Asthma is recognized as a medical problem worldwide and is listed as one of the four most persistent diseases by the World Health Organization. on December 11, 1998, at the opening day of the second World Asthma Conference in Barcelona, Spain, the Global Asthma Initiative Committee and the European Respiratory Society, on behalf of the World Health Organization, proposed to carry out World Asthma Day and made that day the first World Asthma Day. Since 2000, related activities have been held every year, but since then World Asthma Day has been set as the first Tuesday of May instead of December 11 every year. According to the survey, there are at least 20 million asthma patients in China, but only less than 5% of them have received standardized treatment, and at least half of these 5% of patients are misdiagnosed. On the eve of “World Asthma Day”, Zhong Nanshan pointed out that although asthma cannot be cured, the “three steps” of disease assessment, disease treatment and disease monitoring for the purpose of control can be implemented. He was the first to establish the first GERD center in China and even in Asia, and proposed a revolutionary theory – gastroesophageal laryngotracheal syndrome. He has helped thousands of patients with the same cough and asthma symptoms to get out of their predicament. Asthma is traditionally defined as a chronic inflammatory disease of the airways involving multiple cells and cellular components. This chronic inflammation is associated with airway hyperresponsiveness, which can cause recurrent episodes of wheezing, shortness of breath, chest tightness, and coughing, especially at night and in the early morning. These episodes are usually associated with widespread variable airflow obstruction in the lungs, which usually resolves spontaneously or with treatment. The etiology and pathogenesis of asthma is not well understood, but it is mostly considered to be a polygenic genetic disorder, and environmental factors also play an important role in its development. (A) Genetic factors Many survey data show that the prevalence of asthma is higher in relatives than in the group, and the closer the relatives, the higher the prevalence; the more severe the disease is, the higher the prevalence in relatives. The genes associated with asthma are not yet fully understood, but some studies have shown that there are multiple loci of genes associated with allergic diseases. These genes play an important role in the development of asthma. (ii) Contributing factors Environmental factors also play an important contributing role in the development of asthma. There are many relevant triggers, including inhaled antigens (e.g., dust mites, pollen, fungi, animal dander, etc.) and various non-specific inhalants (e.g., sulfur dioxide, paint, ammonia, etc.); infections (e.g., respiratory infections caused by viruses, bacteria, mycoplasma or chlamydia); food antigens (e.g., fish, shrimp, crab, eggs, milk, etc.); medications (e.g., benzos, aspirin, etc.); climate change, exercise, pregnancy, etc. may all contribute to the development of asthma. Exercise, pregnancy, etc. may be the triggering factors of asthma. The pathogenesis of asthma is not fully understood. Most people believe that allergic reactions, chronic airway inflammation, increased airway reactivity, and plant nervous dysfunction interact with each other to participate in the pathogenesis of asthma. (A) Allergic reaction When allergens enter the body with allergic constitution, through the transmission of macrophages and T lymphocytes, they can stimulate the B lymphocytes of the body to synthesize specific IgE and bind to the high-affinity IgE receptors (FcεR1) on the surface of mast cells and basophils. If the allergen re-enters the body, it can cross-link with IgE on the surface of mast cells and basophils, thus promoting a series of intracellular reactions that cause the cells to synthesize and release a variety of active mediators leading to smooth muscle contraction, increased mucus secretion, increased vascular permeability and inflammatory cell infiltration. Inflammatory cells in turn can secrete a variety of mediators under the action of mediators, which aggravate airway lesions and increase inflammatory infiltration, producing the clinical symptoms of asthma. (ii) Airway inflammation Chronic inflammation of the airways is considered to be the basic pathological alteration of asthma and the main pathophysiological mechanism of recurrent attacks. Regardless of the type of asthma and the stage of asthma, it is manifested by the infiltration and aggregation of multiple inflammatory cells, mainly mast cells, eosinophils and T lymphocytes, in the airways. These cells interact to secrete dozens of inflammatory mediators and cytokines. These mediators, cytokines and inflammatory cells interact with each other to form a complex network of interactions and influences that perpetuate airway inflammation. When the organism encounters triggering factors, these inflammatory cells are able to release a variety of inflammatory mediators and cytokines, causing airway smooth muscle contraction, increased mucus secretion, plasma exudation and mucosal edema. A variety of cells, including mast cells, eosinophils, neutrophils, epithelial cells, macrophages, and endothelial cells are known to produce inflammatory mediators. The major mediators are: histamine, prostaglandins (PG), leukotrienes (LT), platelet-activating factor (PAF), eosinophil chemotactic factor (ECF-A), neutrophil chemotactic factor (NCF-A), major base protein (MBP), eosinophil cationic protein (ECP) endothelin-1 (ET-1), and abhesion molecules (AMs). In conclusion, chronic inflammation of the airways in asthma is caused by the involvement of multiple inflammatory cells, inflammatory mediators and cytokines, which interact to form a vicious circle and perpetuate airway inflammation. The interrelationships are complex and need to be further studied. (iii) Airway hyperresponsiveness (AHR), which is manifested as an excessive or premature contractile response of the airways to various stimuli, is another important factor in the development of asthma in patients. It is now generally accepted that airway inflammation is one of the important mechanisms leading to airway hyperresponsiveness. Factors such as airway epithelial damage and intraepithelial nerve modulation are also involved in the pathogenesis of AHR. AHR is a common pathophysiological feature in patients with bronchial asthma, but not all patients with AHR are bronchial asthmatics, such as long-term smoking, ozone exposure, viral From a clinical point of view, the diagnosis of very mild AHR needs to be combined with clinical manifestations. However, moderate AHR is almost certain to be asthma. (iv) Neurological mechanism Neurological factors are also considered to be an important part of the pathogenesis of asthma. The bronchial tubes are innervated by complex vegetative nerves. In addition to cholinergic and adrenergic nerves, there is also a non-adrenergic non-cholinergic (NANC) nervous system. Bronchial asthma is associated with β-adrenergic receptor hypofunction and vagal tone, and possibly increased responsiveness of α-adrenergic nerves. nANC releases neuromediators that relax bronchial smooth muscle, such as vascular enterokinin (VIP) and nitric oxide (NO), and mediators that contract bronchial smooth muscle, such as substance P and neurokinin. The imbalance between the two can cause contraction of bronchial smooth muscle. Another etiology that can easily not be ignored is GERD, a disease in which reflux of gastric contents causes uncomfortable symptoms and/or complications, with typical symptoms of reflux and heartburn (burning sensation in the retrosternal area), but some patients are always asymptomatic or have atypical symptoms such as asthma, hoarseness, sore throat, cough, etc. Due to the diversity and insidious nature of GERD symptoms, it is often difficult to detect and therefore difficult to give proper treatment. When left untreated for a long time, it may cause many complications such as esophageal erosion, bleeding, stricture and adenocarcinoma. In terms of symptoms, patients with GERD may have difficulty inhaling at night due to the reduced expiratory flow and increased airway resistance caused by acid perfusion in the esophagus, and may be easily awakened by breath-holding in the middle of the night, even with symptoms such as nausea and heartburn. These symptoms often mislead patients into thinking that they have asthma, while ignoring the real cause. To distinguish between asthma and GERD, one can start by understanding whether the patient’s symptoms are related to allergens. Common asthma often has allergens such as pollen and dust mites, and the condition can worsen or lessen with seasonal or environmental changes, with dyspnea being the main cause. In contrast, gastroesophageal reflux disease is a common digestive disorder with no obvious allergens, no seasonal distribution, and some patients are associated with full meals, etc. According to studies, asymptomatic GERD exists in most asthmatic patients. Although the pathophysiological relationship between the two has not been fully defined, in most cases, one disease exacerbates the subclinical symptoms of the other. In other words, treating asthma alone does not fully help, but rather a two-pronged approach is needed to treat GERD accordingly as soon as it is diagnosed. In October 2007, the Gastrointestinal Dynamics Group of the Chinese Society of Gastroenterology published the first domestic Consensus Opinion on the Treatment of GERD in the Chinese Journal of Gastroenterology. The article standardized the dose and course of GERD treatment and proposed proton pump inhibitor (PPI) therapy. According to the article, there are three main steps in diagnosing and treating GERD: first, empirical PPI treatment for patients suspected of having GERD for 1 to 2 weeks based on typical GERD symptoms such as heartburn and reflux; second, after identifying GERD, patients should receive a standardized 8-week initial treatment course with the recommended standard dose of PPI; third, depending on the condition of different patients reminded to carry out maintenance therapy to consolidate the efficacy and prevent relapse, such as: maintaining the original dose, halving the dose, and on-demand therapy. It has been proved that after we performed radiofrequency treatment or fundoplication on more than 700 patients with asthma combined with reflux, all the patients’ asthma for years magically disappeared, which reinforces the possibility of asthma caused by GERD. In conclusion, GERD should not be ignored. There are also some misconceptions in the treatment of asthma patients: Misconception 1: Asthma is incurable. Due to the complex causes and pathogenesis of asthma, it is still very difficult to cure it fundamentally or once and for all. After all, asthma is a chronic disease and it is unrealistic to try to achieve never recurrence through momentary treatment. However, patients and their families do not have to be negative, lose confidence in the cure, or even despair or seek a cure instead of asthma. In fact, with the progress of medical research in recent years, asthma is curable in terms of symptoms. The internationally accepted treatment goals are: no (or minimal) chronic symptoms, including nocturnal symptoms; no (or minimal) acute exacerbations of asthma; no emergency room visits; minimal (or no) use of beta2 agonists; no physical activity or exercise limitation; and basically normal lung function. With proper and effective treatment, the patient’s symptoms can disappear completely and the patient can live and work normally as a healthy person. Myth 2: Asthma does not need to be treated when there are no symptoms, and when it is wheezing, then treat it. There are different types of asthma, and their treatment should be individualized. Patients with intermittent attacks of asthma (such as typical allergic asthma), with short attacks, can be treated during asthma attacks; patients with perennial and frequent asthma attacks must adhere to long-term and regular treatment to do so. Such patients who do not pay attention to the treatment of the stable period will easily lead to recurrent asthma symptoms, affecting the quality of life, and in the long run, irreversible bronchial deformation damage will occur and become chronic obstructive pulmonary disease. Both doctors and patients should get out of the misconception of treating only the exacerbation period of asthma and ignoring the remission period, and treating only the symptoms but not the root cause. Myth 3: Thinking that hormones have great side effects and are unwilling to accept inhaled hormone therapy. The essence of asthma is airway inflammation, and glucocorticoids are the most effective drugs for treating airway inflammation. However, oral and intravenous injections are systemic medications, which can be effective at the time but have many side effects on the body when applied for a long time. There are many such patients in outpatient clinics, who either listened to the advertisements or just pursued the immediate effect, and misused oral hormone therapy for a long time, resulting in side effects such as obesity, high blood pressure, diabetes and osteoporosis, and it is difficult to control their condition when they have another asthma attack. In fact, the main ingredients of some advertised “asthma medications” are hormones and short-acting beta agonists. The correct asthma treatment should be inhaled glucocorticosteroids first, with inhaled long-acting beta agonists added according to the degree of the disease, and short-acting beta agonists only when there are acute symptoms. Inhaled hormones only work locally in the airways and are basically not absorbed into the bloodstream, and the dose applied is very small, usually less than 1 mg per day (while prednisone is 5 mg per pill), so no significant side effects occur even with lifelong standardized inhaled glucocorticoid therapy for asthma. With standardized treatment, patients can completely achieve the effect of no asthma symptoms, no acute exacerbations, no nighttime suffocation, no need to see the emergency room, no exercise restrictions, and no side effects from treatment. However, in China, due to people’s fear of hormones, less than 10% of inhaled hormones are preferred for asthma control, and too much reliance is placed on acute relieving drugs, and even long-term misuse of hormones by mistaken belief in advertisements. Myth 4: After asthma symptoms are controlled, there is no need to continue treatment. For a long time some patients, their families and even clinicians only pay attention to the treatment of exacerbations, and once the asthma symptoms are relieved, they misjudge it as a cure and stop the treatment, which results in recurrent asthma attacks and prolonged treatment, and serious cases develop into emphysema and pulmonary heart disease and lose the ability to work. Asthma exacerbations are episodic, but airway inflammation is long-lasting. Inhalation of glucocorticoids or combined with inhaled long-acting beta agonists can suppress airway inflammation well and control asthma more effectively than treating acute bronchoconstriction alone. Once asthma is controlled, inhalation therapy should be maintained for at least 3-6 months, and then a physician should be asked to develop the next treatment plan as appropriate. Myth #5: Asthma is not related to stomach problems. As we all know, gastric juice is a strong acidic liquid, and if the cardia is not fully functional, it may cause reflux, which may lead to reflux esophagitis in mild cases, or aspiration to the trachea by mistake, causing tracheal spasm and asthma-like attacks. Asthma is not scary, what is scary is being misdiagnosed, correct and timely detection and active treatment is the fundamental thing.