咳嗽变异性哮喘的治疗和护理!

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仅供医学专业人士阅读参考

到底是咳嗽?还是哮喘

一项针对中国儿童持续咳嗽四周以上的慢性咳嗽构成调查显示:「咳嗽变异性哮喘」位居我国儿童慢性咳嗽首位,占比达41.95%。因此,今天着重来科普一下这个疾病。

咳嗽为唯一或主要症状的哮喘

「咳嗽变异性哮喘」,所谓的变异就是不同于典型哮喘,它表现出来的可能只有唯一的症状或者主要就是这种症状 ——就是反复的咳嗽,而且以干咳为主,没有明显喘息、气促等症状。
咳咳咳,一文读懂「咳嗽变异性哮喘」的治疗和护理
这种咳嗽在遇到感冒、冷空气以及灰尘、油烟时往往会加重,夜间和凌晨也会咳得比较剧烈,多有较明确的家族过敏史或有其他部位的过敏性疾病史,如过敏性鼻炎、湿疹等。
有些孩子随年龄的增长,自身的免疫功能逐渐完善,「咳嗽变异性哮喘」的发作次数会逐渐减少,甚至停止发作。
一项针对平均年龄5.7岁的咳嗽变异性哮喘患儿3年以上的随访研究显示,有54%的「咳嗽变异性哮喘」患儿发展成典型哮喘。
因此,「咳嗽变异性哮喘」的本质仍然是哮喘,被认为是典型哮喘前期或不典型哮喘!
哮喘作为儿童呼吸系统疾病中最常见的慢性疾病,目前的医学技术水平尚无法治愈,但可以通过药物来达到长期的控制。

哮喘的药物治疗手段

「咳嗽变异性哮喘」的孩子可以只在发作期出现咳嗽症状,发作间隔期可以没有任何咳嗽症状。

虽然发作间期咳嗽症状缓解了,但慢性气道炎症仍然存在,气道高反应性并没有得到根本改变,只是不合并症状时不易察觉。

咳咳咳,一文读懂「咳嗽变异性哮喘」的治疗和护理

因此,一旦明确诊断为「咳嗽变异性哮喘」,及时规范化治疗是非常有必要的,这些治疗手段可以降低咳嗽变异性哮喘发展为典型哮喘的风险。

初始治疗应该遵医嘱采用吸入「支气管舒张剂」和「糖皮质激素」的联合治疗,治疗2周后,若孩子的咳嗽症状仍然没有得到控制,可以加用「白三烯受体拮抗剂孟鲁斯特钠」治疗,疗程至少8周。

儿童常用的吸入糖皮质激素品种主要有:「布地奈德」、「二丙酸倍氯米松」和「丙酸氟替卡松」,而这些吸入激素又被制作成了不同的剂型,比如雾化吸入混悬液、压力定量气雾剂和干粉吸入剂,均具有较好的临床疗效。

「布地奈德」可用于12岁以下儿童,也是美国FDA目前批准的唯一可用于4岁以下儿童的雾化吸入糖皮质激素;「丙酸氟替卡松」适用于 4~16岁儿童;「二丙酸倍氯米松」同样适用于4岁以上儿童。

咳咳咳,一文读懂「咳嗽变异性哮喘」的治疗和护理

我们知道很多家长担心激素副作用,其实,雾化吸入治疗的激素药量仅为全身用药量的几十分之一,吸入性激素直接作用于支气管,吸收入血的量非常少,比口服激素安全得多。

使用雾化器吸入激素的方式家长们已经很熟悉了,除此之外,6岁以下的儿童还可以选择这种压力定量气雾剂+储雾罐的方式,使用起来更经济便捷。

咳咳咳,一文读懂「咳嗽变异性哮喘」的治疗和护理

长期使用吸入性激素较常见的副作用是喉咙痛、声音嘶哑及鹅口疮,通过吸入后漱口或洗脸可以有效的减少相关副作用的发生率。

大量循证医学证据表明,吸入激素并不会对儿童生长发育和骨骼代谢产生明显影响。

反倒是家长因为恐惧激素副作用而过早自行停药会导致慢性气道炎症仍然存在,造成孩子的症状发生影响儿童发育。

咳咳咳,一文读懂「咳嗽变异性哮喘」的治疗和护理

千万记得,平稳状态不等于治愈,家长们千万不要认为没有症状了就可以停药。

研究发现,30%-50%症状消失的孩子仍有反复发作的可能性,或者说这些孩子仍然存在气道高反应性。

一般来说,在症状完全控制3-6个月后,医生会慎重地为孩子做一次全面的评估,目的是预测停药后可能复发的几率以及评估药物使用的获益与风险,最终做出是否减量使用或停药的选择。

至于选择哪种吸入激素以及何时停药,应该听医生的。

医生会根据孩子的病情轻重、临床类型、发作规律、年龄大小等因素选用不同剂型、甚至不同剂量的吸入激素。因此,建议家长把这么专业的事情交给靠谱的呼吸科医生或者哮喘门诊的专科医生。

哮喘的家庭护理措施

对于咳嗽变异性哮喘的孩子,药物固然重要,但合适的家庭护理是可以预防咳嗽变异性哮喘孩子的症状加重或复发的。
咳嗽变异性哮喘孩子的气道非常敏感,许多危险因素可引起咳嗽变异性哮喘的急性加重,我们称之为「触发因素」,包括过敏原、病毒感染、污染物、烟草 烟雾及药物等。
过敏原也叫过敏性触发因素,常见的过敏原包括尘螨、霉菌、动物毛发、花粉、杂草、蟑螂粪便等;除了过敏原以外,还有其他一些非过敏性的触发因素,比如暴露于吸烟的环境、呼吸道感染、室内或室外空气污染、非常干燥和寒冷的空气以及其他刺激性气体。
常见的过敏性触发因素预防措施,理所当然就应该是「规避过敏原」。
针对尘螨
  • 换掉使用时间长的枕头和床垫,保持室内的湿度在50%以下。
  • 保持室内空气清新,每日通风,考虑使用含有HEPA滤网的空气净化器,并定期更换滤网。
  • 使用防螨床笠包裹床垫,选择可以机洗的枕头和被子,每周用热水清洗一次床单、毯子、枕套、抱枕;定期清洗窗帘和空调滤网。
  • 将卧室里的杂物清理干净,使用除螨仪清洁床褥,注意在清理房间时,不要让孩子待在房间里。
  • 把孩子的毛绒玩具收起来,如果孩子实在不愿意放弃毛绒玩具,可以尝试降尘螨冰冻法,将毛绒玩具用塑料袋装起来,然后放进冰箱的冷冻室冷冻24小时,再拿到太阳下自然晒干,并且尽量减少孩子玩这些玩具的时间。
针对霉菌
清除可见霉菌斑,修补渗水墙壁和水管,清理旧书报,移走地毯和室内植物以防霉菌滋生。
每周清洗一次浴帘,定期彻底清洗洗衣机内槽、洗手间,并保持家中潮湿区域的充分通风。
针对宠物
保持室内卫生,减少动物皮屑尿液口水的污染,有条件的把宠物移至室外,若孩子对宠物毛发过敏,考虑将家中的宠物送走。
针对蟑螂粪
杀灭蟑螂,不遗留厨房垃圾和脏碗碟过夜。
常见非过敏诱发因素的预防措施有:
要劝说家庭成员戒烟,避免孩子吸二手烟和闻到吸烟者身上的味道,经常有吸烟爸爸说没有对着孩子吸烟就不算,其实三手烟,也就是吸烟者身体上的味道和二手烟的危害一样重。
远离厨房油烟,以及所有明火周围的烟雾。家中避免使用香水、香味清新剂或其他具有刺激性的香味物品。
在寒冷的冬季,外出使用口罩丝巾围住孩子口鼻,室内注意整个房间的保湿保暖;室外空气污染严重时,避免户外活动;在呼吸道感染季节性流行期间避免带孩子去人多密集的场所,每年接种流感疫苗。
另外,加强身体锻炼和呼吸系统锻炼,合理膳食,也是行之有效的预防手段。
有很多家长认为,孩子诊断为咳嗽变异性哮喘,都是哮喘了,哪还能参加体育运动呢,保不齐动着动着哮喘就发了,其实咳嗽变异性哮喘的孩子是应该运动的,适当的运动可以增强孩子的身体素质,提高孩子抵御外来病原的能力,感冒少了,咳嗽变异性哮喘急性发作的风险也降低了。
但参加体育运动的前提是在规范化药物治疗达到症状控制,目前研究表明,游泳对于呼吸系统功能的改善有明显效果,非常适合咳嗽变异性哮喘的孩子,实际上在稳定期,孩子们完全可以参加正常的体育运动,和正常孩子一样成长,一样健康生活
本文来源:冀连梅药师

本文作者:冀连梅

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葵花妈妈小儿止咳贴咳嗽咳喘远红外宝宝药化痰神器非日本婴幼儿童 券后价¥9.90 天猫 优惠券¥25.00 立即领券
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【高性价比】欧姆龙雾化机 家用儿童雾化器C25S 成人哮喘化痰止咳 券后价¥248.00 天猫 优惠券¥50.00 立即领券
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