*For medical professionals only
Control of asthma is extremely important for its prognosis
At today's Beijing Winter Olympics, Japanese figure skater men's single free skater Yu Yu tied the strings and challenged the ultra-difficult Axel Four-Sided Jump (4A), demonstrating the Olympic sportsmanship of constantly challenging himself.
Yu Yu is the first super grand slam player in the history of figure skating to win gold medals in men's singles events in international competitions such as the Olympic Games, World Championships, Grand Prix Finals, Four Continents Championships, World Youth Championships, and Youth Finals. He was once named one of the top ten international athletes in 2018 by the Sports Department of Xinhua News Agency, and is also an athlete praised by CCTV.
However, Yusei Yusuke is a patient who was diagnosed with asthma at the age of 2. In order to exercise and overcome asthma at the same time, he put in greater efforts than ordinary people, higher training intensity, more sweat and pain, and eventually became the "Ice Prince".
Image source: NetEase
Yusei's courage to surpass himself sets an example for us, especially children who suffer from asthma from an early age. His life experience tells us that asthma is not as terrible as imagined, as long as it is well controlled, the child can not only participate in sports, but even go to the peak of competitive sports.
Children with asthma can also participate in sports
Asthma is a heterogeneous disease characterized by chronic airway inflammation and airway hyperreactivity. Clinical manifestations are recurrent episodes of wheezing, cough, shortness of breath, chest tightness, etc., often at night and /or in the early morning or exacerbated. The specific manifestations and severity of respiratory symptoms can vary over time and are often accompanied by obstructed expiratory airflow and obstructive ventilation dysfunction. [1]
Some patients will have respiratory symptoms after exercise, so some parents of children with asthma do not let their children engage in physical activity, which is actually completely wrong. There are currently no studies suggesting that exercise worsens symptoms in asthma patients, and some studies believe that exercise is beneficial for improving lung function and asthma control in asthma patients.
The recommended exercise prescription for children with asthma at the American Sports Medical College is: Choose a form of aerobic exercise, walk or take part in any form of aerobic exercise using a large muscle group, which can be used for the treatment of children with asthma. Walking, swimming, cycling, running, basketball, etc. are all physical activities that asthma sufferers can try.
However, physical activity in children with asthma presupposes that the disease is well controlled. Next, let's learn about asthma.
Diagnostic criteria for bronchial asthma in children
Asthma is diagnosed primarily on the basis of respiratory symptoms, signs, and pulmonary function tests, which confirm the presence of variable expiratory airflow restriction and exclude other disorders that can cause associated symptoms. [2]
Principles of treatment and commonly used drugs
Principles of treatment: start early, long-term adherence, continuous standardization, and treatment according to the person.
The drugs commonly used in children's asthma mainly include bronchodilators, glucocorticoids, and leukotriene regulators, and the following drugs need to pay attention to the details of use in use.
Inhaled corticosteroids (ICS)
At present, there are three kinds of ICS suspensions for nebulized inhalation in children: budesonide, beclomethasone dipropionate, and fluticasone propionate. Among them, budesonide is currently the only ICS approved for nebulization in children ≤ 4 years old; fluticasone propionate is only used for the treatment of mild to moderate asthma exacerbations in children aged 4 to 16 years.
Long-term, low-dose ICS is better than intermittent or on-demand use. Repeated inhalation of high doses of ICS has potential adverse reactions, such as hoarseness, pharyngeal discomfort, oral Candida infection, etc., and can be rinsed with water and washed on the face to reduce adverse reactions after atomization. [3]
It is worth noting:
Systemic use of hormones, only for severe uncontrolled asthma, should avoid long-term use affecting growth and development.
When asthma is under control and can be maintained for at least 3 months, downgrading therapy may be considered, with ICS doses downgraded by 25% to 50% each time.
majority
Beta2 receptor agonists
Inhalation is most commonly used and takes effect within a few minutes, not more than 4 times a day. Adverse reactions include palpitations, skeletal muscle tremor, heart rhythm disorders, hypokalemia and so on.
Inhaled long-acting beta2 receptor agonists, generally used in asthma over 6 years of age in moderate doses of ICS uncontrollable, not alone, often combined with ICS synergistic anti-inflammatory asthma.
Long-acting oral beta2 agonists do not advocate long-term use and are not indicated for exercise-induced bronchospasm.
Severe asthma that is ineffective in nebulization can be injected intravenously with salbutamol, which requires vigilance against tachycardia, prolongation of the Q-T interval, hypertension or hypotension, hypokalemia, and so on.
Long-term application of β2 receptor agonists can cause downregulation of β2 receptor function, which can be restored after general withdrawal.
Inhaled anticholinergic drugs
Such as ipratropium bromide, nebulization drugs are generally difficult to enter the central system, children's medication is relatively safe, common adverse reactions are headache, dizziness, dry mouth, pharyngeal irritation, nausea, cough, gastrointestinal motility disorders and so on.
Bronchodilators other
Magnesium sulfate is mostly used in patients with no response to initial treatment with persistent hypoxemia; the therapeutic amount of theophylline is close to the amount of toxicity, the treatment window is narrow, not as the first choice, generally combined with ICS for moderate to severe asthma, because of the more side effects, long-term control therapy is not recommended.
Leukotriene modulator
For example, montelukast sodium is not as good as ICS alone; combined with ICS treatment of moderate to severe persistent asthma can reduce hormone volume and improve ICS efficacy; children are well tolerated, but neuropsychiatric events have also been reported. The acute phase is 5 to 7 days, usually at least 1 month.
In short, at present, asthma is still difficult to eradicate, and the purpose of treatment is to control symptoms through standardized medication, maintain normal lung ventilation function and reduce acute attacks, and finally achieve and maintain good clinical control of the disease. This not only requires the correct guidance of doctors, but also the active cooperation of children and parents, and the next time we have "Prince Charming" and "Ice Princess" are worth looking forward to.
bibliography:
[1] Editorial Board of Chinese Journal of Pediatrics, Respiratory Group of Science Branch of Chinese Medical Association, Pediatric Respiratory Professional Committee of PediatricIans Branch of Chinese Medical Doctor Association. Recommendations for standardized diagnosis and treatment of bronchial asthma in children (2020 edition).Chinese Journal of Pediatrics,2020,58(9):708-717.
[2] Respiratory Group, Science Branch of Chinese Medical Association, Editorial Board of Chinese Journal of Pediatrics. Guidelines for the Diagnosis and Prevention of Bronchial Asthma in Children (2016 Edition).Chinese Journal of Pediatrics,2016,54(3):167-181.
[3] Respiratory Group of Science Branch of Shanghai Medical Association, Pediatric Medical Consortium of Shanghai Children's Medical Center (Pudong).Expert Consensus on The Identification and Prevention of Adverse Reactions of Commonly Used Asthma Drugs in Children.Chinese Clinical Journal of Practical Pediatrics,2021,36(20):1521-1528.
[4] National Clinical Research Center for Respiratory Diseases, Asthma Collaboration Group of Respiratory Group of Science Branch of Chinese Medical Association, Pediatric Professional Committee of Chinese Medical Education Association, etc. Expert consensus on clinical application of China Children's Asthma Action Plan. Chinese Clinical Journal of Practical Pediatrics,2021,36(7):484-490.
This article was first published: Pediatrics Channel of the Medical Professions
This article is written by Zhang Guangcheng
Editor-in-Charge: CiCi