哮喘的诊断与分级修改.ppt

2021/3/13 * 病例 XX,男,咳嗽，气喘5月，予每天400微克BDP等治疗，目前症状如下:白天症状每周2-3次，急性发作时影响活动，每月1次夜间发作。PEF 85%Pre, PEFR 25%。 该患者哮喘的分级? 轻度持续的 治疗方案 轻度持续 间歇发作 轻度持续 * * * * * * Slide 16 ? When classifying asthma severity according to the GINA guidelines, it is important to realise that the ‘clinical’ setting can be very different from the situation in real life for many reasons * * * 3 Pearson MG et al. (Thorax 1995; 50(2): A51) interrogated the AAH Meditel database covering 102 UK general practices and, purely on prescribing information, allocated the proportions of patients receiving treatment at the then current steps of the BTS Asthma Management Guidelines (Thorax 1993; 48 (2): S1-S24). Over 17,000 patients were identified, of whom over 15,000 (91%) could be allocated to a step. Over 80% of these patients were at Steps 1 and 2. The authors went on to see how many at each step were receiving 2 puffs of beta agonist/day (or equivalent) and should therefore perhaps have been on a higher step. The results are: at Step 1: 55.4% at Step 2: 54.6% at Step 3a: 66.8% at Step 3b: 68.8% Key point: Many patients are still suffering symptoms at each step of the guidelines, in particular at Step 2. (not presented on slide) } * * * * * * Slide 16 ? When classifying asthma severity according to the GINA guidelines, it is important to realise that the ‘clinical’ setting can be very different from the situation in real life for many reasons 2021/3/13 * 哮喘的诊断与分级 2021/3/13 * 内容 哮喘现状 哮喘的诊断与鉴别诊断 哮喘严重度分级 病例讨论 2021/3/13 * AIRIAP研究 2001年 支气管哮喘一个全球性的严重健康问题 慢性疾病,累及各年龄组 病情严重者可致命 全球有超过1亿人,中国超过1千万人患有哮喘 患病率在不断增加尤其在青少年 2021/3/13 * 哮喘诊断不足是一个普遍的问题 全世界范围内都存在哮喘未能得到充分诊断的问题 在儿童和成人的流行病学调查中不断提示哮喘诊断不清,其结果导致治疗的不当 (GINA2002) 2021/3/13 * 哮喘的诊断 家族史及症状特征 体格检查 肺功能检查 过敏状况检查从而发现过敏原 2021/3/13 * 诊断标准 1、反复发作喘息、气急、胸闷或咳嗽,多与接触变应原等有关。 2、发作时在双肺可闻及散在或弥漫性,以呼气相为主的哮鸣音，呼气相延长。 3、上述症状可经治疗缓解或自行缓解。 4、除外其它疾病所引起的喘息、气急、胸闷和咳嗽。 5、临床表现不典型者（如无明显喘息或体征）应至少具备以下一项试验阳性: （1）支气管激发试验或运动试验阳性; （2）支气管舒张试验阳性一秒用力呼气容积（FEV1）增加15%以上，且FEV1增加绝对值＞20