撰文：鄭萃雯
小朋友咳不停，咳嗽情況往往持續整整一個月，尤其到半夜三更最嚴重，咳醒、咳至失眠，再倦極睡著，對小朋友、大人，都是折磨！到底為何久咳不止? 氣管敏感還是發炎? 請教醫生，原來這也屬於哮喘！
孩子年紀小，氣管自然會比較幼、比較窄，就算只是普通傷風感冒，亦較容易有鼻塞、鼻鼾，甚至氣促的情況。不過和支氣管炎不同的，普通傷風感冒大約一星期內會康復，但支氣管炎的咳嗽持續時間可以長達二十多日，所以由發病起持續咳嗽一個月，絕對不足為奇。
這又引申另一個問題：為何會有支氣管炎？醫生說，其中一個常見的原因是孩子感染呼吸道合胞體病毒（RSV）。這是一種非常常見的病毒，經飛沫及空氣傳播。它會令氣管收縮、發炎，並產生痰涎，痰涎積聚又令氣道進一步狹窄，刺激患者咳嗽，造成惡性循環。醫生指，這些情況可能會處方氣管擴張藥，讓小朋友病徵減退，靠自身的免疫力擊退病毒，不過小朋友一旦試過感染RSV，氣管某程度上亦受過破壞，日後演變成哮喘的機會亦增加。經醫生這樣一說，我的大兒子過往的確因感染RSV入院，而之後每次感冒咳嗽，所需的康復時間均比小兒子長啊！
Written by：Cheng Sui Man
The children can’t stop coughing, often continuing for an entire month, especially severe in the middle of the night, waking up from coughing, leading to insomnia, and then falling asleep from extreme fatigue. This is torturous for both children and adults! What exactly causes this persistent coughing? Is it sensitivity or inflammation of the trachea? Upon consulting a doctor, it turns out this is also a form of asthma!
Children are naturally more prone to having narrower airways due to their young age, making them more susceptible to nasal congestion, snoring, and even shortness of breath even with just a common cold. However, unlike bronchitis, a common cold usually recovers within a week, but the cough from bronchitis can last over twenty days, so it’s not surprising that the coughing continues for a month from the onset of the illness.
This leads to another question: Why does bronchitis occur? According to doctors, one common cause is the child contracting the Respiratory Syncytial Virus (RSV). This is a very common virus that spreads through droplets and air. It causes the airways to constrict and become inflamed, producing mucus that accumulates and further narrows the airways, stimulating the patient to cough and creating a vicious cycle. Doctors indicate that in these cases, bronchodilator medication may be prescribed to reduce symptoms and allow the child’s immune system to fight off the virus. However, once a child has been infected with RSV, the airways are somewhat damaged, increasing the likelihood of developing asthma in the future. As the doctor explained, my eldest son had indeed been hospitalized due to RSV infection in the past, and since then, every time he catches a cold and coughs, his recovery time is longer than that of my younger son!
「那麼你的大兒子應該是有哮喘了。」醫生這一句結論，絕對是我最不想聽到的。哮喘，最壞的可致死亡啊！等一等，這是最壞情況。醫生補充，哮喘其實分為四級。
第一級 偶發性哮喘
通常因為感染呼吸道病毒，例如RSV或過濾性病毒引起，一年中偶發幾次，其餘時間正常。所以只要在氣管收縮、氣促時候使用氣管舒張劑紓緩不適，無甚副作用，亦毋須長期用藥。
不過如果無適當紓緩氣管收縮問題，氣管會越來越容易收窄，哮喘有可能升級。
第二級 輕微持續性哮喘
患者大約一個月會發病一至兩次，氣管舒張劑不足以處理，需要以吸入式類固醇「治本」，控制發炎情況。吸入式類固醇有分不同的度數，醫生會按情況，處方不用劑量，有需要時使用。
第三級 中度持續性哮喘
患者平均每星期哮喘發作一次，每日需要使用氣管舒張劑。
“So it seems your eldest son might indeed have asthma,” the doctor’s conclusion was definitely the last thing I wanted to hear. Asthma, in its worst case, can be fatal! Wait, that’s the worst-case scenario. The doctor added that asthma is actually classified into four stages.
Stage 1: Intermittent Asthma
Usually caused by respiratory viruses such as RSV or filtrable viruses, occurring sporadically a few times a year, with normal conditions the rest of the time. Therefore, it is only necessary to use a bronchodilator during episodes of airway constriction and shortness of breath to relieve discomfort without significant side effects, and there is no need for long-term medication.
However, if the airway constriction is not properly relieved, the airways can become increasingly prone to narrowing, and the asthma could progress.
Stage 2: Mild Persistent Asthma
Patients have episodes about once or twice a month, and bronchodilators are insufficient to manage the condition. Inhaled steroids are needed to “treat the root cause” and control inflammation. Inhaled steroids come in different strengths, and the doctor will prescribe the appropriate dosage as needed.
Stage 3: Moderate Persistent Asthma
Patients have asthma attacks on average once a week and need to use a bronchodilator daily.
第四級 嚴重持續性哮喘
患者每天都要使用氣管舒張劑，每日三至四次，同時要使用吸入式類固醇控制病情。
經醫生提醒，我以後不應再害怕讓小朋友使用吸入式氣管舒張劑了！及早紓緩孩子咳嗽氣喘，長遠亦希望可以避免哮喘情況惡化。
Stage 4: Severe Persistent Asthma
Patients need to use a bronchodilator daily, three to four times a day, while also using inhaled steroids to control the condition.
Following the doctor’s advice, I should no longer be afraid to let my child use inhaled bronchodilators! Relieving the child’s coughing and asthma symptoms early on can also hopefully prevent the worsening of asthma conditions in the long run.
