口罩下的童年──氣喘兒

:::

1996 / 10月

文‧張瓊方



范又中今年剛上小學,問他有沒有上幼稚園,小腦袋想半天,好像有、又好像沒有。原來他是上過幼稚園的,只是天數少得可憐。「我們經常白白把學費貢獻給幼稚園,因為又中常生病,根本很少有機會上學。」范媽媽說,打從兒子出生四個多月得支氣管炎起到七歲為止,又中已經創下住院怳C次的紀錄了。

又中罹患的正是現代兒童很普遍的過敏性疾病之一──氣喘。

過敏疾病是目前兒童最普遍的慢性病。過敏疾病包括:氣喘、過敏性鼻炎、食物過敏、皮膚過敏、藥物過敏等等。其中氣喘對兒童生活作息影響最大,也是怳@歲以下孩童活動受限制最大的原因。

根據長庚兒童醫院院長謝貴雄針對台北市學童所做的「流行病學調查」,民國六怳T年,氣喘罹病率是百分之一•三,到民國八怳T年躍升為百分之怴E七九,二怞~來增加了八倍。過敏性鼻炎盛行率更高達百分之三怳T•五三,換句話說,三個孩子當中就有一個鼻子過敏。

為何氣喘吁吁?

什麼是過敏?簡單地說,有過敏體質的人,接觸了環境中的刺激因素──過敏原後,身體產生過度敏感的反應,稱之為過敏。過度敏感的反應產生在皮膚稱之為「異位性皮膚炎」;表現在鼻子叫「過敏性鼻炎」;表現在氣管就是「氣喘」。

過敏性鼻炎的症狀是打噴嚏、流鼻水,通常最常在一大早起床後發作。由於症狀較輕微,不會引起明顯的生活障礙,因此很多家長並不在意。但長庚兒童醫院小兒過敏氣喘風濕科醫師黃璟隆指出,兒童罹患過敏性鼻炎是不能忽視的,因為孩子長期鼻子不舒服,不僅影響專注力、學習效果大打折扣,也容易產生中耳炎、鼻竇炎等後遺症。

至於兒童氣喘,大多數父母都會很緊張。一般人以為氣喘的症狀是氣蹙、喘鳴。黃璟隆指出,其實不一定要有喘鳴才是氣喘,很多氣喘病人表現出來的症狀是慢性咳嗽。特別是乾咳、半夜咳、運動後咳的病人,很可能就是氣喘病的早期徵兆。

至於異位性皮膚炎則有特定部位,新生兒好發部位在頭部、臉頰、耳後,年紀稍大時則在身體背部、四肢外側出現,幼稚園階段的兒童則在關節彎處、嚴重的甚至全身都有發紅、發癢等症狀。

現代孟母──三遷為過敏

過敏性疾病經常混合發生,目前全台灣人口中,超過三分之一以上的人,患有至少一種以上的過敏疾病。

過敏體質是一種家族性的遺傳。根據調查,父母一方有過敏疾病,孩子有過敏疾病的機率是四分之一;父母雙方都有則孩子過敏的機率在一半以上。一項針對台北地區學齡兒童所做的調查顯示,氣喘學童有百分之三怞b二等親當中有過敏體質;過敏性鼻炎甚至將近一半。

然而,有過敏體質的人,不一定就會產生過敏現象,台大醫院小兒部過敏免疫風濕科主治醫師周正成指出,只要及早避免暴露在過敏原環境當中,就能避免發病。

問題是,身處文明環境中的現代兒童,要如何避免文明環境的傷害呢?

為了避免過敏原的滋生,有氣喘兒的家庭,家裡擺設力求簡單、環境保持清潔,避免(、灰塵等過敏原滋生。外出則口罩、帽子、長袖外套一應俱全。

其實即使如此小心翼翼,環境中還是存在許多不可控制的因素。一位病童的媽媽表示,為求安全起見。只有在「好日子」才敢帶孩子出門。她所謂好日子不是黃曆中的黃道吉日,而是指不颳風、不下雨、風和日麗、空氣品質良好的日子。也有媽媽說,自從孩子罹患氣喘病,連親友、鄰居家都不敢帶孩子去,因為別人家的環境無法控制。

氣喘的孩子食物禁忌更是一大堆,刺激食品不能吃、生冷東西不能碰。趙媽媽的小兒子自幼就罹患氣喘,她說,當她看到六歲的小兒子眼巴巴望著別的小朋友吃冰淇淋時會自動說「強強不能吃」的那副渴望又自我克制的表情,真是心都碎了,更不要談半夜抱孩子衝進急診室的心焦和折磨。最後她選擇了移民美國,雖然自己和先生重新打拼、辛苦萬分,但孩子確實從此告別氣喘,回想起來,她認為一切辛苦都是值得的。

環境不改身體改

但是也有人舉家移民國外,過了第一年的「蜜年期」後,第二年孩子開始產生「花粉熱」,打噴嚏、眼睛癢等過敏症狀又出現了。既然外在環境難以改變,那麼只好改變體質了。所謂的「減敏治療」,就是試圖改變病人體質以適應環境的治療方式。

減敏治療的療程很長,平均要二、三年才有效果。首先要找出病人的過敏原,然後將過敏原打入病人體中,由低劑量、低濃度,慢慢適應到高劑量、高濃度,直到病人暴露在過敏原環境中可以不再產生症狀,或是症狀輕微。開始時每週打一針,慢慢改成兩週、四週。

百分之八怚H上的病人在接受減敏治療後症狀會改善,但因具有些許危險性,不是每個人都適合作減敏治療。周正成指出,病人須確定過敏原而且是單一過敏原,這種過敏原在環境中不容易避免,過敏症狀屬中、重度,用藥無法控制或不宜長期用藥,醫生才會考慮為病人做減敏治療。

文明法療文明病

一般過敏兒藥物治療就能達到很好的療效。「吸入型」的類固醇藥物是目前治療過敏的主要用藥,但一般父母總以為孩子一旦開始吸藥就終生無法擺脫了;也有父母聞類固醇色變,認為只要一吃類固醇就會有嚴重的副作用產生。周正成解釋,吸藥可以用較少的劑量達到比吃藥同樣甚至更好的效果,因為吃藥是把要吃進去,經過消化進到體內、全身循環後到肺部來保養,吸藥是把藥直接送到有問題的地方,藥量輕、效果佳。

過去氣喘病童的家長多要醫生開證明,證明孩子不能上體育課、不能朝會、不能打掃;有些甚至休學在家裡。而今只要適當的治療,幾乎所有的氣喘病童都不必為了氣喘病休學或是放棄他所喜歡的運動。周正成指出,今年奧運許多拿下金牌的游泳選手是氣喘病人,就是最好的證明。

至於許多過敏病人夢寐以求的「過敏預防針」是不是有可能實現呢?周正成表示,疫苗目前已經有一些基礎研究,但尚在動物實驗階段。

看來,隨著文明腳步而至的文明病,治療的希望也終將繫於更進步的科技文明,但屆時是否又會產生更令人頭痛新興文明病,就不是我們所能預見的了。

p.16

圖中的孩子在參加氣喘兒夏令營時發病,「久病成良醫」的小病號對此情況並不陌生,也忙著在一旁「指導」。﹙薛繼光攝﹚

p.18

近二怞~台北市學童過敏病增加情形﹙單位:﹪﹚

過敏性鼻炎

氣喘

蕁痲疹

異位性皮膚炎

資料來源:台大醫院小兒部提供李淑玲繪圖

相關文章

近期文章

EN

Childhood Under a Mask--Growing up with Asthma

Chang Chiung-fang /tr. by JonathanBarnard


When Fan Yu-chung entered elementary school this year, he was asked if he had gone to kindergarten. He thought for a long time, and it seemed as if he had and it seemed as if he hadn't. It turned out that he had gone to kindergarten but that the days he had attended were pitifully few. "We usually just gave away our tuition money for nothing, because he was so often ill that he rarely could go," the boy's mother says. All of seven, he has already checked into the hospital for overnight stays 17 times since he got bronchitis at four months.

What's behind his poor health is an allergy common among today's children: asthma.

Allergies are now the most common chronic ailments suffered by children. They include asthma, rhinitis (nasal allergies), allergies to food, atopic dermatitis (skin allergies), and allergies to medicines. Among these, asthma has the biggest impact on children's lives, keeping more children under the age of 11 from pursuing normal activities than any other medical problem.

According to an epidemiological survey of Taipei children carried out by Hsieh Kuei-hsiung, the head of Chang Gung Children's Hospital, the percentage of children suffering from asthma rose from 1.3% in 1974 to 10.79% in 1994-an eight fold increase in 20 years. Those suffering from allergic rhinitis (whose seasonal variety is commonly known as "hay fever") rose to 33.53%, or one out of three children.

Why are they gasping?

How does an allergic reaction take place? Simply put, after a person with an allergy comes into contact with an allergen (allergic stimulant) in the environment, the body displays a sensitivity to it. If this sensitivity is on the skin, it is called "atopic dermatitis;" if it is in the nose, it is called rhinitis; and if it is in the trachea it is called "asthma."

The symptoms of rhinitis are sneezing and a runny nose, and they usually start right after rising from bed. But because the symptoms aren't severe and don't present major obstacles to going about life, most parents aren't very concerned about rhinitis. Still, J. L. Huang of the pediatrics department of Chang Gung Memorial Hospital points out that rhinitis shouldn't be ignored, because if children suffer from it for a long time, their noses will be uncomfortable, and they will lose their concentration, not perform as well as they should academically, and more likely suffer from otitis and nasosinusitis.

Parents, however, get quite nervous about asthma. Most assume that it always causes its victims to wheeze and gasp for air, but J. L. Huang points out that one can have asthma without such breathlessness. Constant coughing, particularly dry coughing, coughing in the middle of the night, or coughing after exercise, is potentially a sign of asthma in its early stages.

Atopic dermatitis tends to be concentrated in certain areas. New-borns get it on the head-on the cheeks and behind the ears. Later it goes to their backs and the skin on the outside of joints. When they are old enough to go to nursery school, it tends to spread to the skin on the inside of joints and may even cover the whole body with its itchy rashes.

Many people suffer from several allergies, and in Taiwan today more than one-third of the population suffers from at least one.

Allergies are hereditary. Studies show that if one parent has an allergy, there is a one-in-three chance a child will have one; if both parents have one, the chances rise to two in three. A study of school-age children in Taipei shows that 30% of children with asthma have a parent or grandparent who suffers from it too, and as many as half of children with rhinitis have a parent who also has it.

But those with allergies do not necessarily have to endure allergic reactions. Chou Cheng-cheng, a specialist in allergies and rheumatism in the pediatrics department at NTU Hospital, says that if you limit exposure to allergens in the environment, you can prevent allergic reactions.

Good mothers

The question is, how do children living in modern "civilized" environments avoid being harmed by them?

In order to minimize allergens in the home, families with asthmatics aim for cleanliness and simplicity in decoration. Outside, children with allergies can protect themsleves with surgical masks, hats and long-sleeved shirts.

But too much about the environment is beyond one's control. One mother of an allergic child says that for the sake of safety, she only dares to take her child outside on "good days." By good days, she doesn't mean those regarded as auspicious in the traditional farmer's almanac, but rather days without rain or strong winds-sunny days when the air quality is good. Another mother says that ever since her child began suffering from asthma, she hasn't dared to bring the child to the homes of good friends or neighbors, because she has no control over the environment there.

And many asthmatic children face numerous prohibitions on what they can eat: overly spicey food is off limits, as are raw and cold foods. One Mama Chao says that when her six-year-old asthmatic son sees other children or family members eating ice cream, she automatically says, "Chiang Chiang can't eat that." His expression of longing combined with his self-restraint is truly heart-breaking-it's just that the torturous, anxiety-ridden scenes of bringing him to the emergency room in the middle of the night are more so. Eventually his mother decided to emigrate to America. Although she and her husband struggled there, starting from scratch, their son no longer suffers from asthma, and so she thinks the move was worth the trouble.

But some people move abroad, and have a honeymoon first year, only to find that their child starts showing symptoms of hay fever-sneezing and irritated eyes-in the second year.

Changing the body

When the outside environment is too hard to change, then the only choice is to change one's own body. Immunotherapy is designed to change a body's ability to adapt to an environment.

Immunotherapy treatment is very long, and it usually takes two or three years before there are results. First it is necessary to find the source of a patient's allergy, and then these allergens are put into the body in tiny quantities and concentrations. These desensitize the body, until an environment with such allergens won't trigger an allergic reaction, or at least the symptoms will be greatly lessened. Immunotherapy starts with injections once a week, after which they are given once every two weeks and then finally once every four weeks.

More than 80 percent of allergy sufferers will find that their symptoms improve after such treatment, but there is a degree of risk. Not everyone is suited to such treatment. Chou Cheng-cheng points out that patients must be absolutely certain that a given allergen is the one and only source of their allergy, and doctors will only consider immunotherapy if this allergen is hard to escape in the environment, the patient has at least a fairly heavy allergic reaction to it, and there are no drugs that can control it.

Civilized treatments

Standard drugs used against allergies can also bring good results. Inhaled steroids are currently the main drug used to treat asthma, but most parents believe that once their children start taking steroids, they'll never be able to shake the habit. Other parents worry that the child will immediately suffer from serious side effects. Chou Cheng-cheng explains that by inhaling steroids, they can use smaller amounts than they would taking them orally and still get better results, because when steroid pills are swallowed, they must get digested and be circulated through the whole body to get to the lungs, whereas inhaling steroids brings them right to where they are needed.

In the past, the parents of asthmatic children used to ask doctors to write notes excusing their children from gym class, outdoor assembly, and clean-up-or even to allow them to take a leave from school. Now, with proper treatment, asthmatics almost never need to stay away from school or abstain from enjoyable exercise. Chou points out that several swimmers who won gold medals at this summer's Olympics were asthmatics.

As for the "allergy vaccinations" that allergy sufferers dream about, could they become reality? Chou points out that basic research has already been done on vaccines, but it hasn't gotten to the stage of animal testing.

It seems that for civilization's diseases, hope of effective treatment is closely tied to progress in science and technology. But might not those advances in turn lead people to even greater suffering from new diseases? That is beyond our ability to predict.

p.16

During a summer camp for asthmatics, one camper has had an attack. Other campers, "who have gained a doctor's knowledge through being ill," are no strangers to this condition, and are busy "directing" the procedure. (photo by Hsueh Chi-kuang)

p.18

Rising rates of allergies among school-age Taipei children

Allergic rhinitis

Asthma

Nettle rash

Atopic dermatitis

Source: NTU Hospital pediatric department

Graph by Lee Su-ling

X 使用【台灣光華雜誌】APP!
更快速更方便!