小结
定义
病史和体格检查
关键诊断因素
- wheezing episode triggers
- increased work of breathing
- features of atopic disease
- history of response to treatment within appropriate time frame
- family history of asthma
- history of passive or active tobacco smoking
其他诊断因素
- age >3 years
- dry nighttime cough
- dyspnea on exertion
- expiratory wheezing
- chest wall deformity
危险因素
- allergic sensitization
- atopic disease
- respiratory tract infections in early life
- serum eosinophilia
- family history of asthma or atopy
- gene polymorphisms and epigenetics
- passive or active cigarette smoking
- vaping
- maternal smoking in pregnancy
- abnormal lung function and airway hyperresponsiveness
- indoor and outdoor air pollution
- low socioeconomic status
- pesticide exposure
- male sex
- obesity
- gastroesophageal reflux disease (GERD)
- obstructive sleep apnea (OSA)
- assisted reproductive technologies
- cesarean section
- intestinal microbiota
- acid-suppressive drug use in pregnancy and childhood
- acetaminophen use in pregnancy
- antibiotic use in pregnancy
诊断性检查
首要检查
- spirometry
- peak expiratory flow (PEF)
- response to bronchodilator
需考虑的检查
- fractional expired nitric oxide (FeNO)
- airway challenge tests
- exercise challenge test
- CBC
- sweat test
- sputum culture
- skin prick testing
- chest x-ray
- electron micrograph ciliary studies
- chest CT
- sinus CT
- bronchoscopy
新兴检查
- bronchoalveolar lavage
治疗流程
age 0 to 5 years
age 6 to 11 years
撰稿人
作者
Paul D. Robinson, MBChB, MRCPCH, FRACP, PhD, ATSF
Respiratory and Sleep Physician
Queensland Children's Hospital
Conjoint Professor
Child Health Research Centre
University of Queensland
Brisbane
Queensland
Australia
利益声明
PDR declares that he has no competing interests.
Anne Chang, MBBS, FRACP, MPHTM, PhD, FAPSR, FThorSoc, FAHMS
Professor
Respiratory and Sleep Physician
Queensland Children's Hospital
Queensland University of Technology
Brisbane
Menzies School of Health Research
Charles Darwin University
Darwin
Australia
利益声明
AC is an author of a number of references cited in this topic.
同行评议者
Kenan Haver, MD
Associate Professor of Pediatrics, Harvard Medical School
Boston Children's Hospital
Division of Pulmonary Medicine
Boston
MA
利益声明
KH receives royalties from UpToDate.
Peter Griffiths, MBChB
General Practitioner
Harborne Medical Practice
Birmingham
UK
利益声明
PG declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
参考文献
关键文献
Global Initiative for Asthma. 2024 Global strategy for asthma management and prevention. May 2024 [internet publication].全文
National Institute for Health and Care Excellence. Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN). Nov 2024 [internet publication].全文
National Institute for Health and Care Excellence. Asthma pathway (BTS, NICE, SIGN). Nov 2024 [internet publication].全文
National Heart, Lung, and Blood Institute; National Asthma Education and Prevention Program. Guidelines for the diagnosis and management of asthma. Aug 2007 [internet publication].全文
Expert Panel Working Group of the National Heart, Lung, and Blood Institute (NHLBI) administered and coordinated National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC), Cloutier MM, Baptist AP, et al. 2020 focused updates to the asthma management guidelines: a report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol. 2020 Dec;146(6):1217-70.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Bronchiolitis
- Episodic (viral) wheeze
- Inhaled foreign body
更多 鉴别诊断指南
- Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN)
- Asthma pathway (BTS, NICE, SIGN)
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