| BackgroundBronchial asthma is the most common chronic childhood respiratory disease, it is not only a serious threat to children’s health, but also influence the participation of children in normal social activities, resulting in children’s absence and a decline in academic performance. Most children with asthma may develop into refractory asthma, which could be continuation of adulthood asthma. Asthma prevalence in the world especially the developing countries are increasing at an alarming speed in recent20years. Many areas in the recent10to20years asthma prevalence has increased nearly1times. While the development of medical science and the carrying out of the global initiative for asthma (Global Initiative for Asthma, referred to as GINA), increasing of prevention and cure of asthma drugs, the morbidity and mortality are not significant decline. No practical implementation of standardized treatment regimens as well as children and parents lack of knowledge of prevention and treatment of asthma may be the main reason. So the master of community children asthma prevalence, the use of community resources, to regulate the comprehensive prevention and control, may be a worthy of exploration and research.ObjectiveTo master of the asthma prevalence in students of Shanghai Jin Yang community primary school, by the questionnaire survey, screening inspection and diagnosis. To implement GINA in students with asthma, and the control measures of targeted groups and individual combination of community comprehensive prevention. So as to reduce the prevalence of childhood asthma attacks, improve their quality of life. To preliminary evaluation of community comprehensive prevention and treatment in children with asthma management role, and to explore the children chronic disease prevention and control in the new pattern of community health services.MethodsStudents of grade1to4in six primary schools in Jin Yang community as the research object, to flow adjustment, screening, and the confirmed cases were randomly divided into2groups. The intervention group to implement the overall GINA management plan as the target, give community comprehensive prevention and cure. Control group was treated with routine treatment, follow-up once every quarter, a year of follow-up, control effect evaluation.Results1. Investigation of basic conditions:6primary schools were in Jin Yang community. The total of students grade1to4was5040. The actual survey was4895, and the investigate rate was97.1%. Survey of the male2544, female2351, accounting for51.97%and48.03%respectively.2. The prevalence rate of asthma:110students were diagnosis of asthma, the prevalence rate was2.25%, among which67cases were male by the rate of60.91%, the prevalence rate was2.63%.While43cases were female, accounting for39.09%, and the prevalence rate was1.83%. Asthmatic students sex ratio of1.56:1.3. Birth weight:110asthmatic students, low birth weight (body weight<2500g) in9cases, accounting for8.18%; great children (body weight>4000g) in10cases, accounting for9.09%.4. Mode of delivery of birth:110asthmatic students,67cases of born with mode of delivery for cesarean section, accounting for60.90%, and41cases of natural birth, accounting for37.27%.5. The first age of onset:the survey of asthma onset age of most students in the past3years, a total of82cases, accounting for74.55%of the total number of asthma in students.6. Asthma seasonal incidence:most incidence in winter, accounted for34.54%, followed by summer and spring, incidence in summer was least6.36%.7. Asthma predisposing factors:the main cause was respiratory infection, accounting for86.36%, followed by changes in weather and sports, respectively50.90%and19.09%.8. Episodes of symptoms:the most common aura symptoms as a runny nose, sneezing and nasal obstruction69.09%.9. Onset of symptoms:The most common symptoms were cough, accounted for94.54%; followed by prolonged expiration, accounted for47.80%.10. Intensity of attack:intermittent episodes of up to, a total of77cases, accounting for70%. followed by mild persistent, a total of29cases, accounted for26.36%.11. Attack time:usually happened at night, accounted for59.09%. 12. History of allergy asthma:65.45%students with a history of allergic disease. While the allergic disease in infant eczema was the most common, accounted for26.36%, followed by allergic rhinitis, accounted for21.82%.13. Family history of asthma:students in immediate family had asthma for14.55%. second degree relatives had asthma for10.91%14. Previous drug use:the use of antibiotics in the ratio of95.45%, the use of systemic hormone ratio was80.90%. The ratio of using inhaled corticosteroids was37.27%.15. Peak flow meter use:never heard of peak flow meter in the ratio of56.36%, once used only17.27%.16. The community comprehensive prevention effect:The intervention group standardized management after1years patients treatment, asthma attacks, ER visits, hospitalizations, days absent, PEF value compared with the control group were significantly difference.17. Social economic effect:The intervention group children for asthma caused by direct and indirect economic losses were significantly lower than the control group. Community integrated management plan, the implementation of GINA and comprehensive prevention and control measures, which can effectively control the occurrence of asthma, reduce medical costs, improve the quality of life of patients.18. Intervention in the problem of existence:community physicians on asthma control scheme of the cognition and skills could be improved, especially in the part of doctor of Chinese traditional medicine. Parents’cognitive of GINA asthma hierarchical control scheme were deficiency, particularly of the inhaled corticosteroid understanding existence error. School health teachers also lack of asthma prevention and monitoring skills.ConclusionPrevalence of asthma in primary schools in Jin Yang community was similar to the national level. First onset age of asthma in students was small, pathogenesis and genetic factors were closely related. The main cause of asthma was still respiratory tract infection. Although the GINA was implementing for many years, but in children with asthma treatment was still not very standard, use of antibiotics and the use of systemic hormone ratio was high, and the use of inhaled corticosteroids proportion was very low. Clinical symptoms in children with asthma could be controlled through the asthma standard community comprehensive prevention. It could also reduce the asthma attack in the emergency department and inpatient, improve the life quality of the children, lightens the burden of family and society, it was worthy of popularization and application. |
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