Bronchial asthma (ASTHMA for short) is a common and heterogeneous chronic airway inflammatory disease that seriously endangers human health.
The more inflamed the airways are, the more difficult it is to breathe normally.
If no anti-inflammatory measures are taken, this can lead to bronchial obstruction or contracture, and may even be life-threatening due to breathing difficulties.
Lin Jiangtao, chief director of the Chinese Asthma Alliance, stressed that as asthma is a preventable and controllable disease, standardized treatment and self-management are very important.
Even during an outbreak, asthmaticsshould continue to take asthma medication as usual.
According to the study, although the level of asthma control in China has been significantly improved in recent years, 71.5% of patients still fail to control asthma, which is far from the goal of “achieving and maintaining the clinical control of asthma” proposed by the Global Initiative for Asthma Prevention and Control (GINA).
It is the misdiagnosis of asthma that prevents GINA from achieving her asthma management goals.
Common mistake: False diagnosis
It is not uncommon to treat all asthmatic patients as bronchial asthma.
In addition to bronchial asthma, asthma symptoms may occur in patients with acute and chronic left cardiac insufficiency, spontaneous pneumothorax, chronic obstructive pulmonary disease (COPD), allergic bronchopulmonary aspergillosis (ABPA), endotracheal benign/malignant tumors, eosinophilic infiltrative lung disease, allergic vasculitis, and other diseases.
According to the guidance of clinical advice, through regular treatment, poor efficacy of asthma patients, should be vigilant, do a good differential diagnosis.
Select necessary assistive examinations such as lung function, bronchofiberscope, chest radiograph, chest and paranasal sinus CT, bronchodilation/stimulation test, noninvasive airway inflammation test, etc., for accurate diagnosis.
Two common misconceptions are that people should be satisfied only with medication
To achieve the goal of asthma control, comprehensive management is required, involving medical care, patients, family and society, medicine, environment (allergens, smoking) and other factors.
Studies have shown that asthma management can improve asthma patients’ compliance and asthma control rate, patient management can help reduce the number of asthmatic emergency visits, and the correct use of inhaled devices and standardized medication can help patients improve asthma control level.
Asthma management requires the following approaches: A doctor-patient partnership;
To identify and reduce exposure to factors that give rise to asthma.
C. Assessment, treatment and monitoring of asthma;
- Management of acute exacerbations of asthma;
Special type of asthma treatment.
Common misconception is that the target location of asthma treatment is incorrect
Patients and family members hope to “cure” asthma, expectations are too high;
Some doctors think there is “no rule of law” and lack confidence.
Some cynical people, under the banner of “ancestral cure for asthma”, illegally make and sell fake asthma medicine mixed with glucocorticoid powder to make huge profits.
GINA’s definition of asthma emphasizes that asthma can be prevented or treated.
It calls on medical workers to actively communicate with patients, expose the harm of fake drugs from the perspective of patients’ psychology, and let patients receive regular treatment.
Call on the media and regulatory bodies to strengthen the supervision of advertising;
The state promotes the enactment of relevant laws to avoid the tragedy caused by “magic medicine”.
Common mistake 4 does not pay attention to the application of inhaled hormone
Some physicians and asthmatics use inhaled glucocorticoids (ICS) as a medication to relieve acute asthma symptoms, hoping to achieve immediate relief.
The wrong conclusion that inhaled hormone is not effective is drawn because it does not achieve the desired goal.
Many asthmatics and their families, especially young women, are reluctant to use ICS for fear of side effects.
ICS is not used as a basis or first-line treatment for asthma.
Bronchial asthma is a disease characterized by chronic airway inflammation, and long-term maintenance therapy is required to control airway inflammation. Inhaled corticosteroids based on airway inflammation can reduce the acute exacerbation of asthma.
In the course of anti-inflammatory treatment, there are some problems such as inadequate treatment, improper drug selection, insufficient dose and short course of treatment.
In their clinical work, medical staff should help patients realize that asthma is a disease characterized by chronic airway inflammation. ICS is a first-line essential drug for asthma control.
To make patients understand the characteristics and different use methods of palliative and control drugs;
Help patients understand the safety and effectiveness of ICS, overcome their fear of ICS, and receive standardized treatment.
Common misconception 5: Ignoring compliance of asthma patients
Asthma, as a chronic disease, is self-medicated most of the time.
Therefore, patient compliance is the key to determine the efficacy of bronchial asthma.
Poor compliance is the main problem in asthma management.
Improving compliance has a far greater impact on health outcomes than changing a particular treatment.
Doctors in clinical work, as long as the reasons for poor patient compliance, can be readily solved.
Patient and adequate education is required for patients with insufficient knowledge of the disease, inadequate understanding of medication regimen and inhalation techniques, and insufficient understanding of health benefits.
For economic reasons, the optimal drug regimen can be considered.
Electronic reminders, such as text messages, can be used if patients tend to forget medications, and asthma diaries can be encouraged.
Key points to improve patient compliance: repeated and adequate education;
Active treatment, the initial diagnosis after the obvious curative effect;
Timely understand the patient’s real thoughts, concerns, targeted persuasion;
Demonstration effect of successful treatment of asthma patients.
Common misconception six: misuse of antibiotics
Reasons why asthma patients use excessive antibiotics: Mistaking the upper respiratory tract virus infection that induces asthma attacks as a bacterial infection;
The yellow phlegm caused by eosinophilic growth was mistaken for a purulent bacterial infection.
Abnormal chest X-ray behavior during an acute attack of asthma should be taken as “lung infection”.
- Attempts to prevent asthma attacks with antibiotics.
The abuse of antibiotics in asthma patients is very harmful, which can easily lead to delayed illness, induced selection of drug-resistant bacteria, increased medical costs and drug-induced asthma.
Indications of antibiotic use need to be strictly controlled: Asthma caused or aggravated by paranasal sinusitis;
When severe asthma attacks;
- Reduce the use of hormones in patients with steroid-dependent asthma.
Common mistake # 7 does not pay attention to finding and avoiding asthma factors in the environment
The incidence of asthma is closely related to environmental factors. Environmental factors make susceptible individuals develop asthma, or induce symptoms, or aggravate/persist symptoms. It is of great significance for the prevention and treatment of this disease to actively identify allergens or other asthma factors related to asthma attacks of a specific patient.
Some asthma patients with specific asthma factors, as long as they can effectively avoid contact again, can receive “no medicine and the more” comic effect.
There are common allergies to the original dust mite (house dust mite, dust mite), pollen (caraway, ragweed, etc.), mold, etc., cockroach, rat urine, silk, methyl toluene (TDl) may also induce asthma.
In addition to asking medical history, medical staff can also make on-site investigations if necessary;
Allergen skin test, bronchial provocation test and in vitro test should be done in laboratory examination.
In cases where treatment under GINA’s regimen is “ineffective,” instead of blindly “upgrading treatment,” the environmental controls should be checked first.
Common errors in the detection of eight lung functions
When the predicted value of FEV1 (forced expiratory volume in one second) ≥ 70%, bronchial provocation test was used to evaluate airway reactivity.
Ventilation function was decreased and the reversibility of airflow limitation was evaluated by bronchodilation test.
Asthma can be diagnosed and monitored by the intraday mutation rate of PEF.