What Are the Pros and Cons of Immunotherapy for Asthma?

Allergic asthma is a more stubborn disease that occurs in infants and young children. If treatment is ignored, it can accompany lifelong. Most asthma patients have allergies or allergic rhinitis. Asthma patients with allergic rhinitis may have symptoms such as sneezing, runny nose, itchy nose, itchy eyes, and tears. Because the symptoms are similar to respiratory infections or inflammations, adults lack relevant knowledge, often neglect treatment early, and are very likely to be misdiagnosed.

Allergic asthma

Allergic asthma is a more stubborn disease that occurs in infants and young children. If treatment is ignored, it can accompany lifelong. Most asthma patients have allergies or allergic rhinitis. Asthma patients with allergic rhinitis may have symptoms such as sneezing, runny nose, itchy nose, itchy eyes, and tears. Because the symptoms are similar to respiratory infections or inflammations, adults lack relevant knowledge, often neglect treatment early, and are very likely to be misdiagnosed.

Etiology and pathology of allergic asthma

Allergic asthma

Allergic asthma

It is a chronic airway inflammation involving multiple cells, especially mast cells, eosinophils, and T lymphocytes. This inflammation can cause recurrent wheezing, shortness of breath, chest tightness, and / or cough in susceptible persons. Symptoms occur at night and / or early in the morning, and the airway is more responsive to various stimuli. However, symptoms can be resolved on their own or through treatment. Over the past ten years, the prevalence and mortality of asthma in the United States, Britain, Australia, New Zealand and other countries have increased. About 100 million asthma patients worldwide have become a major chronic disease that seriously threatens public health. The prevalence of asthma in China is about 1%, and children can reach 3%. It is estimated that there are more than 10 million asthma patients in China.

Clinical symptoms of allergic asthma

Allergic asthma has aura symptoms such as sneezing, runny nose, cough, chest tightness, etc. If it is not handled in time, asthma may occur due to aggravated bronchial obstruction. In severe cases, you may be forced to take a seated or sitting breath, dry cough or slightly A lot of white foamy sputum, and even cyanosis. But generally can be relieved by themselves or by themselves or with antiasthmatic drugs. Some patients may relapse after a few hours of remission and may even cause asthma persistence.

Atypical asthma also exists clinically. Such as cough variant asthma, patients have no obvious incentive for coughing for more than 2 months, frequent attacks at night and in the morning, exacerbations caused by exercise, cold air, etc., there is high reactivity in airway reactivity measurement, antibiotics or antitussive, expectorants Treatment is ineffective, and bronchial spasmolytic or corticosteroids are effective, but other diseases that cause cough need to be ruled out.

Allergic asthma allergic asthma complications

Long-term repeated episodes of allergic asthma can be complicated by chronic bronchitis and pulmonary interstitial fibrosis. In addition, there are:

1. Obstructive emphysema and chronic pulmonary heart disease. During an asthma attack, the patient's chest is swollen, his shoulders are high, and shortness of breath is evident after a short movement. When the chest is seen, the light transmission increases. Swelling, which is actually not the case. This is because breathing is difficult during an asthma attack, and many breaths in the lungs cannot be exhaled, forming clinical manifestations similar to emphysema, but these symptoms can disappear once the attack is relieved. Some scholars believe that if asthma is not complicated by chronic bronchitis, some people can still have no obvious emphysema after decades of illness. Statistics: About 80% of emphysema patients have chronic bronchitis, and 1/3 of patients with chronic bronchitis are associated with emphysema, but only about 1/10 of asthma patients have emphysema.

Like emphysema, whether secondary heart disease is also a concern of patients. In fact, even with advanced asthma, secondary pulmonary heart disease is rare, especially in pediatric patients.

2.Stoppnea and respiratory failure

Sudden respiratory arrest refers to a sudden stop of breathing by a patient. Most of them occur during meals and coughs after the patient has been onset for several days, and can also be after mild activity, before this serious complication occurs, usually the condition is not too serious, and there is no warning. Therefore, most patients are at home, and timely treatment of their families is very important. If you do not recover after 2 to 3 minutes after breathing stops, and do not perform timely artificial respiration and other treatments, you will often die of cardiac arrest before being sent to the hospital. The cause of respiratory arrest is unknown and may be related to neuroreflexia at the time of onset. Although the chance of such complications is very small, people who have had a sudden stop often have the possibility of a second occurrence, and they should be particularly vigilant.

The onset of respiratory failure is much slower than the sudden respiratory arrest. It is mostly caused by the continuous development of asthma to the later stage. It is manifested as a change of mind and obvious cyanosis, and should be sent to the hospital for treatment. Therefore, allergic asthma needs timely treatment, timely find allergens, and cooperate with TCM diagnosis and treatment, asthma roots, to prevent the emergence of complications. It is recommended to use a combination of Chinese and Western methods to treat, based on traditional Chinese medicine, Western medicine auxiliary treatment can reduce pain It is treated with advanced traditional Chinese medical methods such as external burial and internal sterilization.

3.Pneumothorax and mediastinum

During breathing, due to the movement of the chest wall, it acts like a bellows, allowing gas to enter and exit the lungs. During an asthma attack, due to the obstruction of the small trachea, the pressure in the alveoli can be higher when coughing. At this time, some weak alveoli may rupture. The ruptured alveoli can be connected together to form alveoli, or the gas can flow along. Interstitial lungs run to the mediastinum to form mediastinal emphysema. A more common situation is when gas travels to the pleural space outside the lungs, causing pneumothorax.

Causes of allergic asthma

Allergic asthma inhaler

Inhalation is divided into two types, specific and non-specific. The former are dust mites, pollen, fungi, animal hair debris, etc .; non-specific inhalants such as sulfuric acid, sulfur dioxide, chloramine, etc. Occupational asthma specific inhalants such as toluene diisocyanate, phthalic anhydride, ethylenediamine, penicillin, protease, amylase, silk, animal dander or feces, etc. In addition, non-specific forms of formaldehyde, formic acid Wait.

Allergic asthma infection

The formation and onset of asthma is related to recurrent respiratory infections. In asthmatic patients, there may be specific IgE of bacteria, viruses, mycoplasma, etc., and inhalation of the corresponding antigen can trigger asthma. After virus infection, it can directly damage the respiratory epithelium, resulting in increased respiratory responsiveness. Some scholars believe that interferon and IL-1 produced by viral infection increase the release of histamine from basophils. In the infantile period, there are many people with asthma symptoms after respiratory virus infection (especially respiratory syncytial virus) infection. Asthma caused by parasites such as roundworms and hookworms is still visible in rural areas.

Allergic asthma food

(Common in daily life, need more attention)

Milk and dairy products

Milk and eggs

Milk and milk products are the most common foods for infants and young children, and are the most common food allergens that induce asthma in infants. Milk contains alpha lactalbumin, beta lactalbumin, and casein, among which alpha lactalbumin is all Allergens with the strongest allergenicity in milk ingredients. Although this protein can be significantly weakened after heat treatment, it can still induce more severe symptoms in patients with high milk allergy. In the past, alpha lactalbumin was considered to have a higher species specificity, so children who were allergic to milk considered goat milk instead. However, recent studies have confirmed that certain antigenicities in animal milk foods of many different species are similar. For children who are allergic to milk, goat's milk is not a reliable substitute food, especially children who are allergic to milk should not include goat's milk in their food prescriptions.

Eggs and eggs can cause allergies in patients of all ages, with infants and young children having the highest allergy rate. Egg albumin in egg white is the main allergen that induces allergies, and egg yolks rarely induce allergies.

Seafood and aquatic products

Shrimp Crab Seafood

The increased incidence of asthma in fisheries-developed areas has been found, and it is unclear whether this is related to fish allergies. However, many studies have confirmed that fish, shrimp, crab, shellfish, and mussels can induce respiratory symptoms. For example, fish with reddish-colored fish such as trout, frogfish, and catfish can easily induce allergic symptoms. Shrimp, Crustacean seafood such as crabs, oysters, and squid, cuttlefish, etc. also contain high allergens. Allergens in these foods are usually heat-resistant, and cooked food often induces allergies, especially the consumption of stale seafood can cause allergies. The incidence has increased significantly. It has also been proven in recent years that inhalation of airborne fish meal can also induce symptoms in patients with allergic asthma to fish.

Oil crops such as peanuts, sesame and cottonseed

Vegetable oil

Mainly related to the high protein content of these foods, once made into oil products, it rarely causes allergic symptoms. However, patients with asthma caused by eating raw peanuts can often be encountered clinically.

Wheat, grain

Beans

Various beans

Such as soybeans, mung beans, red beans and black beans can induce symptoms of respiratory allergies.

Nuts

Various nuts

Including walnuts, pecans, pistachios, hazelnuts, cashew nuts, pine nuts and chestnuts.

Meat and meat products

Common include beef, lamb, and pig

Various meat products

Meat, chicken, rabbit, duck, etc., uncommon meats including dog, goose, carcass, and bird meat can also induce allergies. For example, allergies to bird meat often occur in the presence of bird- egg syndrome (bird- egg syndrome).

flour

Like bread

flour

Baker & acute; s asthma is related to contact with flour. In addition, mites in flour and cereals are the main cause of allergies.

Certain vegetables

Various vegetables

Including kidney beans, green beans, white lupins, mushrooms, tomatoes, peppers, chives, coriander, toon, garlic, eggplant, cabbage and bracken.

Other food

Liquor

Coffee, beer, wine, whiskey, white wine, health products made from pollen, chocolate, and certain edible insects (such as bean worms, grasshoppers, and silkworm pupae, etc.) can induce varying degrees of respiratory allergies.

Allergic asthma climate change

Asthma can be induced when air temperature, temperature, air pressure, and / or ions in the air change, so it is more common in cold seasons or autumn and winter climate changes.

Allergic asthma mental factors

Agitated, anxious, resentful, etc. all contribute to asthma attacks, which are generally thought to be caused by the cerebral cortex and vagus nerve reflexes or excessive ventilation.

Allergic asthma exercise

About 70% to 80% of asthma patients induce asthma after strenuous exercise, which is called exercise-induced asthma, or exercise-induced asthma. The typical case is 6 to 10 minutes of exercise, bronchospasm is most obvious within 1 to 10 minutes after stopping exercise, and many patients recover on their own within 30 to 60 minutes. There is a refractory period of about 1 hour after exercise. During this period, 40% to 50% of patients do not exercise bronchospasm. Clinical manifestations include cough, chest tightness, shortness of breath, wheezing, auscultation and wheezing. Although some patients have no typical asthma after exercise, lung function tests before and after exercise can detect bronchospasm. The disease is more common in adolescents. If sodium cromoglycate, ketotifen or aminophylline is given in advance, the onset can be reduced or prevented. Relevant research believes that due to excessive ventilation after strenuous exercise, the water and heat of the airway mucosa are lost, and the respiratory epithelium temporarily has a high molar concentration, resulting in contraction of bronchial smooth muscle.

Allergic asthma asthma and drugs

Some drugs can cause asthma attacks, such as propranolol, which cause asthma by blocking 2-adrenergic receptors. About 2.3% to 20% of patients with asthma induce asthma by taking aspirin, which is called aspirin asthma. The patient is also referred to as aspirin triad due to nasal polyps and low tolerance to aspirin. Its clinical features are: taking aspirin can induce severe asthma, symptoms often appear within 2 hours after administration, and occasionally as late as 2 to 4 hours. Patients may have cross-reactions with other antipyretic and analgesics and non-steroidal anti-inflammatory drugs; children with asthma usually develop before the age of 2 years, but most of them are middle-aged patients, most of whom are 30 to 40 years old; women are more than men The ratio of male to female is about 2: 3; there is no obvious seasonality, the disease is severe and stubborn, and most of them are dependent on hormones; more than half have nasal polyps, often accompanied by perennial allergic rhinitis and / or sinusitis, nasal Asthma symptoms sometimes worsen or occur after polypectomy; common inhalant allergen skin tests are mostly negative; total serum IgE is normal; there are fewer patients with allergic diseases in the family. Its pathogenesis has not been fully elucidated. Some people think that the bronchial cyclooxygenase in patients may be affected by an infectious agent (which may be a virus), which makes cyclooxygenase susceptible to aspirin inhibition, that is, intolerance to aspirin. Therefore, when patients take aspirin, it affects the metabolism of arachidonic acid, inhibits the synthesis of prostaglandins, unbalances PGE2 / PGF2, increases the production of leukotriene, and leads to strong and durable contraction of bronchial smooth muscle.

Allergic asthma menstrual pregnancy and asthma

Many women with asthma suffer from asthma exacerbations 3 to 4 days before the menstrual period, which may be related to the sudden decrease in progesterone in the premenstrual period. If some patients have monthly episodes and they have a small menstrual period, they can be injected with progesterone in a timely manner, which can sometimes prevent severe premenstrual asthma. The effect of pregnancy on asthma is not regular. There are those who have improved asthma symptoms and those who have worsened, but most of them have not changed significantly. The effect of pregnancy on asthma is mainly manifested in the mechanical effects and changes in asthma-related hormones. With the enlargement of the uterus in late pregnancy, the position of the diaphragm muscles rises, which makes the residual volume, expiratory reserve, and functional residual volume different. The degree decreases, and there is an increase in ventilation and oxygen consumption. If asthma is properly managed, it will not have adverse consequences for pregnancy and childbirth.

The WHO's guidance document on immunodesensitization clearly states that "immunodesensitization is the only fundamental treatment that can completely treat bronchial asthma."

Allergic rhinitis asthma syndrome

Especially after liberation, people have gradually realized that allergic rhinitis and allergic asthma often coexist, so they have proposed a new concept that these seemingly different diseases are to some extent the same disease of the upper and lower respiratory tracts. Clinically, some patients are predominantly allergic rhinitis while asthma is undiagnosed or in a subclinical state, while other patients may have both diseases.

Clinically, new important concepts are often injected into the diagnosis and management of some common diseases and potentially disabling diseases, resulting in some new disease terms. For example, allergic rhinitis and allergic asthma that have been clinically concerned have been called "combined airway disease", "allergic nasal bronchitis", "allergic rhinitis asthma syndrome" or "total respiratory inflammation synthesis" disease". There is currently no agreement on which disease name should become the universally accepted international name. Based on feedback from readers, the World Organization of Allergy (WAO) and its subsidiaries, Allergy & Clinical Immunology International and International Archives of Allergy and Immunology, advocate the use of the term allergic rhinitis asthma syndrome.

Much evidence supports the new medical term for Combined Allergic Rhinitis and Asthma Syndrome (CARAS). The World Organization of Allergy (WAO) has included CARAS as a keyword on the organization's website under the official disease name, and has discussed it in terms of pathogenesis, immunology, diagnosis and treatment to evaluate upper or lower respiratory tract treatment The interaction between the two patients was pointed out, and pointed out that the diagnosis and treatment of "allergic rhinitis and asthma syndrome" can guide the clinical and patients to actively perform upper or lower respiratory tract therapy.

Allergic rhinitis is often considered a risk factor for the development of asthma. This concept is not entirely accurate, as rhinitis may also be an early stage of allergic rhinitis and asthma syndrome, but persistent rhinitis is an independent risk factor for asthma, even without any other atopic symptoms.

It is known that sinusitis and asthma can coexist, especially in children. In patients with allergies, parasinusitis is often associated with the development of lower respiratory tract diseases. Endoscopy confirmed sinusitis and / or tonsillitis in more than 50% of children with asthma.

Because the sinuses and nasal mucosa have a close anatomical relationship, it is rarely found that there is only sinusitis without nasal mucosal inflammation. The term closer to this situation is rhinosinusitis. Sinus infected by bacteria is a place where bacteria multiply easily, which can often aggravate asthma. Endotoxin secreted by the cell wall of Grignard-negative bacteria has strong pro-inflammatory properties. It has been demonstrated that inhalation of endotoxin can induce airway stenosis and airway hyperresponsiveness in asthma patients.

Allergic asthma epidemiology

Clinical observations during the 1960s have shown a link between allergic rhinitis and allergic asthma. In the effectiveness of specific immunotherapy studies, about 50% of children who had not been treated with immunotherapy developed asthma within a few years. A 10-year follow-up survey of 99 patients diagnosed with allergic rhinitis, allergic asthma, or both shows that 32% of allergic rhinitis patients develop asthma; 50% of asthma patients develop rhinitis.

A series of global studies have shown that: 70-90% of asthma patients are associated with rhinitis; 40-50% of allergic rhinitis is associated with allergic asthma.

Different studies have confirmed that: 25-70% of adults with asthma have sinusitis; 20-60% of children with asthma have sinusitis; 50% of patients with asthma have sinusitis

Airway hyperresponsiveness triggered by acetylcholine indicates that 15-65% of patients with allergic rhinitis have increased airway responsiveness.

The basic mechanisms that cause allergic rhinitis and asthma syndrome.

Allergic asthma physical mechanism

The functions of the upper respiratory tract, such as physical filtering, resonance, heat dissipation and wetting, keep the air in the trachea at about 37 ° C and moist. Inhaled particles larger than 5-6 microns can be blocked in the nasal cavity. Disorders of certain functions of the upper respiratory tract can cause steady state changes in the lower respiratory tract. Inhalation of high flow of cold air with aspiration in the mouth of asthmatic patients can reduce FEV and increase nasal ventilation resistance, and the mechanism of nasal allergic inflammation spreading down the respiratory tract: Marchand et al.'S study of asthma patients with rhinitis found that the nasal mucosa and There are many similarities in the pathological changes of the bronchial mucosa, including a large amount of eosinophil infiltration, lymphocytosis, goblet cell proliferation, rich subepithelial microcirculation, and a large amount of plasma exudation. Modern medicine confirms that the allergic inflammation of the upper respiratory tract of allergic rhinitis can gradually spread to the lower respiratory tract, and allergic pharyngitis, allergic bronchitis, and asthma can occur in succession, forming a full respiratory allergy phenomenon. Because the upper and lower respiratory tracts of allergic rhinitis-asthma syndrome are allergic inflammations, only the lesions are different, and the anatomy continuity and pathophysiology are similar, so the lower respiratory tract allergic inflammation of asthma is actually The upper is an extension of the upper respiratory tract inflammation of allergic rhinitis. In addition, there is a neural reflex between the nose and the bronchus, such as nasal-bronchial reflexes (when the nasal mucosa of a person or animal is mechanically stimulated, it can affect respiratory rhythms and increase airway smooth muscle tension and increased glandular secretion. -Bronchial reflex) and so on. Based on the above reasons, a new concept of allergic rhinitis-asthma syndrome was proposed clinically.

Allergic asthma causes allergen exposure

The development of allergic inflammation of the upper or lower respiratory tract is associated with exposure of atopic individuals to specific allergens. Seasonal allergens, such as grass or tree pollen, can cause intermittent symptoms, which are intermittent / seasonal allergic rhinoconjunctivitis. Allergens that are present throughout the year, such as animal fur and house dust mites, are more likely to cause persistent symptoms of asthma and / or rhinitis.

To some extent, the allergenicity of allergens may be related to the size of the allergen particles, because pollen is usually about 5 microns in diameter and is very easy to be filtered by the upper respiratory tract barrier. When patients with nasal congestion change to oral breathing, the filtering function of the upper respiratory tract is avoided, which can cause symptoms of the lower respiratory tract. House dust mites and pet allergens are smaller (about 1 micron in diameter). Easy to enter the lower respiratory tract and induce asthma.

Allergic Asthma Immunology Research

Inflammation of the nasal and bronchial mucosa plays a key role in the pathogenesis of allergic rhinitis and asthma. Although there are different indicators of inflammation in allergic rhinitis and asthma, allergic inflammation in the upper and lower respiratory tracts has similar inflammatory cell exudation, and immunopathology has confirmed that chronic allergic inflammation in the upper and lower respiratory tracts is similar All have the participation of Th2 cells, mast / basophils, eosinophils, and IgE. The participating cytokines such as IL-4, IL-5, IL-13, RANTES and GM-CSF, inflammatory chemical mediators.

The systemic immunological response to inhaled allergens is consistent in allergic rhinitis and asthma. can be confirmed by the increase of eosinophils in peripheral blood, progenitor cells of eosinophils and mast / basophils in the blood, the response of polymorphonuclear cells (PMBC) to specific allergens, and Compared with healthy individuals, patients with CARAS have increased PM-4 production and reduced gamma-interferon production by PMBC.

In sensitive individuals, tissue mast cells and basophils that bind IgE are activated after exposure to allergens, releasing histamine, leukotriene, and other mediators. This reaction can cause rapid nasal irritation symptoms, such as nerve-mediated sneezing and runny nose, and nasal congestion caused by vascular congestion. Rapid symptoms in the lower respiratory tract are bronchospasm and high secretion of mucus, causing cough, dyspnea, chest tightness and wheezing.

Nasal mucosal challenge test in asthma patients can cause non-specific airway hyperresponsiveness, bronchial challenge test for rhinitis patients and cause asthma symptoms, with the accumulation of inflammatory cells and pre-inflammatory cellular mediators. This shows that the upper and lower respiratory tracts can be regarded as a unique organ, including the inflammatory process, and they can continue to develop each other through mutually continuous mucosa.

Even in the absence of symptoms, continuous exposure to low levels of allergens can lead to inflammatory infiltration of the airways and ICAM-1 expression, known as minimal persistent inflammation (MPI). ICAM-1 is the primary receptor for rhinoviruses. Rhinovirus is the most common cause of exacerbation of asthma. The worsening of the condition may be due to increased airway inflammation. Rhinovirus infection has been shown to lead to an increased airway response, promote the development of late-phase asthma responses after inhalation of allergens, and increase the recruitment of eosinophils in the airways after allergen challenge, which may be related to the stimulation of cytokines, And can increase airway mucosa eosinophilic inflammation.

Epithelial shedding is more pronounced in the bronchi than in the nasal cavity. Most patients with asthma have airway remodeling confirmed under the microscope. Although not all asthma, rhinitis patients can maintain the integrity of the nasal mucosa without such obvious changes. The reason why rhinitis patients can keep the mucosa intact and asthma patients cannot, may be due to the ability of epithelial cells to synthesize and release anti-inflammatory substances that play a key role. These anti-inflammatory substances can prevent inflammatory damage caused by eosinophils.

The focus of CARAS research is on local pathogenesis, such as the production of local tissue IgE and the differentiation of selective T lymphocytes, which determine that the inflammatory response after inhalation of allergens mainly occurs in the upper or lower respiratory tract.

Clinical diagnosis of allergic asthma

Before the onset of allergic asthma, there are aura symptoms such as sneezing, runny nose, cough, chest tightness, etc. If not treated in time, asthma may occur due to the increase in bronchial obstruction, which is called "allergic rhinitis asthma syndrome". People with severe asthma attacks can be forced to take a seated or sitting breath, dry cough or a lot of white foamy sputum, and even cyanosis. But generally can be relieved by themselves or by themselves or with antiasthmatic drugs. Some patients may relapse after a few hours of remission and may even cause asthma persistence. In addition, clinically asthma also exists. Such as cough variant asthma, patients have no obvious incentive for coughing for more than 2 months, frequent attacks at night and in the morning, exacerbations caused by exercise, cold air, etc., there is high reactivity in airway reactivity measurement, antibiotics or antitussive, expectorants Treatment is ineffective, and bronchial spasmolytic or corticosteroids are effective, but other diseases that cause cough need to be ruled out.

Diagnostic tests for allergic asthma: those with atypical symptoms (if there is no obvious wheezing and signs), the following tests should be selected according to the specific situation, at least one of the following three items should be positive, and the combination with asthma treatment can significantly relieve the symptoms and improve Pulmonary function can be diagnosed.

1. Bronchial challenge test or exercise test is positive: Bronchial challenge test often uses histamine or methacholine inhalation method. The cumulative dose of inhaled histamine is less than 7.8mol or the concentration of methacholine is 8mg / ml. Those with a 20% decrease in pulmonary ventilation function (FEV1) are airway hyperresponsiveness, which is strong evidence to support bronchial asthma. It is generally applicable to normal ventilation function. 70% or more of the patients expected.

2. Bronchodilator test positive: 15 minutes after inhaling 2 agonists, or intensive asthma treatment (including hormone use, so also called hormone test) 1-2 weeks later, EFV1 increased by more than 15%, and the absolute value increased> = 200ml is positive, suitable for those with an EFV1 <60% of the normal expected value during the onset period;

3. The intra-day variation rate or day-night fluctuation rate of PEFR is 20%.

Diagnostic criteria

In the guidelines for the prevention and treatment of bronchial asthma (definition, diagnosis, treatment, and education and management of bronchial asthma) formulated by the Asthma Group of the Chinese Medical Association Respiratory Branch in 2008, the diagnostic criteria for asthma are:

1. Recurrent wheezing, shortness of breath, chest tightness, or cough are often related to exposure to allergens, cold air, physical, chemical stimuli, viral upper respiratory infections, and exercise.

2. During the onset, diffuse or diffuse, wheezing sounds predominantly exhaled in both lungs and prolonged exhalation.

3. The above symptoms can be alleviated by treatment or spontaneously.

4. Excluding wheezing, shortness of breath, chest tightness or cough caused by other diseases.

5. Atypical clinical symptoms (if no significant wheezing or signs) should be positive for at least one of the following tests:

bronchial provocation test or exercise test is positive;

Bronchodilator test positive (FEV1 increased by more than 15%, and the absolute value of FEV1 increased by> 200ml);

PEF intra-day variability or day-night volatility 20%

Those who meet the above 1-4 or 4, 5 can be diagnosed with bronchial asthma. These three test methods are described in the relevant sections of this book.

Routine treatment of allergic asthma

Past treatments: the old model of seizure-treatment-relief-stop-relapse

The current treatment mode: new mode of seizure-treatment-relief-continuation treatment-drug reduction-long-term control

Common allergens in allergic asthma

Allergic asthma pollen

There are different kinds of pollen in the air during each season. There are two types of pollen: wind-borne and insect-borne. Wind-borne pollen is the main cause of asthma, and the particle diameter is between 17 and 58 microns. The sensitized pollen in North America is mainly ragweed pollen, which has been found to contain about 20 different allergen components. Pollen disease in autumn in northern China is a compositae, which is likely to have allergen crossing. Pollen disease in Shanghai, China is mainly caused by pollen such as poplar, mulberry, sycamore, and maple poplar, while autumn is caused by pollen such as rhododendron, castor, artemisia.

pollen

Allergic asthma house dust

House dust is composed of many ingredients, including animal hair debris, fungi, bacteria, pollen, animal and plant fibers, and so on. It is generally believed that the main allergen in house dust is dust mites. For those who have respiratory allergic symptoms in all four seasons, they should pay more attention to the allergic effect of house dust.

Allergic asthma mite

There are more than 5,000 mites, and house dust mites and cosmic dust mites are the main allergens. Dust mites are distributed all over the world and are mostly born in human living environments. The optimum temperature for dust mites to survive is about 25 ° C, and the relative humidity is 75% to 80%. Asthma occurs frequently in spring and autumn, which is consistent with the season of dust mites. The incidence of allergies to dust mites is higher in children than in adults and higher in men than in women.

Dust mite-electron microscope

Allergic asthma animal dander

Cat and dog dander are recognized allergens. Stale feathers and wool can also be used as allergens.

Allergic asthma fungus

Fungi multiply easily in wet, rainy and offshore areas. As in the rainy season, asthma patients caused by Streptomyces are often seen.

Fungi-electron microscope

Allergic asthma insect excrement

Asthma caused by inhalation of insect waste is rare, but in the United States, asthma caused by cockroaches has been taken very seriously in recent years, and it has been reported in China.

Allergic asthma food

It mainly refers to animal foods such as fish, shrimp, crab, shellfish, eggs, and milk. Some people cause allergic reactions such as vomiting and diarrhea mainly after eating, but some can also cause allergic reactions in the respiratory tract and general rash. Nuts such as walnuts, pistachios, cashews, big almonds, sticks, pine nuts and chestnuts often cause allergies. Nuts are more allergenic and can induce severe allergic symptoms.

Allergic asthma cold air

It occurs frequently in the autumn and winter seasons, and it is difficult to avoid it because of temperature changes.

Allergic asthma other

other reasons

Allergic Asthma Treatment

Goals for successful asthma treatment

1. Control your symptoms as much as possible, including nighttime symptoms.

2. Improve activity and quality of life.

3 Keep your lung function close to optimal.

4 Prevent outbreaks and exacerbations.

5. Improve self-awareness and ability to deal with acute exacerbations and reduce emergency department or hospitalization.

6. Avoid affecting other medical issues.

7. Avoid the side effects of the drug.

8. Prevent death from asthma.

The goal of the above treatment is to emphasize:

Treatment should be aggressive and strive for complete control of symptoms.

Protect and maintain lung function as normal as possible.

(3) Avoid or reduce adverse reactions to drugs.

In order to achieve the above goals, the key is to have a reasonable treatment plan and adhere to long-term treatment.

Bronchodilators , in addition to their main role in dilating the bronchus and controlling the acute symptoms of asthma.

1. 2 agonist: 2 agonist drugs are mainly divided into fast-acting 2 agonists and long-acting 2 agonists. Fast-acting 2 agonists: including salbutamol, terbutaline and fenoterol, etc., the action time is 4-6 hours. Long-acting 2 agonists (LABA): including salmeterol, formoterol, and procaterol. Action time> 12 hours, especially suitable for nighttime asthma. Beta2 agonists are the first-line drugs to relieve the symptoms of an acute attack. The 2 agonist can be administered by inhalation, oral or intravenous injection. The inhalation method is preferred, which has a rapid effect, a high amount of drugs in the airway, and few systemic side effects. Methods of inhalation include quantitative aerosol, dry powder inhalation and continuous nebulization. Quantitative aerosols are the most commonly used. However, the use of quantitative aerosols needs to be combined with the use of aerosol cans to ensure efficacy.

2. Theophylline oral aminophylline is usually dosed at 5 to 8 mg / kg per day, and theophylline is slowly released at 8 to 12 mg / kg per day. Intravenous administration is mainly used in critically ill asthma. The first injection dose is 4-6mg / kg and it should be injected slowly. The injection time should be greater than 15min. The intravenous drip maintenance amount is 0.8-1.0mg / kg per hour. The daily dosage generally does not exceed 750mg-1000mg.

3 Anticholinergic drugs Inhalation of anticholinergic drugs, such as Ipratropine bromide, etc., combined with 2 agonist inhalation therapy to enhance and last the bronchodilator effect. It is mainly used in asthma patients whose 2 agonist alone fails to control symptoms. It is especially suitable for patients with chronic obstructive pulmonary disease. Can be inhaled with MDI or continuous nebulization, 3 to 4 times a day, 75 to 250 g each inhalation. It takes about 15 minutes and lasts for 6 to 8 hours. There are few adverse reactions, and a few patients have bitter or dry mouth.

Folk remedies

Recipe 1

[Raw materials] Schisandra 250 grams, 10 red-skinned eggs.

[Instruction] Put Schisandra chinensis into pottery, boil it with water for 30 minutes, wait until the juice is cool, put 10 red-skinned eggs, soak in a cool place for 7 days, and take 1 egg every morning.

[Indications] Allergic asthma

Recipe 2

[Raw materials] 10 grams each of Ganoderma lucidum and perilla leaves, 15 grams each of Poria and rock sugar, 8 grams of Pinellia oleifera and 5 grams of Magnolia officinalis.

[Usage] Shuijianbi.

[Indications] Allergic asthma

Upper or lower respiratory tract treatment

Similarities : The treatment of allergic rhinitis and asthma syndrome should be combined with anti-inflammatory treatment for the basic inflammation process of allergic rhinitis and asthma,

Differences : The pharmacological effects of sympathomimetics in controlling upper and lower respiratory tract symptoms are different. Nasal congestion caused by vascular congestion in the nasal mucosa can be improved by vasoconstrictor drugs, -adrenergic agonists, while bronchial smooth muscle requires the application of bronchodilators such as 2-adrenergic agonists.

Allergic asthma diet considerations

Experts remind that allergic asthma diets should be warm, light, and soft, but eat less and eat more. In addition to avoiding foods that will definitely cause allergies or asthma, avoid other foods to avoid losing the proper nutritional balance. During an asthma attack, you should also eat less flatulent or indigestible foods, such as beans, potato, etc., to avoid abdominal distension and compression of the chest cavity and increase breathing difficulties.

Many foods such as fish and shrimp (sea fish), sesame, shellfish, nuts (cashews, peanuts, etc.), dairy products and even wheat products can be used as allergens to cause asthma attacks. In this regard, after clarifying the allergens, you can try to avoid eating the corresponding foods or foods that are highly suspected as allergens through dietary regulation. In addition, some foods are not suitable for patients with different sexual tastes. For example, asthma patients often have the pathogenesis of phlegm and turbidity. At this time, it is not suitable to eat pork, fish, or fatty products. Moisturize and produce phlegm. At this time, you can eat more phlegm and dampness products such as radish, loofah, barley, citrus, ginkgo; for patients with internal body heat or phlegm fever, it is not suitable to eat pepper, pepper, mustard, fennel and other spicy stimulation Sexual food, because of its warming nature, can eat mung beans, rape, bitter gourd, grapefruit and other hot things.

The diet of asthma patients should be warm, light, and soft, but eat less often. In addition to avoiding foods that will definitely cause allergies or asthma, avoid other foods to avoid losing the proper nutritional balance. During an asthma attack, you should also eat less flatulent or indigestible foods, such as beans, potato, etc., to avoid abdominal distension and compression of the chest cavity and increase breathing difficulties.

Generally speaking, people with asthma should not eat (or eat less) foods such as egg yolks, roosters, fatty pork, lamb, dog meat, marine fish, clams, crabs, shrimps; papaya, leek, golden needles, bamboo shoots (or dried bamboo shoots), peanuts , Pickles, peppers, peppers; sweeteners, flavors, pigments, chocolates; cold drinks such as ice cream, carbonated drinks such as soft drinks, wine, coffee, strong tea, etc.

Everyone's allergens are very different. If you don't know the cause, you should take the initiative to observe which things can be eaten, and which things can cause asthma after eating.

Allergic asthma life aspects

Keep your home clean, avoid children when vacuuming, and keep children away from allergens.

As the dust mites easily attach to the hair doll, it is best not to put the hair doll on the child's bed. If it is necessary to place the hair doll, it is best to wrap the hair doll in a plastic bag or wash it with hot water every week. You can also put hair dolls in the refrigerator for two or more hours a week to prevent the breeding of dust mites.

Avoid raising small animals, because the hair on their bodies is more likely to breed bacteria, and cat fur is most common in pets. Therefore, if you have asthma in your home, it is best to avoid raising small animals.

Children should be actively encouraged to participate in sports, but preventive measures should also be taken, such as jet dilators before exercise, to avoid too strenuous exercise.

On days when the weather is changing, be careful not to let your children catch cold. Take off your clothes when entering the room to avoid getting cold when you leave.

Children and parents should understand the long-term and potential dangers of asthma, and how to deal with it gradually and gradually in the event of an asthma attack. If there is no sign of asthma relief, you also need to know when or where to ask for help.

People with allergic asthma should swim more

Most people with asthma are reluctant to exercise, because exercise may induce asthma and cause danger to life, but "life lies in exercise". If a person is not active, his body's immunity will decrease, which will form a vicious circle, which is not conducive to the treatment of asthma. In fact, asthma patients can exercise in a moderate amount, and swimming is a good fitness activity for asthma. Then what are the benefits of swimming, here is a brief introduction to everyone:

<1>; Swimming can improve immunity and prevent colds. When swimming, cold water is in contact, so it can improve the body's ability to adapt to the environment, thereby improving the body's immunity, reducing the chance of colds, and reducing the chance of asthma.

<2>; Enhance cardiopulmonary function

During swimming, the burden on the respiratory muscles is greatly increased. The pressure of 12-15 kg of water pressures the entire brain cavity and helps the vital capacity. The data shows that swimming for half an hour a day and maintaining one summer can increase the vital capacity by 500 ml.

<3>; swimming can effectively exercise the chest muscles, diaphragm muscles, and intercostal muscles, and improve lung ventilation.

Reasonable exercise is conducive to the treatment and rehabilitation of asthma patients. Come together!

Common methods for removing mites in patients with allergic asthma

General household mite removal method :

Weekly or bi-weekly cleaning will achieve some results, but it is more troublesome. What the family can do includes:

1. Centralized change of washing seat, bedding cotton fabrics and velvet toys, high temperature dipping above 55 degrees;

2. Use a powerful vacuum cleaner with a vibrating mite head to remove live mites, dead mites and feces from mattresses, sofas and carpets;

3. Be absolutely light-footed and keep in slow motion to avoid suspension of mite harmful substances, otherwise you will give up all your efforts;

4 Try to ventilate for more than 4 hours;

5. Bathe your pets at the same time;

Unfortunately, the mite suspension cannot be controlled and handled once a week or every other week; the rapid reproduction of the original and newly introduced mites in the room cannot be suppressed; a comprehensive deep cleaning is required every week to clear the new mite mite carcasses. Mites die in dry environments with humidity below 15% and cannot reproduce further in cold environments. Therefore, even though they are now more adaptable and resistant to traditional pesticides, so that they cannot be completely killed, cleaning households and individuals is still a cost-effective way to remove insects. The specific method is to keep Ventilate and dry the room and work room, change clothes and bedding frequently, and regularly expose and pat the bedding, mattress, pillow, straw mat and carpet. In spring and summer, grass and bamboo mats are often dried and patted in the sun, or wiped with 75% ethanol, or aromatic insect repellents such as camphor essence are placed under mattresses or mats. You often use a vacuum cleaner to remove the dust on the carpet. You can also spray the carpet with a pyrethroid insecticide, or wipe the carpet with cotton yarn dipped in turpentine. It is best not to let pets enter the bedroom, and regularly bathe, deworm and disinfect pets.

How to get rid of mites in the office:

Dust mites are the most common in home life and offices. It is the number one enemy of many allergic diseases and is widely distributed on carpets, mattresses, pillows, quilts and sofas. The insect bites the human body, mites 'secretions and excreta, mites' corpses, etc. can cause disease. If it invades the respiratory tract, it can cause cough and asthma. In addition to causing asthma, mites can also cause allergic rhinitis, such as snot, itching, and sneezing. In addition, it can cause allergic skin diseases. The main symptoms are erythema, rashes, blisters, itching, recurrent attacks, and long-term cure. Medical experts estimate that 1/3 of allergic dermatitis diagnosed are caused by mites. The office is the place where people work and the largest parasitic place for dust mites. The following methods can greatly reduce the dust mite levels:

1. Put an anti-mite cover on the seat cushion of the office chair and use it after tightening the zipper. Isolate people from dust mite allergens. This will not only prevent the internal dust mite and dust mite allergens from penetrating the isolation material, but also cannot feed on human dander. At the same time, the external dust mites can no longer enter the cushion for reproduction So as to achieve the purpose of controlling dust mites.

2. Clean the sofa cover with hot water above 55 every one to two weeks.

3. Try not to use carpets.

4. Instead of using padded furniture (such as fabric sofas), use wooden furniture or leather sofas.

5, often maintain good indoor ventilation, keep the workplace dry and ventilated. Mites die in a dry environment with a humidity of less than 15% and cannot reproduce further in a low temperature environment.

6, simplify the layout of the office as much as possible to facilitate dust removal, do not place too many books and debris.

7. Don't place tapestries and other things that are easy to accumulate dust.

8. It is best to use blinds instead of fabric curtains. If fabric curtains must be used, they need to be cleaned frequently.

9, try to keep office supplies and books in the cabinet, do not place on the table for a long time and accumulate dust.

10. Because the dust mites like to live in a humid environment, the humidity index is controlled below 50% through the use of air conditioning.

11. When cleaning allergic to dust mites, it is best to wear a dust mite mask, wipe the dust with a mite-removing cloth, and develop the habit of "wet operation" to reduce the chance of dust floating in the air and being inhaled. .

12. Ordinary vacuum cleaners will diffuse tiny allergens into the air again during dust removal, making the environment worse. Therefore, high-efficiency vacuum cleaners that can filter allergens should be used for regular dust removal to achieve "vacuum without exhausting." the goal of.

13. When necessary, take medicine for prevention and control. Wipe office furniture with 75% ethanol, or place aromatic insect repellents such as camphor essence under a cushion or sofa. You can spray the carpet with pyrethroid insecticides, or wipe the carpet with cotton yarn dipped in turpentine.

Allergic asthma

With the improvement of people's living standards, various seafood products have entered the tables of inland people. At the same time, technological advancements have caused a large number of fruits to go on sale in the off-season, and North-South communication has caused a large number of foreign fruits to enter the mainland. These invisible increase allergen It is well known that the more allergic sources will increase the chance of asthma symptoms, and increase the chance of asthma induction, so asthma experts here recommend that asthma patients should establish a reasonable asthma according to their physical constitution. Diet files, reasonably avoid allergens, have obvious effects on the treatment of asthma.

What are the prevention and treatment of allergic asthma

1. Avoid cold stimulation. Patients with allergic asthma return to home sweating from the outside, do not immediately enter the air-conditioned room, let alone open the refrigerator and pick up cold drinks. You can let allergic asthma patients wipe their sweat with a towel first, drink some warm water, and wait for the mood to stabilize before enjoying air conditioning.

2. The air-conditioned room should pay attention to ventilation and cleaning. In the air-conditioned rooms, the air cannot be completely renewed and circulated. The virus and dust accumulated in the air conditioner may also induce asthma. There have been reports of "air conditioner-induced asthma" in foreign countries. It can be said that air-conditioning refrigeration is one of the main causes of asthma in children in summer, so air-conditioned rooms must be thoroughly cleaned every day, and windows are opened regularly for ventilation.

3. The temperature of the air conditioner should not be too low. It must be noted that the difference between the indoor temperature and the outdoor temperature should not exceed 5 ° C, and patients with allergic asthma should not be facing the air outlet of the air conditioner.

4. Try to keep cold drinks for allergic asthma patients as little as possible. In summer, allergic asthma patients eat a lot of cold drinks, which is also a "cold" stimulus. "Cold" is also an allergen for children with asthma, and it is an important cause of asthma regardless of the season.