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
- 哮鸣音
- 呼吸短促
- 胸闷
- 睡眠障碍
- 辅助呼吸肌参与呼吸
- 呼吸急促
- 心动过速
- 喘息、气流不畅或呼吸音减弱
- 不能说话
其他诊断因素
- 运动受限
- 喘鸣
- 紫绀
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
- 第一秒用力呼气容积（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
- 最大呼气流速
- 血氧饱和度
需考虑的检查
- 动脉血气分析 (ABG)
- 胸部 X 线检查
治疗流程
致命性哮喘加重或临界呼吸衰竭
重度急性发作
轻中度加重
有症状的哮喘
撰稿人
作者
Sourav Majumdar, MD
Clinical Assistant Professor (Affiliated)
Division of Pulmonary, Allergy 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.
Lauren Eggert, MD
Fellow
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.
鸣谢
Dr Sourav Majumdar and Dr Lauren Eggert would like to gratefully acknowledge Dr Ware Kuschner, Dr Michael Ezzie, and Dr Jonathan P. Parsons, the previous contributors to this topic.
利益声明
WK and ME declare that they have no competing interests. JPP is a member of Speakers' Bureaus for GlaxoSmithKline, Inc.; Schering-Plough, Inc.; and AstraZeneca, Inc.
同行评议者
Anne Dixon, MD
Assistant Professor
Pulmonary and Critical Care Medicine
University of Vermont
Burlington
VT
利益声明
AD declares that she has no competing interests.
Neil C. Thomson, MBChB, MD, FRCP
Professor of Respiratory Medicine
Institute of Infection, Immunity & Inflammation
University of Glasgow
Glasgow
Scotland
UK
利益声明
NCT declares that he has no competing interests.
Graeme P. Currie, MBChB, MD, FRCP
Consultant Chest Physician
Chest Clinic C
Aberdeen Royal Infirmary
Aberdeen
Scotland
UK
利益声明
GPC declares that he has no competing interests.
鉴别诊断
- 异物/阻塞
- 声带功能障碍
- 心功能障碍
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