最后审阅: 8 十一月 2022
最后更新: 05 一月 2022

小结

定义

病史和体格检查

关键诊断因素

  • 呼吸困难
  • 咳嗽
  • 痰液脓性成分增加、痰量增多
  • 喘鸣
  • 胸闷/胸痛
  • 呼吸急促
  • 心动过速
  • 危险因素
  • 肺心病

其他诊断因素

  • 呼吸衰竭体征
  • 发热
  • 胃食管反流和/或吞咽功能障碍

危险因素

  • 细菌感染
  • 胃食管反流和/或吞咽功能障碍
  • 病毒感染
  • 污染物
  • 非典型细菌感染
  • 天气变化

诊断性检查

首要检查

  • 动脉血气(医院)
  • 脉搏血氧测定(医院及社区情境)
  • ECG(适用于医院情境,如社区有条件,也可使用)
  • FBC,包括血小板(医院)
  • 尿素、电解质和肌酐(医院)
  • CRP(医院)
  • CXR(医院)
  • 痰液镜检、培养和革兰染色(医院)
  • 维生素 D(医院或社区)

需考虑的检查

  • 血液培养
  • 呼吸道病毒诊断
  • 心肌肌钙蛋白
  • 血清茶碱水平
  • 脑利钠肽(brain natriuretic peptide, BNP)前体
  • 胸部 CT 扫描
  • 肺量测定法

新兴检查

  • 降钙素原
  • 床旁即时 CRP
  • 嗜酸性粒细胞计数

治疗流程

急症处理
持续性治疗

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 (BTS). He is also deputy medical director RCP Invited service Reviews, and speaker at National Society (eg., BTS), Primary Care respiratory Society, Society Cardiothoracic Surgeons meetings.

利益声明

JB declares that he has no competing interests.

Richard Russell

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 team of expert contributors, whose work has been retained in parts of the content:

Carolyn L. Rochester MD

Associate Professor

Yale University School of Medicine

New Haven

VA Connecticut Healthcare System

West Haven

CT

Richard A. Martinello MD

Associate Professor

Yale University School of Medicine

New Haven

Veterans Health Administration

Office of Public Health

West Haven

CT

利益声明

CLR serves on the COPD scientific advisory board for GlaxoSmithKline Pharmaceuticals but has no competing interests pertaining to this publication. RAM declares that he has no competing interests.

同行评议者

Carlos Echevarria

Consultant Respiratory Physician

Royal Victoria Infirmary

Newcastle upon Tyne

UK

利益声明

CE declares that he has no competing interests.

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.

专家顾问:合并症

Martyn Patel, BMBcH, FRCP, MA

Consultant, Older People's Medicine

Norfolk and Norwich University Hospitals

NHS Foundation Trust

Norwich

UK

利益声明

MP is a contributor to the Oxford Textbook of Otolaryngology, Oxford University Press, 2021, having written a chapter about mental capacity law, for which he received no fee. MP is the NHS representative on the board for Norwich Institute for Healthy Ageing (unpaid role). MP has spoken at the International Forum on Quality and Safety in Healthcare, virtual conference in November 2020 for which he received no fee. MP has accepted speaker fees and/or travel expenses to deliver lectures from: University of East Anglia, Leicester University (speaker fees only); Astellas Pharma Ltd (speaker fees and travel expenses). MP has accepted travel expenses from Newton Europe to present a joint project conducted by his main employer (Norfolk and Norwich University Hospitals NHS Trust) and Newton Europe at the NHS Confederation conference (Manchester 2018).

Andrew Lewington, BSc (Hons), MBBS, MEd, MD, FRCP

Consultant Renal Physician

Honorary Associate Professor

Nephrology Department

Leeds Teaching Hospitals NHS Trust

Leeds

UK

利益声明

AL is Associate Clinical Director of NIHR Leeds In-Vitro Diagnostics Co-operative, Co-Chair of UK Kidney Research Consortium Renal Clinical Study Group, Member of Kidney Research UK Research Grant Committee, Committee Member of NICE Kidney Injury Clinical Guideline Update 2018-20, Committee Member of NICE Diagnostic Assessment for Point of Care Creatinine Testing 2018-19. AL attended the Acute Dialysis Quality Initiative Meeting in San Diego 2018 (accommodation expenses); AL was a speaker at the AKI & CRRT Conference in San Diego 2019 (travel and accommodation expenses), the AKI Conference in Coventry 2019 (travel expenses), and the NIHR AKI and Sepsis Meeting in Leeds 2019 (no expenses).

Martin Cowie, MD, MSc, FRCP, FRCP (Ed), FESC, FHFA, FACC

Professor of Cardiology

Imperial College London (Royal Brompton Hospital)

London

UK

利益声明

MC is chair of the European Society of Cardiology Digital Health Committee and a trustee of the Atrial Fibrillation Society. He has previously been a non-executive director of the National Institute for Health and Care Excellence. MC provides consultancy advice to AstraZeneca, Servier, Abbott, Medtronic, Boston Scientific, & Genomics PLC. MC declares that none of these interests is directly related to topics advised on for this project.

Rachael Evans, MBChB, FRCP (UK), PhD

Associate Professor (Clinical)

University of Leicester

Honorary Consultant Respiratory Physician

Glenfield Hospital

Leicester

UK

利益声明

RAE has given lectures for non-promotional industry-led sessions on COPD management, including for GSK and Chiesi for individual payment and travel expenses totalling <£2,000.

Gerry Rayman, MD, FRCP

Consultant Physician and Head of Service

Diabetes and Endocrine Centre and the Diabetes Research Unit

Ipswich Hospitals NHS Trust

Ipswich

UK

利益声明

GR has been paid for advisory board meetings with the following companies: Safoni Aventis, Abbott Diabetes UK, Lilly Diabetes, Bayer. GR has received lecture fees from Safoni Aventis, Abbott Diabetes UK, Lilly Diabetes, Novonordisk, Napp Pharmaceuticals Ltd.

Sotiris Posporelis, MD, MRCPsych

Consultant Liaison Neuropsychiatrist

King’s College Hospital

South London and Maudsley NHS Foundation Trust

Honorary Senior Clinical Lecturer

Institute of Psychiatry, Psychology & Neuroscience

King’s College London

London

UK

利益声明

SP declares that he has no competing interests.

Hamish McAuley, MBBS, BSc, MRCP

Clinical Research Fellow

Specialist Registrar (ST5)

Department of Respiratory Sciences

University of Leicester

Respiratory Biomedical Research Unit

Glenfield Hospital

Leicester

UK

利益声明

HM declares that he has no competing interests.

Asangaedem Akpan, MPH, FRC

Consultant Geriatrician

Liverpool University Hospitals NHS Foundation Trust

Visiting Professor

University of Cumbria

Carlisle

Honorary Clinical Associate Professor

University of Liverpool

Liverpool

UK

利益声明

AA declares that he has no competing interests.

同行评议:合并症

Martyn Patel, BMBcH, FRCP, MA

Consultant, Older People's Medicine

Norfolk and Norwich University Hospitals

NHS Foundation Trust

Norwich

UK

利益声明

MP is a contributor to the Oxford Textbook of Otolaryngology, Oxford University Press, 2021, having written a chapter about mental capacity law, for which he received no fee. MP is the NHS representative on the board for Norwich Institute for Healthy Ageing (unpaid role). MP has spoken at the International Forum on Quality and Safety in Healthcare virtual conference in November 2020, for which he received no fee. MP has accepted speaker fees and/or travel expenses to deliver lectures from: University of East Anglia, Leicester University (speaker fees only); Astellas Pharma Ltd (speaker fees and travel expenses). MP has accepted travel expenses from Newton Europe to present a joint project conducted by his main employer (Norfolk and Norwich University Hospitals NHS Trust) and Newton Europe at the NHS Confederation conference (Manchester 2018).

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