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Abstract: The patient in this case is a 14-year-old girl who has been diagnosed with exercise asthma since childhood, which can be triggered after every strenuous exercise. This time, she had symptoms such as wheezing and shortness of breath and interglottal croup after running 1 day ago, and her symptoms recurred with self-medication, so she was seen in our hospital. Through physical examination and lung CT, Western medicine diagnosed: acute attack of exercise asthma; Chinese medicine diagnosed: croup – deficiency of lung and kidney yang. After treatment, the lung function was normalized, the discomfort disappeared and the asthma was controlled.
Basic information】Female, 14 years old
Disease Type】Bronchial asthma
Hospital】Xiyuan Hospital, Chinese Academy of Traditional Chinese Medicine
Date of consultation】04/2022
Treatment plan】Therbal dialectical treatment (Erxian Tang plus reduction: Xianmao, Xianling Spleen, Boneset, Pueraria Mirifica, Nansha Ginseng, Mai Dong, Honey Mahuang, Almond, Bai Guo, Wu Wei Zi, Zi Zi Zi, Pierced Mountain Dragon, Di Long, Cicada Molt, Stiff Silkworm, Dry Ginger, Baicalin, Huang Lian, Hooked Vine)
[Treatment period] Outpatient consultation, 42 days of self medication
Effectiveness】Lung function returned to normal, discomfort disappeared, asthma control
I. Initial consultation
The patient came to the outpatient clinic because of shortness of breath after running. Parents’ description: 6 years ago, shortness of breath and croup in the throat occurred after strenuous exercise and was relieved after rest. His parents refused to use hormonal inhaler treatment because they were afraid of various side effects caused by hormones (obesity, oral fungal infections, etc.), and gave tonics and dialectical treatment to relieve the symptoms. This time the onset was 1 day ago, wheezing, shortness of breath and interglottal croup reappeared after running, and the symptoms recurred after self oral spray of albuterol sulfate aerosol and came to our clinic.
The patient reported: chest tightness, shortness of breath, coughing with phlegm, coughing up a small amount of white mucous sputum, difficulty in coughing, sleepiness and bowel movement. On examination: light red tongue, thin moist coating, punctured tongue, weak pulse and weakness in both feet. Auscultation: both lungs are full of croup, no wet rales. CT of the lungs: no obvious active lesions. Blood count: no significant abnormality. Airway diastolic test: positive. Combined with past medical history, preliminary diagnosis: Western medicine diagnosis: acute attack of locomotor asthma, Chinese medicine diagnosis: croup – deficiency of lung and kidney yang.
II. Treatment history
When the patient had an asthma attack, he was treated with oral spray of albuterol sulfate aerosol to relieve spasm and calm asthma, but the symptoms were not completely relieved. Prescription: Xian Mao, Xian Ling Spleen, Boneset, Ge Ge Gen, Nan Sha Shen, Mai Dong, Honey Ephedra, Almonds, Bai Guo, Wu Wei Zi, Zi Zi Zi, Pierced Mountain Dragon, Di Long, Cicada Molt, Stiff Silkworm, decoction in water. After taking 3 doses of the soup, the shortness of breath was significantly reduced.
Treatment effect
The patient complained in the second consultation, taking 3 doses of medicine, the shortness of breath was reduced, the boredom in the chest was reduced, the phlegm was easy to cough up, the phlegm sound disappeared, the smell and odor still have wheezing, occasionally have abdominal distension, auscultation: both lungs can occasionally hear a little dry rales, the above plus dry ginger, scutellaria, Huang Lian, hooked vine, water decoction. After taking the above asthma basic control, sputum reduction, auscultation: both lungs did not hear obvious dry and wet rales, continue to consolidate 21 days of treatment, check lung function: completely normal, did not appear again wheezing shortness of breath. In summary, the patient in the outpatient clinic, self-medication 42 days, lung function returned to normal, discomfort disappeared, asthma control.
IV. Notes
We are glad that the patient’s symptoms improved after treatment, but since the main trigger of acute asthma attack is strenuous exercise, we must pay attention to avoid strenuous exercise in life, such as fast running, playing soccer, basketball, etc. However, it is not true that patients with sports asthma cannot do exercise, but generally brisk walking, jogging, swimming and other exercises can be done in moderation, as long as they are not too strenuous and the body can bear it.
When patients have an acute attack, they must have a short-acting β2 agonist, which is the fastest airway dilator and can quickly relieve bronchospasm, and if necessary, hormonal drugs can be inhaled for anti-inflammatory treatment.
V. Personal insight
Exercise asthma is not uncommon, it belongs to a special type of asthma, also known as croup in Chinese medicine, usually acute attacks are induced by strenuous exercise, exercise asthma can occur at any age, but the incidence of adolescents is higher, as the age of patients gradually increase resistance, the number of asthma attacks will gradually decrease. To avoid an acute attack of sports asthma, you can do some prevention before exercise, such as: inhaling a short-acting beta2 agonist a few minutes before exercise, or doing sufficient warm-up exercises. It is also important to emphasize the importance of stopping exercise immediately if an acute attack occurs during exercise. In this case, the patient has been wheezing since childhood and is slightly deficient in physical fitness, and wheezing attacks occur when there is a lot of exercise. For such patients, you can also exercise in moderation, such as jogging, brisk walking, swimming, etc. Be careful to find the amount of activity you can tolerate without causing an acute asthma attack, which can enhance your physical fitness and reduce acute asthma attacks. Chinese medicine is also advantageous in the treatment of asthma. In this case, the patient chose Chinese medicine for evidence-based treatment to warm the kidneys and help the yang, nourish the qi and calm the asthma, and obtained good results.