小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 喘息发作诱因
- 呼吸功增加
- 特应性疾病的特点
- 在适宜时间框内患者对治疗的反应情况史
其他诊断因素
- 年龄>3 岁
- 夜间干咳
- 劳力性呼吸困难
- 呼气性喘鸣
- 胸壁畸形
危险因素
- 过敏原致敏
- 特应性疾病
- 由非病毒/非过敏性环境因素诱发的喘息
- 早期呼吸道病毒感染
- 血清痰嗜酸粒细胞（4% 或更高）
- 哮喘家族史
- 被动或主动使用香烟或电子烟
- 肺功能异常和气道高反应性
- 室外空气污染
- 女性
- 肥胖
- 妊娠期间抑酸药物的使用
- 胃食管反流病 (GORD)
- 阻塞性睡眠呼吸暂停（OSA）
诊断性检查
首要检查
- 肺量测定法
- 肺量测定法评估疾病对支气管舒张剂的反应
需考虑的检查
- 胸部 X 线检查
- 呼气流速峰值 (peak expiratory flow rate, PEFR)
- 气道激发试验
- 运动激发试验
- 全血细胞计数（FBC）
- 支气管镜检查
- 发汗试验
- 痰培养
- 电子显微镜下纤毛检查
- 皮肤点刺试验
- 呼出气一氧化氮 (FeNO)
- 支气管肺泡灌洗
治疗流程
年龄为 0 至 5 岁
年龄为 6 到 11 岁
撰稿人
作者
Paul D. Robinson, MBChB, MRCPCH, FRACP, PhD
Respiratory and Sleep Physician
The Children's Hospital at Westmead
Clinical 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, FAPSR, FThorSoc, FAHMS
Professor
Respiratory and Sleep Physician
Queensland Children's Hospital
Queensland University of Technology
Brisbane
Menzies School of Health Research
Charles Darwin University
Darwin
Australia
利益声明
AC's institution has received fees from her work on independent data monitoring committees for several unlicensed products including vaccines and a monoclonal antibody (GSK, AstraZeneca, and Moderna). She is an author of a number of references cited in this topic.
同行评议者
Chris Cates, MA, FRCGP
Senior Clinical Research Fellow
Community Health Sciences
St. George's University of London
London
UK
利益声明
CC is an author of a number of references cited in this topic.
Peter Griffiths, MBChB
General Practitioner
Harborne Medical Practice
Birmingham
UK
利益声明
PG declares that he has no competing interests.
Karin A. Pacheco, MD, MSPH
Assistant Professor
Division of Environmental & Occupational Health Sciences
National Jewish Health
Denver
CO
利益声明
KAP declares that she has no competing interests.
Ware Kuschner, MD
Associate Professor of Medicine
Stanford University
Stanford
Staff Physician
US Department of Veterans Affairs
Palo Alto Health Care System
Palo Alto
CA
利益声明
WK declares that he has no competing interests.
鉴别诊断
- 毛细支气管炎
- 发作性（病毒诱发）喘息
- 吸入异物
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