Childhood Asthma Program: Let the child breathe leisurely

China's first child asthma action plan has been officially launched. In the past, the state of relying solely on doctors to assess asthma control status and the lack of family self-management is changing. Looking forward to the future, doctors, children with asthma and parents will become intimate "control" partners.

Wen|"Xiaokang" reporter Yang Liu

Whenever I walk into Tian Hao’s home, I feel that she is keeping her home clean and tidy: the sweeping robot is equipped with a hand-held vacuum cleaner to keep the house clean, the curtain bed is regularly cleaned, and the corners of the bathroom can be cleaned all the year round. dry. Not to mention the combination of fresh air systems, air purifiers and humidifiers that she spent tens of thousands of units a few years ago. These habits that have gradually developed in these years of life are due to the fact that there is an asthma daughter in the family.

Nothing between breathing

The daughter had a cold when she was 3 years old. After the symptoms of the cold improved, she coughed for nearly a month. The doctor clearly diagnosed that the fruit was asthma, and Tian Hao realized the seriousness of the problem, and from that time on, he gradually began to understand asthma.

Tian Hao said: "I can control many factors at home. I don't grow flowers, don't raise cats and dogs, don't lay carpets, but it's hard to say outside." Dust mites, mold, pollen, catkins, secondhand smoke, dog hair, etc. The dust that is visible or invisible in the world is her enemy, because these small things that are insignificant in the eyes of healthy people can induce asthma in any fruit.

"Treasure," Tian Hao used these words to describe his life in four years. From the beginning of the kindergarten period, the fruit is only used for half a day every day, carrying asthma drugs with him, and must go to the hospital if he has a cold. Every season, the whole family is like an enemy. Asthma is a chronic inflammatory disease of the respiratory tract. The more severe the inflammation, the more difficult it is to inhale and exhale the lungs. The symptoms may worsen over time. If no mitigation measures are taken, it will lead to bronchoconstriction and breathing. Difficulties may even be life-threatening.

There is a special group in Tian Hao's circle of friends. There are 16 parents of asthmatic children like her. Some people have never even met, but similar medical experience has brought everyone together. Tian Hao knows that he is not alone. In the past two decades, the prevalence of asthma in children in China has increased rapidly. In 2010, the cumulative prevalence of asthma in children under 14 years old in China was 3.02%. That is to say, the number of children with asthma in the country reached more than 6 million, of which nearly 30% Children's asthma is not effectively controlled. According to the current situation of the control of asthma in 42 top three hospitals across the country, asthma is seriously affecting children's physical and mental health, growth and survival, quality of life, and placing a heavy burden on families and society.

However, as far as the disease itself is concerned, asthma is not a “endiac disease” but a disease that can be well controlled through self-management. Professor Kun Kunling, the director of the National Center for Clinical Research of Respiratory Diseases, who has been engaged in the clinical and scientific research of pediatric respiratory diseases for a long time, said in an exclusive interview with the reporter of "Xiaokang": "Asthma management is a long-term standardized process, which needs to be established in this management process. Partnership between doctors, parents and children."

Standardized diagnosis and treatment + family management

Asthma is not only a chronic disease that seriously harms children's health. Studies have shown that at least 22% of adult asthma patients can be traced back to childhood wheezing symptoms, while a considerable number of children with asthma continue to adulthood. Asthma and even late stage may have an impact on chronic obstructive pulmonary disease, so how to prevent childhood asthma is an important issue in the medical profession and the whole society.

In fact, many countries around the world have their own asthma education and prevention programs, such as Australia's implementation of the asthma action plan 30 years ago. Studies abroad have shown that asthma control has improved significantly after the implementation of the asthma action plan. In acute attacks, unplanned medical treatment was significantly reduced, and asthma mortality was significantly reduced. It is against this background that China’s first child asthma action plan came into being.

On February 19, 2017, the National Respiratory Disease Clinical Medical Research Center, the Chinese Medical Association Pediatrics Branch, the Chinese Medicine 600056, the Pediatric Education Association Pediatric Professional Committee, and the China Research Hospital Association Pediatric Professional Committee jointly launched China. The Childhood Asthma Action Plan (CCAAP) was officially launched in Beijing.

It is understood that the action plan is divided into two forms: traditional paper version and mobile application (APP). In the paper version of the action plan, the children's asthma control status is divided into three areas: green, yellow and red. Each area has specific evaluation indicators to facilitate parental identification, and corresponding response tips, including medication adjustment and whether it is needed. Seek medical treatment as soon as possible, so that parents can accurately grasp the child's condition, promptly find the "yellow warning", and relieve the asthma attack by adjusting the drugs to avoid the "red danger". The mobile app enables remote management of asthma and, at the same time, interacts with doctors through the uploading and analysis of daily monitoring data.

After learning this information from the group, Tian Hao immediately logged in and registered the “Leily Breathing” Child Asthma Management Platform. The interface design is fresh and concise. On the front page is the word “Asthma can be controlled”. Click on the link to get the latest asthma articles, drug-related knowledge, and video guides for drug applications. In addition, the lung function monitoring device, like the alcohol tester, can be used to breathe a breath, and the intelligent peak flow meter can automatically record lung function parameters on the mobile phone and establish an asthma attack warning curve. Tian Hao can regularly monitor the breathing of the fruit and automatically enter the APP system. The system will also divide the condition into green, yellow and red according to the traffic symptoms of asthma symptoms and respiratory peak flow rate. Each category has corresponding medication guidance. This way is a bit like Tian Hao’s “Asthma Diary”, which has been remembered for a few years. The difference is that this experience is completely a smart upgraded version of “Asthma Diary 2.0”.

Premier Li Keqiang held a standing meeting of the State Council to determine the application measures for the development and regulation of health care big data, and better meet the needs of the masses through "Internet +" medical care. Premier Li Keqiang has repeatedly stressed that the development and utilization of health care big data is a major livelihood project. "Developing and promoting intelligent health medical equipment and collecting and analyzing medical big data resources can not only provide better medical services for users, but also promote the development of medical and health industry. It is also of great significance for the work of overcoming high-risk diseases." In fact, Li Keqiang The Prime Minister proposed that the second key area for the development of the health care big data industry is to develop and promote intelligent health medical equipment and provide more effective medical services to the masses through intelligent equipment.

Under the guidance of national policies, in response to the characteristics of childhood asthma disease, Professor Shen Kunling led China's top pediatric respiratory allergic disease experts, and for a year, launched a paper version of the Chinese Children's Asthma Action Plan, and at the same time, "leisure breath" The simultaneous design of the children's asthma management platform was launched and quickly accepted by Tian Hao and other parents in her group.

“Leisure Breathing” can be seen as a set of asthma management solutions for mobile phone “APP+” smart hardware for childhood asthma management. In most mobile medical chronic disease management models, the most common is a doctor's end, a patient's end, and the doctor manages and diagnoses the patient remotely online. However, this model does not apply to asthma. Because the incidence of asthma in children is often not in the hospital, but in the home, school or other public areas, relying on online remote consultation, doctors to consult patients, obviously not the most efficient way.

Through daily monitoring and evaluation of changes in the condition of equipment such as intelligent peak flow meter, and health education for children and parents, parents can identify the condition of children and understand the treatment of asthma attacks and acute exacerbations. Management – ​​The Children's Asthma Action Plan, which focuses on asthma management tasks, invisibly amplifies the role of patients and families.

The implementation of this action plan is not only beneficial to individuals, Professor Shen Kunling further elaborated the significance and necessity of the Children's Asthma Action Plan: "By the APP platform, you can effectively collect family data of children with asthma. By analyzing these data, you can Targetedly develop personalized treatment plans for children with asthma to ensure the treatment of children. It can also be used to analyze the environmental factors, regional differences and possible causes of asthma attacks and related information for children with asthma. Provide evidence for the diagnosis and treatment of asthma in children."

Childhood Asthma Action Plan starts

This year's May 2nd is the 19th World Asthma Day. The theme of this year's Asthma Day is "Fresh Air, Comfortable Breathing". Before the World Asthma Day, the Department of Allergy Response, Beijing Children's Hospital Affiliated to Capital Medical University, and the team, with the support of the Hospital Medical Department and the Propaganda Center, held on-site consultation services. Many parents got a handbook on children allergies and asthma at the event. Whether it's a knowledge book or a handheld app, doctors are sending confidence to parents in various channels of asthma knowledge: Children with asthma can be cured clinically, as long as parents can follow the doctor's advice and follow the doctor's prescription. Regular monitoring of peak function of lung function and understanding of the relief and control of asthma attacks will definitely improve the control rate of asthma in the whole child.

In the past, the state of relying solely on doctors to assess asthma control status and the lack of family self-management is in urgent need of change. In the past, many parents of children with asthma, the child went to the hospital with a cough and asthma, and stopped taking the medicine as soon as the symptoms eased. The Children's Asthma Action Plan may help parents avoid these erroneous practices, better identify asthma symptoms, learn about daily asthma control methods and treatment options for acute attacks, and learn about children's asthma attacks due to exposure to allergens and predisposing factors. Causes and risks, and how to avoid them. “Asthma Action Plan is actually the link between doctors, parents and children. It is the most important way to establish a partnership between doctors, parents and patients.” Professor Shen Kunling said, “The establishment of the China Children’s Asthma Action Plan has filled There is a gap in the management of asthma in children. We hope that the promotion of the Asthma Action Plan will further improve the overall management level of childhood asthma in the country."

Because the Beijing-Tianjin-Hebei region has similar atmospheric environment and living habits, it is the first to pilot the China Children's Asthma Action Plan and the Leisure Breathing APP Management Platform in Beijing-Tianjin-Hebei, in order to improve and optimize the entire childhood asthma management process, and to run the Chinese Children's Asthma Action. The application of the program in clinical and family management is planned to better coordinate with the next national popularization and promotion. Considering the difference in geography, among the first batch of pilot hospitals, 4 hospitals were selected in Beijing, 3 in Tianjin, 3 in Hebei (including Shijiazhuang, Tangshan, Qinhuangdao), across 3 provinces, municipalities, 5 regions, and 10 hospital. For this kind of cross-regional joint project, it will be promoted through unified formulation, district management, and fixed-point follow-up. For example, Beijing has a core team of project members responsible for designing and deploying the overall plan of the pilot project. Each district has designated project leaders, and each hospital has set up project coordinators to cooperate with the project promotion and clinical support of the project. At the same time, there is also a customer service team on the APP platform, responsible for the application and guidance of the home monitoring products, the solution of the APP usage process and related application and technical support to ensure that each group of children can be monitored according to the requirements of the project. And records. This also fully reflects the characteristics of "Internet +" medical treatment, greatly reducing the labor costs of data collection, transmission, aggregation and analysis, and also improving the accuracy of the data.

In China, children's asthma still has different levels of diagnosis and treatment, irregular treatment, and low level of knowledge in asthma diagnosis and treatment. Academician of the Chinese Academy of Engineering, Chairman of the Chinese Medical Association Respiratory Branch, Director of the National Center for Respiratory Disease Clinical Medicine, National Academic Leader of Respiratory Diseases, and Dean of the China-Japan Friendship Hospital, at the launching ceremony of the Children's Asthma Action Plan, said: "Some international inhalation therapy and standardized treatment measures are still not popular enough in China. Not only in the grassroots doctors, but also in the specialists, there are still misunderstandings about asthma and diagnosis and treatment. So from the perspective of children and adults It is of special significance to jointly promote effective prevention and treatment of asthma and standardized treatment."

In the process of advancing the China Children's Asthma Action Plan, the first problem is the education, training and popularization of pediatric doctors' asthma diagnosis and treatment knowledge. At the same time, the China Children's Asthma Action Plan should also be an education project for children's asthma in the whole society. This process requires long-term effective diffusion and diffusion. On the one hand, it is necessary to let more doctors, especially the grassroots doctors, understand the diagnosis and treatment methods and treatment plans of asthma, know how to evaluate the treatment effect, and how to adjust the treatment plan; on the other hand, spread the symptoms of asthma to the parents of children and deal with different states. Underlying asthma attacks and how to conduct effective family management. This is still a long way to go. Professor Shen Kunling said: "The next step will be the promotion of the China Children's Asthma Action Plan for three years, so that every child asthma doctor can understand the effective management of asthma. In this way, it is bound to It will also form a model for the classification and treatment of childhood asthma, and ultimately achieve asthma, a basic management of chronic diseases of the respiratory system and effective family control, reduce and reduce unplanned medical and acute attacks in children with asthma, reduce medical costs and expenses, and improve children. Overall health level."

(Editor: Song Zheng HN002)

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