Source: [Doctor's News] "One of the things we have been doing over the past 20 years is the popularization of standardized diagnosis and treatment knowledge of asthma and the promotion and implementation of clinical treatment plans.

Source: [Doctor's News]

"One of the things we have been doing over the past 20 years is the popularization of standardized diagnosis and treatment knowledge of asthma and the promotion and implementation of clinical treatment plans." Recalling 20 years ago, several severe asthma patients could always see the pain in the wards when they had a severe illness. Professor Sun Yongchang, director of the Department of Respiratory and Critical Care Medicine at Peking University Third Hospital, still remembers it vividly. Since then, he has begun to focus on chronic respiratory diseases such as asthma. "More than 20 years ago, asthma treatment was not standardized, and severe asthma patients who were always seen "going to the emergency room for some drip". But in the emergency room now, patients with severe asthma attacks rarely appear, which is due to long-term standardized treatment for the stable period of asthma." He said with relief.

Direction and Critical Care Medicine, Peking University Third Hospital

Professor Sun Yongchang

Control asthma has become an important treatment target

The population of asthma patients in my country is large. According to the results of the Chinese adult lung health study published by the Lancet, the prevalence of asthma among people aged 20 and above in China is 4.2%, and there are about 47.5 million people nationwide. In addition to the patient under 20 years old, there are about 60 million asthma patients in total. 1, and the overall disease burden is serious. The high incidence of asthma seriously affects the health and quality of life of our residents. Acute asthma attacks can produce various complications and may even endanger patients' lives. However, asthma is not an incurable disease, and controlling asthma is not out of reach. "We want patients to establish such a view that although asthma cannot be cured, it can be controlled." Professor Sun Yongchang introduced that the Global Asthma Prevention and Treatment Initiative (GINA) once proposed the concept of asthma control, namely, it is divided into several levels of good control, partial control, and uncontrolled as the evaluation of the effect of asthma treatment. The goal is to achieve asthma satisfactory control2. In view of whether the goals proposed by GINA can be achieved clinically, the 2004 Gaining Optimal Asthma Control (GOAL) adopted a regular upgrade control treatment plan to test whether "full control" is feasible and, if feasible, how many patients can achieve this goal. There are also 8 hospitals in China who have participated in this international multi-center study. The results of the study show that continuous treatment with inhaled glucocorticoids for 1 year can enable most uncontrolled bronchial asthma patients to achieve the asthma treatment goal proposed by GINA, namely to achieve and maintain clinical control of asthma3. "The results of this study provide an important evidence-based medical basis for establishing the goal of long-term management of asthma and achieving the goal of good control of asthma through standardized treatment, and also boosting everyone's confidence." Professor Sun Yongchang said that the research results also laid the cornerstone of the important concept of actively treating asthma with active drug treatment, and pointed out the direction for subsequent research and practice.

Treatment of asthma Long-term anti-inflammatory is the key

Long-term standardized treatment is the primary principle of asthma control, and most patients do not understand or pay attention to standardized treatment. This is also an important reason for the high acute attack rate and poor control of asthma patients in my country. The essence of asthma is a chronic airway hyperresponsive disease closely related to inflammation. When stimulation such as allergens, the inflammatory response will aggravate and cause acute attacks. It can be said that inflammation is the core of asthma, so anti-inflammatory treatment is the key to controlling asthma. 4. Even in the remission and early stages of the disease, patients with asthma have persistent chronic inflammation in the airway, so long-term anti-inflammatory treatment is necessary. Patients in the stable stage should adhere to standardized medication to avoid the possibility of acute aggravation.

At present, inhaled glucocorticoids have become the world-recognized first choice for long-term control treatment of asthma. GINA 2021 recommends moving high-dose inhaled glucocorticoids forward for patients with asthma level 4 and above 6, which helps patients control asthma more quickly and earlier. Early active treatment can control symptoms, reduce the occurrence of irreversible airflow obstruction, and curb the progress trend of the disease. Asthma control and maintenance treatment can be performed for at least 3 months before dose reduction and degradation treatment can be considered. If it cannot be controlled, treatment must be upgraded.

Source: [Doctor's News]

"One of the things we have been doing over the past 20 years is the popularization of standardized diagnosis and treatment knowledge of asthma and the promotion and implementation of clinical treatment plans." Recalling 20 years ago, several severe asthma patients could always see the pain in the wards when they had a severe illness. Professor Sun Yongchang, director of the Department of Respiratory and Critical Care Medicine at Peking University Third Hospital, still remembers it vividly. Since then, he has begun to focus on chronic respiratory diseases such as asthma. "More than 20 years ago, asthma treatment was not standardized, and severe asthma patients who were always seen "going to the emergency room for some drip". But in the emergency room now, patients with severe asthma attacks rarely appear, which is due to long-term standardized treatment for the stable period of asthma." He said with relief.

Direction and Critical Care Medicine, Peking University Third Hospital

Professor Sun Yongchang

Control asthma has become an important treatment target

The population of asthma patients in my country is large. According to the results of the Chinese adult lung health study published by the Lancet, the prevalence of asthma among people aged 20 and above in China is 4.2%, and there are about 47.5 million people nationwide. In addition to the patient under 20 years old, there are about 60 million asthma patients in total. 1, and the overall disease burden is serious. The high incidence of asthma seriously affects the health and quality of life of our residents. Acute asthma attacks can produce various complications and may even endanger patients' lives. However, asthma is not an incurable disease, and controlling asthma is not out of reach. "We want patients to establish such a view that although asthma cannot be cured, it can be controlled." Professor Sun Yongchang introduced that the Global Asthma Prevention and Treatment Initiative (GINA) once proposed the concept of asthma control, namely, it is divided into several levels of good control, partial control, and uncontrolled as the evaluation of the effect of asthma treatment. The goal is to achieve asthma satisfactory control2. In view of whether the goals proposed by GINA can be achieved clinically, the 2004 Gaining Optimal Asthma Control (GOAL) adopted a regular upgrade control treatment plan to test whether "full control" is feasible and, if feasible, how many patients can achieve this goal. There are also 8 hospitals in China who have participated in this international multi-center study. The results of the study show that continuous treatment with inhaled glucocorticoids for 1 year can enable most uncontrolled bronchial asthma patients to achieve the asthma treatment goal proposed by GINA, namely to achieve and maintain clinical control of asthma3. "The results of this study provide an important evidence-based medical basis for establishing the goal of long-term management of asthma and achieving the goal of good control of asthma through standardized treatment, and also boosting everyone's confidence." Professor Sun Yongchang said that the research results also laid the cornerstone of the important concept of actively treating asthma with active drug treatment, and pointed out the direction for subsequent research and practice.

Treatment of asthma Long-term anti-inflammatory is the key

Long-term standardized treatment is the primary principle of asthma control, and most patients do not understand or pay attention to standardized treatment. This is also an important reason for the high acute attack rate and poor control of asthma patients in my country. The essence of asthma is a chronic airway hyperresponsive disease closely related to inflammation. When stimulation such as allergens, the inflammatory response will aggravate and cause acute attacks. It can be said that inflammation is the core of asthma, so anti-inflammatory treatment is the key to controlling asthma. 4. Even in the remission and early stages of the disease, patients with asthma have persistent chronic inflammation in the airway, so long-term anti-inflammatory treatment is necessary. Patients in the stable stage should adhere to standardized medication to avoid the possibility of acute aggravation.

At present, inhaled glucocorticoids have become the world-recognized first choice for long-term control treatment of asthma. GINA 2021 recommends moving high-dose inhaled glucocorticoids forward for patients with asthma level 4 and above 6, which helps patients control asthma more quickly and earlier. Early active treatment can control symptoms, reduce the occurrence of irreversible airflow obstruction, and curb the progress trend of the disease. Asthma control and maintenance treatment can be performed for at least 3 months before dose reduction and degradation treatment can be considered. If it cannot be controlled, treatment must be upgraded.Professor Sun Yongchang explained that GOAL research provides individualized drug treatment strategies for asthma patients. That is, if the patient's condition is not controlled by using a lower inhaled hormone dose, upgraded treatment can be adopted, and the continuous increase from moderate to high doses is achieved to achieve the goal of asthma control. Taking salmeterolotecone inhaled powder atomizer as an example, three step dose increments can be used to achieve upgraded treatment, which can be adjusted flexibly according to clinical needs during use. As research continues to deepen and treatment plans are upgraded, doctors and patients have more choices and strategies. Whether to adopt upgraded treatment or downgrade treatment can depend on the specific condition of the patient. "After the patient's condition is controlled, appropriate downgrade treatment can be performed according to the condition." Professor Sun Yongchang added.

"Generally speaking, as long as the inhaled glucocorticoid combined with bronchodilator is standardized for regular treatment, it can avoid death caused by asthma." Professor Sun Yongchang emphasized that of course, some people may be worried that the use of hormones will cause serious side effects, but in terms of inhaled glucocorticoid, its effect on the respiratory tract has a minimal impact on the whole body, and its benefits are more considerable. "In most cases, the systemic impact on the body can be ignored by using general inhaled doses." Professor Sun Yongchang said that through more than 20 years of clinical experience and observation, it was found that the dose required for inhaled glucocorticoids is small and there are few systemic adverse reactions, which can effectively control airway inflammation, reduce asthma symptoms, and improve lung function. 8 It must be used in a standardized manner and in a long-term manner. However, in the use of inhaled glucocorticoids, Professor Sun Yongchang reminded patients to pay attention to the following points: (1) Be sure to follow the doctor's guidance, use the appropriate dose, and use it in sufficient amount. (2) Learn to use the inhalation device correctly and rinse your mouth after taking the medicine. Inhaled drugs are only effective if they enter the respiratory tract and the lungs. However, during the inhalation process, some drugs may remain in the throat and mouth. Not only does they ineffectively, they may cause oral inflammation, so you must rinse your mouth. (3) Follow the doctor's advice and adhere to long-term regular medication. Don’t stop the medication without authorization because you are worried about the side effects of the medication, which will lead to asthma attacks. Consult the attending physician if the dosage is required.

Asthma diagnosis and treatment should be noted in three aspects

Long-term medication and standardized treatment are the two most commonly said in this interview. In order to promote standardized diagnosis and treatment of asthma, over the past 20 years, he and his colleagues in the respiratory academia have made a lot of fruitful work in standardized diagnosis and treatment plans for asthma, promotion of asthma-related guidelines, popularizing asthma knowledge and science, and promoting the formation of policies for relevant government departments on chronic respiratory diseases such as asthma. From large tertiary hospitals to community hospitals and township health centers, from large experts in tertiary hospitals to small doctors at the grassroots level, they have promoted standardized asthma diagnosis and treatment plans and asthma-related guidelines across the country, covering more and more doctor groups, allowing advanced treatment concepts to every household.

The first Tuesday of May in each year is designated as "World Asthma Day". Major hospitals will carry out asthma preaching and free medical consultation activities. This is the efforts of countless respiratory and critical care doctors, and May 3 this year is no exception. In addition, they are also striving to promote standardized inhalation therapy into medical insurance, committed to improving the accessibility and affordability of drugs, allowing more asthma treatment drugs to enter grassroots hospitals, so that asthma patients can receive standardized drug treatment; actively promote the improvement and popularization of lung function examination capabilities, strive to diagnose diseases as soon as possible, and allow patients to treat them as soon as possible, and reduce the medical burden of asthma patients. As a standing member of the Respiratory Diseases Branch of the Chinese Medical Association, Professor Sun Yongchang deeply feels that he is shouldering the important task of spreading "standardized treatment of asthma", and he is also fulfilling his mission with his actions.

Although a lot of efforts have been put into this, there is still a long way to go to prevent and treat asthma. "There are still some problems in asthma treatment." Professor Sun Yongchang is still worried about the current domestic asthma treatment. First, missed diagnosis and insufficient diagnosis still exist. According to the results of the Chinese adult lung health study released by the Lancet, there are about 47.5 million asthma patients in China aged 20 and above, of which 71.2% of adult asthma patients have never been diagnosed by doctors.In response to the missed diagnosis and insufficient diagnosis, he suggested that doctors, patients and relevant departments should pay attention to early diagnosis of asthma. "For patients with respiratory symptoms, especially repeated respiratory symptoms, such as cough, sputum, and seizure, the possibility of asthma should be considered." Then take corresponding measures, such as lung function tests, to clarify the diagnosis. We must raise the public's awareness of asthma, improve the majority of doctors, especially grassroots doctors, about the typical clinical manifestations and atypical clinical manifestations of asthma, and achieve early diagnosis and treatment.

Second, some doctors and patients have not yet established a correct understanding of inhalation therapy. The popularity and accessibility of drugs must be increased, and the importance of inhalation therapy must be emphasized. At present, there are many types of asthma treatment drugs, and the combination of inhaled glucocorticoids and long-acting bronchodilators is also common. It is not only spread throughout major cities across the country, but has also entered primary medical institutions. It has also been included in the medical insurance catalog and basic drug catalog by the state. However, its popularity and usage rate at the grassroots level are still lower than expected. Professor Sun Yongchang hopes that in the future, not only will the Grade A hospitals in big cities, but also to grassroots community hospitals, and inhalation therapy should be popularized to the greatest extent to benefit the patient group who is troubled by asthma. For medical staff, one concept must be repeatedly emphasized: inhaled drugs are the first choice for long-term treatment of asthma, rather than oral drugs; oral drugs are generally less effective than inhaled drugs, and the side effects are greater. In addition, more patients should also understand the importance of actively using inhaled glucocorticoids for a long time. Do not reduce the dosage or do not use it without authorization because of rejecting hormones or improving symptoms.

Third, the patient's concept of insisting on long-term standardized treatment is not firm enough. Asthma, like diabetes, is a chronic disease that cannot be removed but can be controlled. Both doctors and patients should establish the concept that asthma can be cured and adhere to regular medication every day to enable patients to achieve the goal of being asymptomatic and not being affected by life. However, because the concept of long-term regular medication is not firm enough, some patients stop taking medication by themselves after their symptoms improve, resulting in repeated asthma attacks, which continues to develop to the point where the symptoms are severe and the damage to lung function is irreversible. This is a pity. "We must seize the opportunity to treat early and provide standardized treatment to avoid worsening of the condition." Professor Sun Yongchang emphasized again.

The spring in Beijing is warm and dry, and patients who come to see the doctor due to cough often appear in this season. Many asthma patients do not come to see a doctor because of "whistling". If you ask a few more questions, do you cough in the middle of the night, do you cough repeatedly during this season, and do you have allergies, you may find that this is a case of cough variant asthma. After practicing medicine for many years, Professor Sun Yongchang has developed the habit of asking more questions, and thus discovered many "hidden and atypical" asthma patients.

He would unhurriedly emphasize to them, "Don't relax, you must insist on long-term and regular medication. Controlling the condition is victory!" Action is better than words. Promoting the popularization of standardized diagnosis and treatment knowledge has been engraved in his bones and reflected in every action.

References:

1. Huang K, Yang T, Xu J, et al. Prevalence, risk factors, and management of asthma in China: a national cross-sectional study.Lancet.2019;394(10196):407-418. doi:10.1016/S0140-6736(19)31147-X

2.Global Initiative For Asthma, Global Stratrgy For Asthma Managementmnet and Prevention, 2019. Available From: www.ginasthma.org

3. Bateman, E D et al. “Global strategy for asthma management and prevention: GINA executive summary.” The European respiratory journal vol. 31,1 (2008): 143-78. doi:10.1183/09031936.00138707

4. Bai Chunxue. The key to treating asthma-anti-inflammatory [J]. Science and Technology Wencui, 2005(5):71-73.

5. Wang Haoyi, Peng Chuanfeng, Zhang Jianguo. The significance of long-term anti-inflammatory treatment for bronchial asthma patients [J]. China Practical Medical Journal, 2011,38( 01): 116-117. DOI: 10.3760/cma.j.issn.1674-4756.2011.01.058

6.Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention[EB/OL].[2021-05].https://ginasthma.org/wp-content/uploads/2021/05/GINA-Main-Report-2021-V2-WMS.pdf.

7.Haahtela T, Selroos O, O'Byrne PM. Revisiting early intervention in adult asthma. ERJ Open Res. 2015 Sep 14;1(1):00022-2015. doi: 10.1183/23120541.00022-2015. PMID: 27730140; PMCID: PMC5005140.

8. Guidelines for the prevention and treatment of bronchial asthma (2020 edition) [J]. Chinese Journal of Tuberculosis and Respiratory. 2020(12)

This article comes from [Doctor's News] and only represents the author's views. The national party media information public platform provides information release and dissemination services.

ID: jrtt

In response to the missed diagnosis and insufficient diagnosis, he suggested that doctors, patients and relevant departments should pay attention to early diagnosis of asthma. "For patients with respiratory symptoms, especially repeated respiratory symptoms, such as cough, sputum, and seizure, the possibility of asthma should be considered." Then take corresponding measures, such as lung function tests, to clarify the diagnosis. We must raise the public's awareness of asthma, improve the majority of doctors, especially grassroots doctors, about the typical clinical manifestations and atypical clinical manifestations of asthma, and achieve early diagnosis and treatment.

Second, some doctors and patients have not yet established a correct understanding of inhalation therapy. The popularity and accessibility of drugs must be increased, and the importance of inhalation therapy must be emphasized. At present, there are many types of asthma treatment drugs, and the combination of inhaled glucocorticoids and long-acting bronchodilators is also common. It is not only spread throughout major cities across the country, but has also entered primary medical institutions. It has also been included in the medical insurance catalog and basic drug catalog by the state. However, its popularity and usage rate at the grassroots level are still lower than expected. Professor Sun Yongchang hopes that in the future, not only will the Grade A hospitals in big cities, but also to grassroots community hospitals, and inhalation therapy should be popularized to the greatest extent to benefit the patient group who is troubled by asthma. For medical staff, one concept must be repeatedly emphasized: inhaled drugs are the first choice for long-term treatment of asthma, rather than oral drugs; oral drugs are generally less effective than inhaled drugs, and the side effects are greater. In addition, more patients should also understand the importance of actively using inhaled glucocorticoids for a long time. Do not reduce the dosage or do not use it without authorization because of rejecting hormones or improving symptoms.

Third, the patient's concept of insisting on long-term standardized treatment is not firm enough. Asthma, like diabetes, is a chronic disease that cannot be removed but can be controlled. Both doctors and patients should establish the concept that asthma can be cured and adhere to regular medication every day to enable patients to achieve the goal of being asymptomatic and not being affected by life. However, because the concept of long-term regular medication is not firm enough, some patients stop taking medication by themselves after their symptoms improve, resulting in repeated asthma attacks, which continues to develop to the point where the symptoms are severe and the damage to lung function is irreversible. This is a pity. "We must seize the opportunity to treat early and provide standardized treatment to avoid worsening of the condition." Professor Sun Yongchang emphasized again.

The spring in Beijing is warm and dry, and patients who come to see the doctor due to cough often appear in this season. Many asthma patients do not come to see a doctor because of "whistling". If you ask a few more questions, do you cough in the middle of the night, do you cough repeatedly during this season, and do you have allergies, you may find that this is a case of cough variant asthma. After practicing medicine for many years, Professor Sun Yongchang has developed the habit of asking more questions, and thus discovered many "hidden and atypical" asthma patients.

He would unhurriedly emphasize to them, "Don't relax, you must insist on long-term and regular medication. Controlling the condition is victory!" Action is better than words. Promoting the popularization of standardized diagnosis and treatment knowledge has been engraved in his bones and reflected in every action.

References:

1. Huang K, Yang T, Xu J, et al. Prevalence, risk factors, and management of asthma in China: a national cross-sectional study.Lancet.2019;394(10196):407-418. doi:10.1016/S0140-6736(19)31147-X

2.Global Initiative For Asthma, Global Stratrgy For Asthma Managementmnet and Prevention, 2019. Available From: www.ginasthma.org

3. Bateman, E D et al. “Global strategy for asthma management and prevention: GINA executive summary.” The European respiratory journal vol. 31,1 (2008): 143-78. doi:10.1183/09031936.00138707

4. Bai Chunxue. The key to treating asthma-anti-inflammatory [J]. Science and Technology Wencui, 2005(5):71-73.

5. Wang Haoyi, Peng Chuanfeng, Zhang Jianguo. The significance of long-term anti-inflammatory treatment for bronchial asthma patients [J]. China Practical Medical Journal, 2011,38( 01): 116-117. DOI: 10.3760/cma.j.issn.1674-4756.2011.01.058

6.Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention[EB/OL].[2021-05].https://ginasthma.org/wp-content/uploads/2021/05/GINA-Main-Report-2021-V2-WMS.pdf.

7.Haahtela T, Selroos O, O'Byrne PM. Revisiting early intervention in adult asthma. ERJ Open Res. 2015 Sep 14;1(1):00022-2015. doi: 10.1183/23120541.00022-2015. PMID: 27730140; PMCID: PMC5005140.

8. Guidelines for the prevention and treatment of bronchial asthma (2020 edition) [J]. Chinese Journal of Tuberculosis and Respiratory. 2020(12)

This article comes from [Doctor's News] and only represents the author's views. The national party media information public platform provides information release and dissemination services.

ID: jrtt