小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 咳嗽
- 咳痰
- 湿啰音、高音调吸气性喘鸣和干啰音
- 呼吸困难
- 发热
其他诊断因素
- 疲劳
- 咯血
- 鼻窦炎
- 体重减轻
- 喘息
- 胸膜炎性胸痛
- 杵状指
危险因素
- 囊性纤维化
- 宿主免疫缺陷
- 既往感染
- 支气管气道的先天性疾病
- 原发性纤毛运动障碍
- α-1 抗胰蛋白酶缺乏
- 结缔组织病
- 炎症性肠病
- 误吸性或吸入性损伤
- 局部支气管阻塞
- 高、瘦的白人女性，年龄≥60 岁
- 早产
诊断性检查
首要检查
- 高分辨率胸部 CT 扫描
- 胸部 X 线检查（CXR）
- 全血细胞计数（FBC）
- 痰培养和药敏
- 血清 α-1 抗胰蛋白酶表型和水平。
- 血清免疫球蛋白
- 汗液氯化物检测
- 类风湿因子
- 烟曲霉菌特异性 IgE 或皮肤点刺试验
- 血清抗 HIV 抗体
- 鼻呼出气一氧化氮检测 (NNO)
- 肺功能检查 (pulmonary function test, PFT)
需考虑的检查
- 原发性纤毛不动综合征（PCD）检查
- 囊性纤维化跨膜调节（CFTR）蛋白基因突变检测
- 吞咽功能检查
- 食管 pH 值监测
- 6 分钟步行试验
- 结核病检查
- 诊断性支气管镜检查及支气管肺泡灌洗
治疗流程
初期表现
急性加重：轻中度基础疾病
急性加重：重度基础疾病或对初始抗生素治疗无应答/耐药
尽管进行了维持治疗，每年仍然有 3 次或更多次加重
门诊检查时首次或新分离出铜绿假单胞菌
撰稿人
作者
Anne E. O'Donnell, MD
Professor of Medicine
Chief, Division of Pulmonary, Critical Care and Sleep Medicine
The Nehemiah and Naomi Cohen Chair in Pulmonary Disease Research
Georgetown University Medical Center
Washington
DC
利益声明
AEOD has received scientific consulting fees from the following companies: Bayer, Xellia, Horizon, Grifols, Insmed, and Electromed. AEOD is the Principal Investigator for trials sponsored by the following companies (research funding provided directly to Georgetown University): Bayer, Insmed, Aradigm, Parion, Zambon. AEOD has been a faculty member at the annual meetings of CHEST (American College of Chest Physicians), the American Thoracic Society, and the European Respiratory Society. AEOD is the author of a reference cited in this topic.
鸣谢
Dr Anne E. O'Donnell would like to gratefully acknowledge Dr Pamela J. McShane and Dr Sangeeta M. Bhorade, previous contributors to this topic.
利益声明
PJM and SMB declare that they have no competing interests.
同行评议者
Philip W. Ind, BA (Cantab), MB BChir, MA (Cantab), FRCP
Emeritus Professor of Practice (Respiratory Medicine)
National Heart and Lung Institute
Imperial College London
London
UK
利益声明
PWI declares that he has no competing interests.
Meg Coleman, MBBS, BSc, MRCP
Respiratory Consultant
Honorary Senior Clinical Lecturer
Imperial College Hospitals NHS Trust and National Heart and Lung Institute
London
UK
利益声明
MC has received honoraria from Pfizer and Gilead for delivering educational sessions.
Amanda Messinger, MD, MS
Assistant Professor
Section of Pediatric Pulmonary and Sleep Medicine
Department of Pediatrics
Children's Hospital Colorado
University of Colorado Denver School of Medicine
Aurora
CO
利益声明
AM declares that she has no competing interests.
Ware Kuschner, MD
Associate Professor of Medicine
Stanford University
Stanford
Staff Physician
US Department of Veterans Affairs
Palo Alto Health Care System
Palo Alto
CA
利益声明
WK declares that he has no competing interests.
鉴别诊断
- 慢性阻塞性肺疾病 (COPD)
- 哮喘
- 肺炎
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