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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