兒童氣喘病的照護

兒童氣喘病的照護

楊惟婷整理

 

一、空氣污染與氣喘

隨著高度工業化社會進程,氣喘的盛行率也急遽上升,舉世皆然,而過敏性鼻炎更可怕,幾乎每三位學童便有一位罹患過敏病,只是輕重有別而已。

至於為何會如此呢?空氣污染及家庭中環境的複雜化皆脫不了關係。
污染的空氣,很可能在胎兒或幼兒時,便侵犯他們的呼吸道,傷害弱小的呼吸道黏膜,導致隨後而來過敏原的侵入人體,引致一連串的免疫反應發生,最終造成過敏病的發生,當然,也不能全歸咎於污染的空氣,我們只能夠說,氣喘或過敏病是多因子影響產生的,只能盡一切能力,去研究所有可能的影響因素並避免之。

 

二、感冒與氣喘發作

有一半以上的氣喘小朋友,在嬰兒時期有過急性細支氣管炎的經驗,爾後,就容易隨天氣變化或上呼吸道感染而有急性喘鳴的發生。

這些病人常在發燒2~3天後,咳嗽頻率漸增,以至於喘鳴發作,所以當氣喘病童感冒時,千萬不可掉以輕心,看病時需提醒醫生,這小朋友有氣喘病史,以免輕忽而致嚴重的氣喘發作。

一般來說,會引起氣喘發作的感冒,大都為濾過性病毒,如鼻病毒、呼吸道合體病毒、腺病毒、腸病毒及流行性感冒病毒。而細菌感染一般與氣喘較無直接關係,雖然病毒感染一般屬自限型感冒,時間到了自然會痊癒,但假如氣喘病童有感冒發生,應當更加小心以避免氣喘急性發作。
另外,黴漿菌感染亦會引起氣喘發作。

 

三、台灣氣喘病童易發作的時節為何?

1.秋末冬初之時

塵蟎於此時最活躍,而且日夜溫差加大,另外,冬天使用的被單因久久未用,已孶生甚多過敏原如塵蟎、黴菌,若剛拿出來而未經曝曬,便蓋在身上便易因過敏原之散發,而致氣喘發作。

 

2.春末夏初

梅雨季帶來豐配的雨量也帶來陰霾的感覺,塵蟎及黴菌叢生,皆易引起過敏病之發生,另外,冷氣機過濾網及出風口一整年未使用,過敏原亦藏其中,此時一經使用,過敏原也易散播於空氣中,氣喘也易發作。

 

3.剛開學時

開學初期,感冒病例會增加,普通的濾過性病毒感冒易引起氣喘急性發作,避免知道為減少到人多之處,如百貨公司,並常常喝水,減少被感染的機會,外出時,帶上可遮住嘴巴與鼻子的口罩,以避免接觸病原體。

 

四、兒童氣喘病到底會不會好?

 

兒童氣喘病患者,其氣喘症狀會隨年齡而遞減,至少有1/3病患會完成痊癒,另有1/3的病童,症狀會大幅改善,而且會減少其急性發作的次數,所以假如自己的小孩罹患氣喘病,大可不必過份憂慮與絕望,應與醫師好好的配合,則治癒的機會當可大增。

 

(一)氣喘病童上學時要注意些什麼?

首先跟罹患氣喘病小朋友交代,若在學校有任何不舒服,譬如有持續咳嗽、胸悶、呼吸困難,要跟老師報告,以便儘早處理。

父母應到學校拜訪級任老師,懇切與老師討論您小朋友平常氣喘的狀況,例如小朋友現下接受何種治療?治療成效如何?發作頻率?

假如小朋友有急性發作時該如何處理?班上做環境清掃時小朋友該如何避免氣喘或鼻炎的發作?

 

(二)氣喘病童可不可以運動?

雖然,50%到70%的氣喘病童,運動時會引起呼吸道收縮,導致氣管不通暢,甚至引起喘鳴或氣促,但這些不舒服是可以預防的,千萬不可以因噎廢食。
正常的運動,對兒童身體的發育及正常心理人格的發展,都是不可或缺的,據統計,奧林匹克運動會中,至少有20%的金牌擁有者是氣喘病患,但並不因此影響他們的表現。

患有氣喘病的患者只要在運動前(尤其在劇烈的跑步前),有較久的暖身運動(最好

30分鐘),或是運動前適當的使用支氣管擴張劑或intal入劑,這兩種藥物皆可避免運動後會咳嗽或有喘鳴發作的不舒服。

當然選擇較適合的運動,如游泳,也可避免運動引致的氣喘發作。

原則上,要鼓勵小朋友有正常的運動,參加社會活動,以保持他們身心的正常發展,也請老師告訴小朋友的同班同學,氣喘或異位性皮膚炎本身並不會互相傳染,不用害怕。

 

(三)明明平日可以吃的食物,為什麼這次會引發過敏症狀?
小時候吃了會過敏的食物,長大後再吃,為何又不會過敏了?

以上這與人體的免疫系統反應,以及腸道的發育,都有關係。

 

以常見的食物過敏原蛋白質類為例,包括奶、蛋、肉、魚等等,都有人吃了會出現過敏症狀。有些人吃了帶殼的蝦,會誘發氣喘;另一些人,則是會出現癢到不行、紅腫如浮雕的急性蕁麻疹。

 

有些尚在襁褓中的寶寶,若是對牛奶過敏,導致腸道發炎,常會有拉肚子、腹痛,甚至嚴重到出現血便的症狀,或是皮膚長疹子、發紅、脫屑的異位性皮膚炎;有時,還會把自己抓到遍體鱗傷、流湯、流水。有些孩子,甚至會出現喉嚨很緊、呼吸困難的情況。

 

事實上,食物過敏引起的發炎症狀,的確不局限在消化道,也常波及到皮膚或是呼吸系統。而許多幼年時的食物過敏,有可能在長大後逐漸痊癒,主要原因是幼兒的腸道發育尚不完整,免疫系統的調控,也尚未完全定型,仍有機會改變。

 

(四)防塵蟎床罩,枕頭套及其他防蟎設施真能預防過敏病的發作嗎?

台灣氣喘病童最常見的過敏原是塵蟎,也就是說氣喘病童遇到塵蟎時,則他的過敏症狀就容易表現出來,一般來說,小朋友待在家裡最長的時間就是臥室,因為,一天至少有三分之一的時間在睡覺,而枕頭、床墊、被單又都是塵蟎最容易孳生之處,因而市面上有一種特殊的布織成的枕頭套、被套等,可把塵蟎包裹在裡面

,如此可有效防止病童與過敏原的接觸,當可減少過敏症狀的發生。

假如氣喘病兒與父母同睡一間臥室,則父母之寢具亦需使用防蟎製品,否則仍然難以控制病兒的症狀。

 

(五)家有氣喘的病童,是否可使用冷氣機或空調?

有些家長以為使用冷氣機可使溫度冷卻下來,便會引起氣喘的發作,當然,這是不對的,氣喘之所以會發作主要是呼吸道受到環境中的過敏原或刺激物(空氣污染)之持續刺激,導致呼吸道的一連串發炎反應,因而呼吸道會處於過度敏感的狀態,雖然秋冬天氣變冷或日常運動可能帶動氣喘發作,冷氣機之使用固然可降低室內之溫度,但並不足以引起氣喘之發作,只要常常清洗過濾網,而且不要讓室內外溫差過大,皆不至於引起氣喘急性發作。

另外,有些家長以為冷氣機的除濕效果足以控制屋內的濕度,這也是不對的,有過敏兒的家庭,仍然需要購置除溼機,才能有效控制屋內溼度。

 

(六)家中有氣喘兒,居家的周遭環境應做那些配合與調整?

 

台灣地區因地處於亞熱帶地區,較易引起氣喘或過敏病的過敏原為塵蟎、黴菌、蟑螂及寵物的皮垢等,至於對花粉過敏的情況反而不似歐美國家的多,而家中的寢具、棉被、枕頭、窗簾等,正是上述過敏原容易藏匿的地方,下面是幾項家中擺設原則的參考,若能確實掌握,相信對減少氣喘發作或過敏症狀,會有很大的幫助:

◎ 使用除濕機,控制相對濕度於50%左右。

◎ 寢具方面,以尼龍製品為佳,因棉、毛或動物皮製品,容易塵蟎之繁衍。

◎ 儘量不要加裝窗簾,若非不得已加裝,亦需經常清洗。

◎ 被套、枕巾最好每隔2至3星期左右,以撮氏65度的熱水燙過。

◎ 最好以木板取代彈簧床,若已用彈簧床則可加裝防蹣床罩。

◎ 擺設以簡單為原則。

 

五、氣喘發作時,送醫前應如何處理?

若已知為氣喘兒,家中備有藥品者,先以尖端呼吸測驗器(peak

exspiatory flow meter)測試呼吸量,若為基礎量的80%以下,給予吸入性氣管擴張劑,使用後若其PEF仍低於80%,可每隔l5至20分鐘,使用吸入性氣管擴張劑一次,此時若PEF仍低於基準量80%以下,則使用口服類固醇及繼續使用氣管擴張劑(或內服藥),而病患已出現發燒、冒冷汗、神智不清或呼吸量在60%以下,則應儘速送醫。
另在處理過程當中,避免過於緊張,待呼吸情況較緩解後,可以喝溫開水、多休息。

 

六、氣喘兒的居家自我照護

 

氣喘是小兒科門診常見的慢性疾病,每十位小朋友便有一位罹患氣喘,若再加上更常見的過敏性鼻炎,台灣有一半的小朋友跟過敏病脫離不了關係。

過敏病或氣喘病來自遺傳體質,外加過敏原或其他刺激物長久刺激呼吸道所造成,治療過敏病或氣喘病最重要的原則,就是早期診斷及早期治療。

氣喘病人或其家屬,往往誤以為治療氣喘病只需照醫師的處方藥物服用,便可把氣喘控制的很好,但是病人不肯付出更多的心力去征服氣喘。

病患如何在家中測試自己的肺功能?如何知曉氣喘即將發作及適當的處理方式?下列〝氣喘自我照護〞方法簡單,但效果卓著。

◎ 首先需確認自已得了氣喘病,並且接受氣喘病的診斷

不要以為喘嗚發作,呼吸困難才足以診斷氣喘病。百分之五十的氣喘病兒童平常只是用咳嗽來表現而已,當您發現家裡的小朋友,常有夜咳或咳嗽超過十天,便需懷疑小朋友得了氣喘病了。
假若這些小朋友天氣一變冷就咳,天氣轉好,咳嗽也隨之減少,就更需懷疑氣喘

病的可能性了。

當您被醫師診斷為氣喘病時,不需過度憂心,三分之一的兒童氣喘病會〝痊癒〞,另外;三分之一會日漸轉好,只有三分之一會惡化,所以接受它,用心治療它,是戰勝氣喘的不二法門。

 

◎ 用心看待氣喘及治療氣喘

氣喘病有潛在的危險性,突然的急性發作,會引起呼吸困難甚至危及生命,千萬不可輕忽。
治療氣喘病,首先要避免與過敏原的接觸,避免過敏原便可減輕呼吸道受到的損傷;另外避免進出公共場所,避免感冒也都可以減少氣喘的發作。
其次,按照規則使用治療氣喘的藥物,尤其抗發炎的藥物,是治療氣喘病很重要的法寶。吸入型製劑,其副作用不會比口服劑型的藥物來得大,單獨使用氣喘擴張劑也不能完全控制氣喘病。

 

◎ 善加使用尖端呼氣流量測速器(請與您的主治醫師洽商)

只要五歲以上的病童或氣喘病人,就該規則的在家裡使用呼吸流量測速器,病人不但可以知曉自己的肺功能及應變之法,而且藉由病人本身的榮譽感,讓他們知道唯有平常與醫護人員配合,肺功能才會保持在最好的狀況。

◎ 早期警覺到氣喘要發作的現象

一般氣喘要發作前,都會有些症狀,如:

(1) 半夜常會因咳嗽或胸悶醒過來。

(2) 最近使用支氣管擴張劑的次數大增。

(3) 對日常活動或運動的耐性大受影響,原本可輕易爬上三、四樓,最近只要稍微走動一下都會咳嗽或感到胸悶。

(4) 呼氣流量降低超過個人最好值20%以上,都需要特別小心。

 

◎ 保持正常的日常活動與運動

治療氣喘的目標之一是維持正常的運動與日常活動,只要病人能與醫護人員合作,這目標很容易達成,病人千萬不可認為自己身體不好,不敢運動。
雖然50%到70%的氣喘病童,運動時會引起呼吸道收縮,導致氣管不通暢,但這些是可預防的,不可因噎廢食。

患有氣喘病的患者只要在運動前(尤其在劇烈的跑步前),有較久的暖身運動(最好30分鐘),或是運動前適當的使用支氣管擴張劑,都可減少或減緩其發作的嚴重度,另外,選擇較適合氣喘病人的運動,如游泳,也可避免運動引致的氣喘發作。

 

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