儿童哮喘诊断与治疗.ppt

* * GINA：ICS的等效剂量 GINA对于各种ICS不同剂量等级有相应的推荐范围，供临床医生应用具体药物时进行参考。但需注意： ? 确定合适的给药剂量最主要基于临床医生对患者治疗反应的判断。 临床医生必须根据相关临床指标监测患者的治疗反应，并相应调整给药剂量。 阶梯治疗方案的重点是一旦达到哮喘控制，须谨慎调整药物剂量，以获得维持哮喘所需的最低有效剂量，从而减少不良事件的发生1。 由于以氟氯化碳（氟利昂）作为推进剂的气雾剂正在逐步退出市场，因此当改用氢氟烷（非氟利昂）气雾剂时，必须由临床医生调整相应剂量。 * In treatment-na?ve patients with persistent asthma, treatment should be start at Step 2, or, if very symptomatic (uncontrolled), at step 3. All patients with persistent asthma require one or more regular controller medications (Steps 2 through 5). Step 2 is the initial treatment for most treatment-na?ve patients with persistent asthma symptoms. If symptoms at the initial consultation suggest that asthma is poorly controlled, initial treatment may be commenced at step 3. The scheme presented in Figure is based upon these principles, but the range and sequence of medications used in each clinical setting will vary depending on local availability (for cost or other reasons), acceptability and preference. * Slide 18 Montelukast significantly reduced the rate of exacerbation episodes (32%) during the course of the study compared with placebo (p?0.001). The estimated rate of exacerbations was 1.60 episodes/year in the montelukast group compared with 2.34 episodes/year in the placebo group.17 * 4 An asthma management plan consists of 6 parts. All are essential for success. 1. Educate the patient and develop a management partnership 2. Assess and monitor symptoms and lung function regularly 3. Avoid triggers 4. Establish an individualis ed medication plan 5. Plan to manage exacerbations when they occur 6. Provide regular follow up 以下情况应注意 一些年幼儿其发病的最初症状是反复或持续性咳嗽，或在呼吸道感染时伴有喘息，经常被误诊为支气管炎或肺炎（包括急性呼吸道感染—ARI），并被给予无效的抗生素或镇咳药物治疗。此时给予抗哮喘药物治疗是有益的，并有助于诊断婴幼儿期哮喘，故具有以上特点的婴幼儿还是可以采用婴幼儿哮喘的诊断名称。 儿童哮喘诊断与治疗 如果病人反复感冒，发展到下呼吸道，或持续10天以上才恢复，使用抗哮喘药物治疗后才好转，则应考虑哮喘。 如果按照哮喘治疗效果不理想时，应排除支气管异物、支气管淋巴结结核、先天性上下气道畸形、心源性哮喘等可具有喘息、气促或胸闷的疾病。 儿童哮喘诊断与治疗 哮喘的长期管理—— 向病人或家属询问：病人是否有下列情况? 喘息反复发作？ 夜间或晨起是否有剧烈的咳嗽或喘息？ 运动后咳嗽或喘息？ 暴露于空气中的过敏原或花粉后出现咳嗽，喘息