小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 哮鸣音
- 呼吸短促
- 呼吸急促
- 胸闷
其他诊断因素
- 咳嗽
- 运动受限
- 心动过速
- 不能讲话或喂养困难
- 肋间隙、肋缘下或胸骨凹陷
- 辅助呼吸肌参与呼吸
- 奇脉
- 睡眠障碍
- 心动过缓
- 紫绀
- 疲惫
- 意识障碍
危险因素
- 病毒感染
- 未得到控制的哮喘症状
- 大量使用短效 ß2-受体激动剂
- 吸入皮质类固醇使用不足
- 吸入器使用方法不正确
- 一秒用力呼气容积（FEV₁）偏低
- 对支气管舒张剂可逆性高
- 吸入过敏原
- 锻炼
- 对规律哮喘治疗药物依从性差
- 哮喘病史
- 过敏性疾病病史
- 过敏性疾病家族史
- 哮喘加重住院史
- 过去 12 个月内发生一次或多次严重急性发作
- 社会经济地位低
- 环境刺激物
- 非洲裔美国人
- 维生素 D 缺乏
- 肥胖
- 较小的年龄
- 父母受教育水平低
- 细菌感染
- 情感
- 使用非甾体类抗炎药（NSAID）
诊断性检查
首要检查
- 对短效 β-2 受体激动剂的治疗反应
- PEFR（呼气峰流速）或 FEV₁（第一秒用力呼气容积）
- 血氧饱和度
需考虑的检查
- 动脉或静脉血气分析
- 胸部 X 线检查
治疗流程
致死性哮喘加重或临界呼吸衰竭
重度急性发作
轻中度加重
撰稿人
作者
Paul D. Robinson, MBChB, MRCPCH, FRACP, PhD
Respiratory and Sleep Physician
The Children's Hospital at Westmead
Clinical Associate Professor
Discipline of Paediatrics and Child Health
Sydney Medical School
University of Sydney
Sydney
New South Wales
Australia
利益声明
PDR declares that he has no competing interests.
Anne Chang, MBBS, FRACP, MPHTM, PhD
Professor
Menzies School of Health Research
Charles Darwin University
Northern Territory
Respiratory and Sleep Physician
Queensland Children's Hospital
Queensland University of Technology
Brisbane
Australia
利益声明
AC's institution has received fees from her work on the independent data monitoring committee board for an unlicensed vaccine (GSK) and as an advisory member of study design for an unlicensed molecule for chronic cough (Merck), outside the work for this topic. AC also received fees from UpToDate for writing topics on cough in children. AC is an author of references cited in this topic.
同行评议者
Lucille A. Lester, MD
Professor of Pediatrics
University of Chicago Comer Children's Hospital
Chicago
IL
利益声明
LAL declares that she has no competing interests.
Caro Minasian, BSc (Hons), MB, BS, FCPCH, MD (Res)
Consultant in Paediatrics
Adolescent Medicine & Paediatric Respiratory Medicine
University College London Hospitals NHS Foundation Trust
London
UK
利益声明
CM declares that he has no competing interests.
鉴别诊断
- 吸入异物
- 病毒诱发性婴儿喘息
- 误吸
更多 鉴别诊断指南
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- 澳大利亚哮喘手册
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