Jain N, Puranik M, Lodha R, Kabra S K
Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi.
Indian J Pediatr. 2001 Sep;68 Suppl 4:S31-41.
Long-term management of asthma includes identification and avoidance of precipitating factors of asthma, pharmacotherapy and home management plan. Common precipitating factors include viral upper respiratory infections, exposure to smoke, dust, cold food and cold air. Avoidance of common precipitating factors has been shown to help in better control of asthma. Pharmacotherapy is the main stay of treatment of asthma. Commonly used drugs for better control of asthma are long and short acting bronchodilators, mast cell stabilizers, inhaled steroids, theophylline and steroid sparing agents. After assessment of severity most appropriate medications are selected. For mild episodic asthma the medications are short acting beta agonists as and when required. For mild persistent asthma: as and when required bronchodilators along with a daily maintenance treatment in form of low dose inhaled steroids or cromolyn or oral theophylline or ketotifen are required. Moderate persistent asthma should be treated with inhaled steroids along with long acting beta agonists for symptom control. For severe persistent asthma the recommended treatment includes inhaled steroids, long acting beta agonists with or without theophylline. If symptoms are not well controlled, a minimal dose of oral prednisolone preferably on alternate days may be needed in few patients. Newer drugs like leukotriene antagonists may find a place in control of exercise-induced bronchoconstriction and mild and moderate persistent asthma. Patients should be followed up every 8-12 weeks. On each follow up visit patients should be examined by a doctor, compliance to medications should be checked and actual inhalation technique is observed. Depending on the assessment, medications may be decreased or stepped up. For exercise induced bronchoconstriction: cromolyn, short or long acting beta agonists may be used. In children with seasonal asthma, maintenance treatment according to assessed severity should be started 2 weeks in advance and continued throughout the season. These patients should be reassessed after discontinuing the treatment. Parents should be given a written plan for management of acute exacerbation at home.
哮喘的长期管理包括识别和避免哮喘的诱发因素、药物治疗及家庭管理计划。常见的诱发因素包括病毒性上呼吸道感染、接触烟雾、灰尘、冷食和冷空气。已证明避免常见的诱发因素有助于更好地控制哮喘。药物治疗是哮喘治疗的主要手段。为更好地控制哮喘，常用药物有长效和短效支气管扩张剂、肥大细胞稳定剂、吸入性类固醇、茶碱和类固醇节省剂。在评估严重程度后，选择最合适的药物。对于轻度发作性哮喘，按需使用短效β受体激动剂。对于轻度持续性哮喘：按需使用支气管扩张剂，同时以低剂量吸入性类固醇、色甘酸钠、口服茶碱或酮替芬的形式进行每日维持治疗。中度持续性哮喘应使用吸入性类固醇和长效β受体激动剂进行症状控制。对于重度持续性哮喘，推荐的治疗方法包括吸入性类固醇、长效β受体激动剂，可加用或不加用茶碱。如果症状控制不佳，少数患者可能需要每隔一天服用最低剂量的口服泼尼松龙。像白三烯拮抗剂这样的新药可能在控制运动诱发的支气管收缩以及轻度和中度持续性哮喘方面发挥作用。患者应每8 - 12周随访一次。每次随访时，医生应检查患者，检查药物依从性并观察实际吸入技术。根据评估结果，可减少或增加药物剂量。对于运动诱发的支气管收缩：可使用色甘酸钠、短效或长效β受体激动剂。对于季节性哮喘患儿，应根据评估的严重程度在季节开始前2周开始维持治疗，并持续整个季节。在停止治疗后应对这些患者进行重新评估。应给家长一份在家中管理急性加重的书面计划。
