Baculard A, Tournier G
Service de Pédiatrie et Pneumologie de l'Enfant, Hôpital Trousseau, Paris.
Rev Mal Respir. 1988;5(6):565-71.
The treatment of childhood asthma should be considered with respect to age, severity and aetiology. Treatment should be instituted early from the first crisis in order to avoid progression to a more severe form. It consists of two aspects: the treatment of the acute episode and the chronic treatment. The treatment of the acute episode consists of using bronchodilators (BD) (rapid release Theophylline and/or beta agonists) to which one might add corticosteroids if the crisis lasts for more than a few hours or seems severe at the outset, an antibiotic should also be used as infection is often a trigger factor in infants. Maintenance treatment is necessary in asthmatics with frequent exacerbations. It should be tailored to the symptomatology and aetiology. The symptomatic treatment consists of a bronchodilator (slow release Theophylline or an atropine-like pharmacological derivative) to which one may add, in severe cases, corticosteroids which may be in the form of aerosol, or as rarely as possible by mouth. The second aspect of treatment relating to the aetiology is the most difficult to apply as childhood asthma is often multi-factorial: in allergic asthma the avoidance of allergens, disodium cromoglycate, ketotifen, and if necessary specific desensitization. In non-allergic asthma, physiotherapy, treatment of infectious foci, particularly ENT (ORL), and attention to psychosomatic features. When asthma is diagnosed and treated early the prognosis is transformed and progress towards chronicity is avoided.
儿童哮喘的治疗应根据年龄、严重程度和病因来考虑。治疗应从首次发作时就尽早开始,以避免病情发展为更严重的形式。治疗包括两个方面:急性发作的治疗和慢性治疗。急性发作的治疗包括使用支气管扩张剂(BD)(速释茶碱和/或β受体激动剂),如果发作持续数小时以上或一开始就看起来很严重,可加用皮质类固醇,由于感染往往是婴儿哮喘发作的触发因素,还应使用抗生素。对于频繁发作的哮喘患者,维持治疗是必要的。维持治疗应根据症状和病因进行调整。症状性治疗包括使用支气管扩张剂(缓释茶碱或类似阿托品的药理衍生物),在严重情况下可加用皮质类固醇,皮质类固醇可以气雾剂形式使用,或尽可能少地口服。治疗的第二个方面与病因有关,这是最难应用的,因为儿童哮喘往往是多因素的:在过敏性哮喘中,要避免接触过敏原、使用色甘酸钠、酮替芬,必要时进行特异性脱敏治疗。在非过敏性哮喘中,进行物理治疗、治疗感染病灶,特别是耳鼻喉(ORL)部位的病灶,并关注心身特征。如果哮喘能早期诊断和治疗,预后会得到改善,可避免病情发展为慢性。