小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 近期有上呼吸道感染
- 呼吸困难
- 咳嗽
- 呼气相哮鸣音
- 鼻息肉
危险因素
- 家族史
- 过敏原
- 过敏史
- 吸烟
- 早期呼吸道病毒感染
- 鼻息肉
- 肥胖
- 胃食管反流病 (GORD)
- 阻塞性睡眠呼吸暂停
诊断性检查
首要检查
- FEV₁/FVC 比值
- 呼气流速峰值 (PEFR)
- 胸部 X 线检查（CXR）
- 全血细胞计数（FBC）
需考虑的检查
- 支气管激发试验
- 过敏原特异性 IgE 免疫测定
- 皮肤过敏原点刺试验
- 呼出气一氧化氮 (FeNO)
新兴检查
- 痰嗜酸粒细胞增多
治疗流程
初始治疗：哮喘症状不频繁（例如，每月少于两次）且无加重的危险因素
初始治疗：哮喘症状或每月需要使用两次或更多次缓解药物（但每周少于 4-5 天）
初始治疗：大多数时间出现严重哮喘症状，或者每周因哮喘醒来一次或多次，尤其在有任何危险因素的情况下
初始治疗：重度控制不佳的哮喘或急性加重
持续性治疗：第 1 步（症状发作少于每月两次，并且无加重的危险因素）
持续性治疗：第 2 步（第 1 步治疗未控制的哮喘）
持续性治疗：第 3 步（第 2 步治疗未控制住哮喘）
持续性治疗：第 4 步（第 3 步治疗未控制住哮喘）
持续性治疗：第 5 步（第 4 步治疗未控制的哮喘，并且患者已由专科医生复查）
撰稿人
作者
Lauren Eggert, MD
Clinical Assistant Professor
Division of Pulmonary, Allergy, and Critical Care Medicine
Department of Medicine
Stanford University School of Medicine
Stanford
CA
利益声明
LE declares that she has no competing interests.
Sourav Majumdar, MD
Clinical Assistant Professor (Affiliated)
Division of Pulmonary and Critical Care Medicine
Department of Medicine
Stanford University School of Medicine
Stanford
CA
利益声明
SM declares that he has no competing interests.
鸣谢
Dr Lauren Eggert and Dr Sourav Majumdar would like to gratefully acknowledge Dr Irwani Ibrahim, Dr Kay Choong See, Dr Francis Thien, and Dr Catherine Weiler, previous contributors to this topic.
利益声明
II, KCS, FT, and CW declare that they have no competing interests.
同行评议者
Javed Sheikh, MD
Clinical Director
Division of Allergy and Inflammation
Beth Israel Deaconess Medical Center/Harvard Medical School
Boston
MA
利益声明
JS is a consultant for Aventis, GSK, and Novartis/Genentech; is on the Speakers Bureau for Merck, Aventis, GSK, AstraZeneca, Pfizer, Novartis/Genentech, Inspire, and UCB; has had research sponsored by GSK; is an expert witness at Haemonetics; and has received publication honorarium at Emedicine.
Sheree M.S. Smith, PhD
Research Manager
Imperial College Healthcare Trust
NHLI Airways Division
Imperial College London (Honorary) Respiratory Research
Chest & Allergy
St Mary's Hospital
London
UK
利益声明
SMSS declares that she has no competing interests.
Neil Thomson, MBChB, MD, FRCP
Professor of Respiratory Medicine
Respiratory Medicine Section
Division of Immunology, Infection & Inflammation
University of Glasgow
Glasgow
UK
利益声明
NT declares that he has no competing interests.
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