The risk of acute asthma attacks in the spring increases, and people under epidemic control need to be guaranteed emergency medical treatment

"Originally, I didn't prepare too many medicines at home, but now there are more uncertain factors, and I have to develop the habit of leaving enough 'surplus food' for a few months."

Wang Lei, 27, a mild bronchial asthma patient (hereinafter referred to as "asthma"), recalled the changes that the new crown epidemic had brought to his life for more than two years, and he told CBN with emotion that he had become more timid and more self-loving. On the one hand, it is because once an asthma patient is infected, the probability of developing severe disease is higher, on the other hand, it is also because in the face of the uncertainty of outpatient follow-up and drug access, he has to "respond to changes with no change", keep enough drug reserves, and avoid allergens as much as possible.

A respiratory physician said in an interview with First Finance and Economics that during the prevention and control of the new crown epidemic, asthma patients in the sealed control area talked about the most topics in the WeChat group of patients, whether the online shopping and delivery channels of asthma drugs were smooth, whether there was any delay in logistics, and whether the asthma condition was repeated during the home isolation period, whether it could get the diagnosis of professionals at the first time, adjust the treatment plan and dosage in time to effectively control the disease.

Zhang Lei, deputy chief physician of the Department of Respiratory Medicine of Shanghai Children's Medical Center affiliated to Shanghai Jiao Tong University School of Medicine, told CbN that acute asthma attacks are often manifested as a process of progressive exacerbation, characterized by a decrease in expiratory flow. Different sensitizing factors, different individuals have different onset of urgency and severity, i.e., may appear within minutes or hours, and occasionally within minutes. Therefore, it is important to make a timely and correct assessment and identification of the condition and to give effective emergency treatment immediately.

Therefore, the urgent medical needs of this part of the population need to be guaranteed simultaneously in the prevention and control of the epidemic.

The incidence of acute asthma attacks is increased

At the beginning of April, the concentration of allergenic pollen increased significantly in many places. Taking Beijing as an example, according to the pollen allergy index jointly released by China Weather Network and Beijing Tongren Hospital, since April 4, the local pollen allergy index has been at an "extremely high" (≥801) level, and the extreme value is even close to 1800.

Symptoms caused by allergies to pollen, also known as hay fever. When allergenic pollen from trees or weeds is inhaled from the nasal cavity into the pharynx, hay fever patients will feel itching and coughing in the pharynx, and some hay fever patients will also have a variety of allergic diseases such as bronchial asthma.

Zhang Lei said that asthma is a common chronic disease of the respiratory tract with a high prevalence. Patients have a high sensitivity to the airway, that is, they are more sensitive to changes in the external environment, including irritation by alternating hot and cold air, inhaling allergens such as dust mites, pollen, fungi, pet fur, or causing respiratory infection pathogens. "Pollen is not the only allergic factor that triggers asthma exacerbations in different individuals, but with the change of spring weather, the increase of various allergens in the environment and the impact of respiratory infections, the risk of asthma exacerbations increases."

When the seasonal peak of asthma occurs during the global COVID-19 pandemic, Zhang Lei said that there are at least three new risk points for causing acute asthma attacks or aggravation of the disease:

First, with the patient's stay at home for a long time, if the quilt, pillow, bedding, etc. can not be dried in time, it is easy to breed dust mites, and then there is a possibility of causing inhalation allergies; second, in the prevention and control of the epidemic, the inhalation or contact of commonly used antiseptic drugs may also induce asthma exacerbations; third, for people who have not yet been diagnosed with asthma or have been diagnosed with asthma but have not been formally treated, especially young children, during home isolation, may be due to insufficient awareness of the disease, or fail to stay away from allergens in time. As well as the inability to identify critical manifestations early, and the lack of emergency treatment measures will miss the opportunity for first-time treatment, and even the possibility of aggravation of the disease.

Guangzhou Respiratory Health Research Institute has written that if asthma is combined with the new crown virus infection, it is likely to lead to asthma out of control, asthma shortness of breath aggravation, coupled with asthma patients themselves in a state of immune overdrive, on this basis the occurrence of new crown pneumonia will further aggravate the body's immune disorders, secondary respiratory failure, and even inflammatory storms, patient anxiety stress aggravation, the formation of a vicious cycle of primary and secondary infection, the consequences are serious.

Challenges and responses

Zhang Lei said that asthma is divided into acute attack, chronic duration and clinical remission. During the epidemic prevention and control period, the basic medical treatment and treatment needs of asthma patients in these three situations need to be met in a timely manner to reduce the risk of acute asthma exacerbations in various situations.

"Access to professional medical personnel is still the main link in avoiding acute exacerbations of asthma." Chen Peifen, chief physician of the Department of Respiratory Medicine of Shenzhen Third People's Hospital, said that for patients diagnosed with asthma, doctors will give asthma control drugs such as salmeterol/ticasone, budesonide/formoterol and other inhaled drugs according to the actual situation of patients, use them according to medical orders, and increase or decrease the amount of inhaled drugs according to medical orders. In addition, doctors generally recommend an asthma emergency medication, such as salbutamol aerosol, as a first aid for asthma. This emergency medication is recommended to be carried with you during the pandemic in case it is urgently needed.

At the same time, Chen Peifen said that in areas with new crown cases, some hospitals are designated as new crown designated hospitals or temporarily suspended, which may affect the treatment of some asthma patients. Therefore, asthma patients usually need to pay attention to the emergency outpatient clinics and openings of surrounding hospitals to prevent the temporary inability to find a corresponding hospital when the disease worsens.

Since the control of asthma is closely related to the patient's medication compliance, random discontinuation and irregular medication may cause fluctuations in asthma symptoms and increase the risk of acute attack. Yang Zhicheng of the University of Hong Kong Shenzhen Hospital and others have written that during the new crown virus epidemic, it is necessary to ensure the accessibility of medication for asthma patients. "The suspension of outpatient services and pharmacies in some medical institutions has made it more difficult for asthma patients to obtain drugs to a certain extent, which in turn has affected standardized medication and effective control."

At a press conference held by the joint prevention and control mechanism of the State Council on the 6th, Wang Guiqiang, director of the Department of Infectious Diseases of the First Hospital of Peking University, said that in the process of prevention and control of the new crown epidemic, both epidemic prevention and control and basic medical assistance are very important and indispensable. "We have always emphasized that in the state of epidemic prevention and control, we must solve the normal diagnosis and treatment needs of the public, especially the treatment of critically ill patients. During the epidemic gathering period, the problem of the masses in the closed control area and the control area should be paid great attention to, and a series of measures should be taken to ensure that these patients can receive timely and effective treatment. ”

In the sealing area, when asthma patients have an acute attack and their condition is critical, there will be an urgent need to "leave the community and enter the hospital". In order to solve this problem of "one in and one out", Wang Guiqiang also said that it is necessary to cooperate with the multi-departmental linkage mechanism and cooperate with 120 and other emergency institutions to make the convenience services such as 120 first aid play a role in a timely and effective manner; at the same time, in the transportation process, properly arrange transportation to solve the problem of medical treatment for the masses. When necessary, government vehicles and volunteer vehicles can be requisitioned to ensure point-to-point pick-up and drop-off.

In order to facilitate patients to purchase drugs during the epidemic period, at present, in Beijing, Shanghai, Shenzhen and other places, hospitals and online medical service providers have provided online diagnosis and treatment, offline mailing services.

However, Zhang Lei said that for asthma patients in controlled areas, even if they can buy drugs online, they still need to solve the problem of drug distribution and entering the community.

In response to this problem, Wang Guiqiang made it clear at the above-mentioned press conference that for patients with slow and long-term medication, it is necessary to arrange the corresponding drug prescriptions to the nearest medical institution, including some chronic diseases, and it is recommended that the combination of the condition can be extended to a prescription of 12 weeks, and provide door-to-door drug delivery services.

Zhang Lei also said that because children are a frequent group of asthmatics, many families have previously chosen to use desensitization treatment. After the outbreak of the new crown epidemic, especially when the child's family is in a closed area, the patient may not be able to go to the hospital regularly, get a desensitization injection, and face the risk of needing to reformulate the treatment plan in the middle of treatment.

"For more than 4 weeks or more, children may need to reformulate their desensitization plans, which is a dilemma that some children with asthma have to face in the face of current epidemic prevention and control." Based on this, it is best to ensure the normal opening of the desensitized clinic, and the doctors, nurses, and drug supply are all normal. If not, you can first control the condition by avoiding allergens, drug prophylaxis, etc. Zhang Lei said.