最后审阅: 1 十一月 2021
最后更新: 08 七月 2021

小结

定义

病史和体格检查

关键诊断因素

  • 呼吸短促
  • 咳嗽
  • 喘鸣
  • 危险因素
  • 进行性胸闷
  • 肺功能进行性恶化
  • 呼吸急促
  • 心动过速
  • 沉默肺
  • 辅助呼吸肌参与呼吸
  • 睡眠障碍

其他诊断因素

  • 运动受限
  • 摔倒
  • 意识障碍
  • 皮肤症状
  • 紫绀
  • 心律失常
  • 低血压
  • 疲惫
  • 喘鸣

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
  • 当前吸烟者或接触二手烟
  • 暴露于变应原(包括季节性变应性鼻炎病史)
  • 特应性湿疹
  • 空气污染
  • 室内空气质量差
  • 肥胖
  • 慢性鼻-鼻窦炎
  • 胃食管反流病
  • 已证实的食物过敏
  • 哮喘病史
  • 哮喘加重住院史
  • 过去 12 个月发生一次或多次严重发作
  • 口服皮质类固醇的使用
  • 对哮喘治疗依从性差
  • 妊娠
  • 血嗜酸性粒细胞
  • 呼出气一氧化氮(FeNO)升高
  • 呼吸道细菌感染

诊断性检查

首要检查

  • 动脉血气(适用于医院)
  • 峰值流量(在社区和医院中)
  • 脉搏血氧测定(在社区和医院中)
  • 胸部 X 线检查(在医院中)

需考虑的检查

  • 全血细胞计数(在医院中)
  • 尿素和电解质(在医院中)
  • C-反应蛋白(在医院中)
  • 茶碱水平(在医院中)
  • ECG(在医院中)

治疗流程

撰稿人

专家顾问

Jonathan Bennett, MD

Honorary Professor of Respiratory Sciences

University of Leicester

Respiratory Consultant

Glenfield Hospital

Leicester

UK

简介

JB is Chair of the British Thoracic Society.

利益声明

JB declares that he has no competing interests.

Richard Russell, MBBS, PhD, MRCP

Specialty Registrar in Respiratory Medicine

Glenfield Hospital

Leicester

UK

利益声明

RJR received sponsorship from AstraZeneca to attend a conference, May 2018 (covering travel, accommodation, and conference fee).

Acknowledgements,

BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:

Sourav Majumdar, MD

Clinical Assistant Professor (Affiliated)

Division of Pulmonary, Allergy and Critical Care Medicine

Department of Medicine

Stanford University School of Medicine

Stanford

Lauren Eggert, MD

Fellow

Division of Pulmonary, Allergy and Critical Care Medicine

Department of Medicine

Stanford University School of Medicine

Stanford

利益声明

SM and LE declare that they have no competing interests.

同行评议者

Pujan H Patel, MD

Consultant in Respiratory Medicine

Royal Brompton Hospital

London

UK

利益声明

PP has received speaker fees for educational lecture events from GlaxoSmithKline.

编辑

Emma Quigley,

Section Editor, BMJ Best Practice

利益声明

EQ declares that she has no competing interests.

Tannaz Aliabadi-Oglesby,

Lead Section Editor, BMJ Best Practice

利益声明

TAO declares that she has no competing interests.

Julie Costello,

Comorbidities Editor, BMJ Best Practice

利益声明

JC declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice

利益声明

AM declares that he has no competing interests.

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