The story goes like this:
Small day at the doctor’s clinic to a 14-year-old boy xiao Ming (a pseudonym), see xiao Ming did not cough, no room, no shortness of breath, no chest tightness, those prescribed by the asthma symptoms, only provides a history of breathing, breathing but now big also don’t cough, unfortunately a little cough, 1 week ago did atomization is 2 days, to tests,
Don’t worry. Take a look.
Routine lung function starts to look a simple, intuitive!
So, you think the absence of cough and wheezing means the asthma has been cured?
Then you are so shallow!
First of all, what is asthma?
Asthma is a heterogeneous disease characterized by chronic airway inflammation and airway hyperresponsiveness, with recurrent wheezing, cough, shortness of breath, chest tightness as the main clinical manifestations, often at night and/or in the early morning attack or aggravation.
The specific manifestation and severity of respiratory symptoms vary with time and are often accompanied by reversible restriction of expiratory flow and obstructive ventilatory dysfunction.
Chronic airway inflammation in asthma persists throughout the course of the disease, so long-term anti-inflammatory treatment is needed to prevent acute asthma attacks.
Asthma if compared to a huge iceberg, acute attack of asthma clinical symptoms such as breathlessness, difficulty breathing is only part of the iceberg above the surface, the treatment of asthma can’t just on the tip of the iceberg, but to cover the entire iceberg, including control asthma symptoms, improve lung function, reduce airway chronic inflammation and reduce airway reactivity and prevention of airway remodeling.
In this way, comprehensive standardized treatment can make asthma patients get good disease control and improve the quality of life of patients.
Why do asthmatics need to check lung function regularly?
The treatment of childhood asthma is a long process, need regular follow-up, and periodic review of the system treatment goal is the overall evaluation, to make a decision for subsequent treatment, assessment of lung function of asthma is a very important link, with the objective indicators to monitor asthma, lung function as monitoring and other chronic diseases with some tools:
For example, the blood pressure of hypertensive patients is monitored with a sphygmomanometer, and the blood sugar of diabetic patients is measured with a test paper and a digital display. The blood pressure or blood sugar has been significantly increased, but the patients may not have any symptoms. The children with asthma may also not show symptoms such as coughing and wheezing, but the lung function has been significantly decreased.
Therefore, pulmonary function detection, as one of the few objective indicators, appears particularly important, and is an important indicator to evaluate the severity and control of asthma.
Children with asthma should be regularly reexamined for pulmonary function to understand the development of the disease, the recovery of asthma, the efficacy of medication and the prediction of the onset of the disease.
How do foreign asthma experts evaluate whether asthma is under control?
GINA is an acronym for Global Initiative for Asthma. Founded in 1993 by the World Health Organization and the United States Heart, Lung and Blood Institute, GINA has been working to promote Asthma prevention and treatment strategies worldwide for more than 20 years.
Asthma prevention and treatment guidelines are issued every year to track the new progress in the field of global asthma research, which is recognized by the global peers.
Once diagnosed with asthma, lung function is the most useful indicator of future risk.
It should be recorded at the time of diagnosis, 3 to 6 months after the start of treatment, and rechecked regularly.
Any inconsistencies between symptoms and pulmonary function results should be investigated promptly.
Asthma control was assessed on two dimensions: symptom control and risk of future adverse outcomes.
Poor symptom control is burdening and increases the risk of asthma exacerbations, and severe acute exacerbations can occur in people with mild asthma.
Symptom control was assessed based on the frequency of daytime and nocturnal asthma symptom attacks, frequency of use of palliative therapy, and degree of activity limitation.
Symptom Control assessment tools include the Asthma Control Test and the Asthma Control Questionnaire.
Patients need to be assessed for risk of future exacerbations, even when symptoms are well controlled.
Risk factors for persistent airflow restriction, drug side effects, and treatment problems, such as inhalation techniques, compliance, and comorbidities, need to be assessed, and patients are asked about their desired asthma treatment goals.
How do domestic asthma specialists evaluate whether asthma is under control?
The Recommendations for Standardized Diagnosis and Treatment of Children’s Bronchial Asthma published in 2020 in China is slightly different from the management cycle of “assessment — adjustment of treatment — monitoring” suggested by Gina. The control and treatment of children’s asthma in China advocates a multi-directional open asthma management process.
These include initial intensive treatment, pre-intervention or intermittent intervention, escalation or intensification of escalation treatment, de-escalation treatment, regular monitoring, and discontinuation observation.
Common clinical assessment tools for asthma include:
Asthma Control Test
ACT), the Childhood Asthma Control Test (C-ACT) and the Test for Respiratory and Asthma Control in Kids (Track).
The applicable age of the above assessment tools, the quantitative scoring range of subjective indicators, and the difference of clinically significant variables are different. Therefore, assessment tools should be selected reasonably and evaluated regularly according to the applicable age and conditions.
Asthma is one of the most common chronic diseases in children. Its diagnosis is not very difficult, and there are very effective treatment measures, but the recent domestic investigation shows that the current control situation of children’s asthma is not ideal.
With the growth of age, the growth and development of lungs and immune function of infants gradually mature, and it is true that some infants’ wheezing is gradually relieved. 60% of children with asthma can disappear in adolescence, but 12% ~ 35% of children with asthma will reappear in adulthood.
Moreover, a growing body of research has shown that 80 percent of adults with asthma have impaired lung function, with their first wheezing episode occurring within the age of 3 years.
And some children with asthma who seem to heal on their own suddenly have an asthma attack, a relapse, later in life.
Asthma treatment should start as early as possible, and adhere to the principle of long-term, continuous, standardized and individualized treatment.
Including establish or improve asthma children with asthma management files, establish links with the hospital doctors, learn knowledge of asthma, drug inhalation method and how to monitor disease (including PEF instrument using method), how to identify early acute episodes and timely treatment, how to prevent acute (avoiding exposure to allergens, timely deal with complications, etc.), and follow-up appointments, etc.
The purpose of management is to actively monitor and guide the whole process of the disease, prevent the progress of the disease, prevent complications and improve the quality of life of the children and their families.
Department of Respiratory Medicine, Shanghai Children’s Medical Center
Wu Yufen suggested that asthma is a chronic airway disease and should be treated in a long-term, standardized and individualized manner.
Physicians should formulate detailed treatment plans according to the severity of each child with asthma, and conduct comprehensive evaluation according to the clinical symptoms, lung function and airway inflammatory indexes of the children with asthma, observe the efficacy and make adjustments.
The return visit time of children with asthma depends on the specific condition. The return visit time of children with asthma can be once every 2-3 months if the condition is well controlled. It is recommended that the return visit time should be once every 6-12 months after the completion of the whole treatment and entering the follow-up observation period of drug withdrawal.
Why do asthmatics need to check lung function regularly?
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