsiveness.
Based on the above arguments, a more comprehensive modern concept of asthma should be that asthma is an allergic disease characterized by hyperresponsiveness and chronic inflammation of the airways, mainly manifested by airway spasm, narrowing, obstruction, hypoxia and dyspnea. According to this new concept, treatment should focus on reducing airway hyperresponsiveness and eliminating chronic inflammation, while relieving bronchospasm and improving hypoxia. Long-term treatment should still be adhered to during the remission period.
2.How many types of asthma are there?
There are 3 types of asthma according to age and type of attack: infantile asthma; childhood asthma; cough variant asthma
By etiology and pathogenesis: endogenous (infectious); exogenous (allergic); mixed type
3.Stage and classification of asthma:
Acute exacerbation chronic persistent clinical remission
Grading: Mild intermittent; mild attack; moderate attack; severe attack 4
Grading: light, moderate, and severe according to the child’s mental state, coherence of speech, sweating, and respiration and heart rate during the attack
4.Why does cough variant asthma only cough but not wheeze and what are its characteristics?
Cough variant asthma, also known as allergic cough, is essentially asthma. It can be considered as a mild form of early asthma. Because it does not wheeze, it is sometimes called asthma without wheezing or insidious or subclinical asthma. Why is a cough without wheezing still classified as asthma? Namely, because it has the basic features of asthma-allergic inflammation of the airways and airway hyperresponsiveness, and these coughs can be effectively controlled with wheezing medications and ineffective with anti-inflammatory drugs. In fact, I have clinically encountered children who presented with a chronic cough early on and then became truly wheezy. Therefore, I often warn my parents that cough and wheezing are twins and should be taken seriously.
The characteristics of these patients are: (1) They can be seen at any age in children and more often in middle-aged women in adults. (2) A high rate of positive family allergy history and personal allergy history. (3) Episodes are mostly seasonal, with spring and autumn predominating. (4) The cough is heavier at night and in the morning, without fever and with little or no sputum. Anti-infective treatment is ineffective for a longer period of time and worsens after activity. The cough lasts for more than 1 month. (5) Chest X-ray is mostly normal. (6)Salbutamol plus ketotifen is effective.
5.What are the characteristics of asthma in infants and children?
Asthma in children under 3 years of age is called infantile asthma and has the following main characteristics.
*In terms of etiology and performance: (1) Infection plays a more important role in the development of asthma. Parents often say that my child is offended when he has a cold and is fine without it. (2) Symptoms and signs are also less typical than those of childhood asthma, with wheezing sounds predominating, which may be accompanied by fever and blistering sounds; the younger the child, the less obvious it is, and the easier it is to be misdiagnosed as bronchitis, pneumonia, etc. (3) It is easy to be complicated by complications such as respiratory failure and heart failure.
*Therapeutic aspects: (1) less sensitive to calming drugs than older children; (2) control of infection (antibiotics, antivirals) is also important for these children. (3) M-blockers, such as 654-2 and Albuterol, are effective. (4) Immunomodulatory drugs are more important to interrupt the vicious circle of “infection – immune deficiency – reinfection” through immunomodulation, which is more significant. (5) It is difficult to promote inhalation therapy, and compliance is poor.
*Prognosis: Most of the cases can gradually improve or even stop before school age with the gradual improvement of immune function and reduction of respiratory tract infections.
*Care is even more important: As children are young, they cannot speak and their condition changes quickly, so care including dressing, living room, exercise and diet depends entirely on parents, and careful observation of parents is needed to detect the cause of the disease and new triggers. Some children with milk allergy only show refusal of milk and crying during feeding, and it is easy to think that there is a disease in the mouth and ignore the swelling of mucous membranes caused by milk allergy.
6.What are the causes of asthma?
There are many different triggers of asthma, which are generally difficult to determine, but in general, they can be divided into two aspects: endogenous factors including genetic, psychological and physiological factors, which are the basis for triggering asthma, and exogenous factors including allergens, harmful gases, infections, food, specific odors, etc., which are the conditions for triggering asthma. They are briefly described as follows.
(1) Environmental factors
1) Room dust: It is an important trigger for asthma, which mainly enters the airway through human breathing and causes allergic inflammation of the airway due to allergic reaction. Room dust contains a variety of allergenic substances, such as dust mites, pollen, animal fur, human epithelial debris, plant fibers, mold and bacterial metabolites, food residues, etc.
Dust mite: It is the main allergen in room dust. It was found that more than 70% of childhood asthma is caused by dust mites, and more than 80% of asthmatic children and adolescents have a strong positive reaction to dust mite skin tests. Early childhood is the main period of dust mite sensitization. Dust mites use the dander shed by human body as the main food source, and the temperature, humidity, and food source of the bed are most suitable for the growth of house dust mites, so the bed dust contains more house dust mites, which is an important reason why dust mite allergic asthma is prone to attack at night.
2) Fur and fiber: animal fur, poultry feathers, insect residue or debris, cotton fiber, fluffy toys, wool carpets, etc., also tend to induce airway allergic inflammation and cause asthma attacks. The antigenic nature of dander is the strongest among these antigens. In addition, it has been found that cockroaches can also induce small boats.
3) Pollen: Pollen has obvious seasonality, mainly determined by the species of plants, and can be divided into spring pollen, summer pollen and winter pollen.
4)Mold: mold allergy has a certain seasonality, generally with the peak of the onset of June to September, but the air can have perennial drift of mold and its metabolites, so mold allergy induced asthma is mostly perennial attacks or seasonal aggravation of perennial attacks.
5) Infections: viruses, bacteria, mycoplasma and other infections can induce small boats, where viral infections are the main factor causing allergic inflammation of the airways and inducing asthma attacks. Bacterial infections cause asthma is not as important as viruses.
6) Harmful gases and odors: there are many toxic and harmful gases and odors in daily life, and smoke is the most common one/especially smoking is the most serious. In winter, doors are closed and smoke should not be dispersed is one of the triggers of asthma attacks easily in winter.
(2) Drug factors
There are many medications that cause asthma, commonly used drugs such as aspirin, benzoin, anti-inflammatory pain, penicillin, sulfonamides, various protein preparations, serum preparations and certain aerosols.
There are 2 types of asthma caused by drugs. One is allergy to drugs, which is due to the intolerance or atopic reaction to the drug due to factors in the patient’s constitution; the other is the reaction to drugs, the effect of which can also occur in normal people, but may aggravate the asthma attack when applied in asthmatic patients.
(3) Food factors
There are many factors that cause asthma by food, mainly due to allergy to food. Foods include various seafood and river food, such as fish, shrimp, scallops, sea fish, river fish, etc.; animal protein, such as eggs, milk, pork, mutton, beef, etc.; vegetable protein, such as soy products, sesame, peanuts, flour, etc. A diet that is too sweet or too salty can trigger asthma attacks, and even chocolate, cold drinks, and tomatoes can trigger asthma. Food allergy-induced asthma is generally not lifelong and the chance of its onset decreases with age.
It is also important to note that sometimes food factors trigger asthma attacks not by the food itself, but by additives and preservatives in the food.
(4) Exercise factors
All kinds of exercise can induce asthma to different degrees, especially exercise in cold and dry air, the colder the air inhaled, the greater the possibility of inducing exercise asthma. Exercise induced asthma is relatively rare in areas with high humidity. Running exercises are more likely to trigger asthma than swimming. Most patients with exercise-induced asthma can have their symptoms relieved after an hour or so of rest, but symptoms can also worsen with increased exercise.
(5) Mental factors
Asthma is a chronic disease, the torture of the disease, the economic burden, and the drain of the manager will bring mental pressure to the family and the patient, and it is easy to produce fear, depression, tension, boredom, anger and other mental factors, which lead to the attack or aggravation of asthma. For example, children may force themselves to have an asthma attack to blackmail their parents in order to achieve certain goals; most psychogenic induced asthma is combined with other factors.
In addition, adverse stimuli in the family and social environment, such as family discord, parental divorce, economic hardship, poor diet and hygiene habits, smoking families, can also trigger or aggravate asthma attacks.
(6) Genetic factors
The prevalence of allergic asthma, infantile eczema, allergic rhinitis and other general groups among the relatives of asthma patients is high, especially in the relatives of class I.
7.How to treat asthma?
The treatment of asthma in our hospital is now in line with international standards and is carried out according to the GINA protocol. Specifically, inhalation therapy and a stepwise treatment program are advocated. The goal of our treatment is no longer to relieve wheezing, but to reduce the degree and frequency of future attacks, to fundamentally clear the inflammation of the airways, to improve the patient’s quality of life, to ensure normal growth and development, and to enable the patient to live like a normal person.
8.What is the GINA program?
Back in 1994, more than 80 respiratory experts from all over the world gathered for a meeting and introduced the “Global Asthma Prevention and Control Creation”. It has played a pivotal role in guiding asthma prevention and treatment for the past 15 years, and has been revised and improved many times since then.
9.Why should asthma prevention and treatment insist on “four early”?
Early detection Only early detection can take the initiative of asthma, which can occur at any age, but mostly in young children. According to the survey, 85% of children aged 0-14 in our province have asthma before the age of 5, and more than 75% of them have asthma within 3 years of age, and most of them have wheezing symptoms within one year after birth. However, these asthma or wheezing disorders are often overlooked and, because they are not treated appropriately, recurrent attacks continue even into adulthood. Early detection and attention to these wheezes is crucial, therefore, prevention of asthma should start with to start with children.
Early diagnosis Early diagnosis is a prerequisite for early treatment. As long as the diagnostic criteria are met, regardless of age, the diagnosis should be made decisively and never with hesitation. Cough variant asthma should not be spared either.
Early treatment Once the diagnosis is confirmed, inhaled hormone therapy should be given immediately.
Early prevention Preferential breeding, improvement of environment, reduction of pregnancy in December, and prohibition of smoking and alcohol by the father-to-be.
10.What is the “five words” to prevent asthma?
Avoid, avoid, replace, move, take off.
11.Myths of asthma treatment?
(1) Self-healing without treatment and not self-curing
(2) Rapid abuse and afraid to apply
(3) No more asthma is good, it is a waste to use medicine again
(4) Chinese medicine can cure the root of asthma
(5) Asthma patients should not eat fishy things
(6) Asthma patients should not exercise
(7) Abuse of antibiotics