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老年哮喘的诊断与管理

Author
R Graham Barr, MD, DrPH
Section Editors
Peter J Barnes, DM, DSc, FRCP, FRS
Kenneth E Schmader, MD
Deputy Editor
Helen Hollingsworth, MD
Translators
戴元荣, 主任医师，教授

引言

哮喘在65岁以上人群中常见[1,2]，其会显著降低老年人的身体和心理方面的生存质量[2-5]。

一些专家将老年哮喘分为两种类型：第一类指患者的哮喘典型症状在儿童期或成年早期就已出现，并在此后持续存在。在这类患者中，正常的肺功能中常穿插间歇性气流阻塞期，但慢性气道重塑可能导致气流受限不完全可逆。第二类指患者在老年期首次新发哮喘症状，这种类型较为少见。第一类的诊断通常相当明确，而在第二种类型中，由于慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)的发生率较高，以及鉴别诊断较多，所以对其诊断较为困难。我们发现分为这两种类型有助于对该病的讨论，但也承认这种分类方法存在局限性。其临床病程可能较为复杂，例如，儿童期哮喘的症状通常在青春期消失，但后来在成年期症状重新出现。缺乏支持这种分类的定义以及基于这种分类的治疗策略的证据。

老年哮喘患者的临床表现、评估和管理将总结在此，关于哮喘和COPD的评估、诊断和管理的一般专题将单独讨论。 (参见“青少年及成人哮喘的诊断”和“哮喘管理概述”和“慢性阻塞性肺疾病：定义、临床表现、诊断和分期”和“稳定期慢性阻塞性肺疾病的处理”)

流行病学

在65岁及以上老年人中，哮喘的患病率估计为4%-8%[6,7]，而美国所有成人的哮喘患病率估计为7.7%[8]。另外一项报告估计，超过两百万的哮喘患者年龄在65岁及以上[9]。总体的哮喘流行病学将单独讨论。 (参见“哮喘流行病学”)

危险因素与诱发因素

老年哮喘可能的危险因素和诱发因素与其他年龄段中哮喘的诱发因素相似[10-16]。美国国家哮喘教育与预防计划(National Asthma Education and Prevention Program, NAEPP)已制定了一份问卷，以帮助临床医生评估诱发因素暴露与哮喘症状之间的关系(表 1)。值得花时间询问老年哮喘患者有关诱发因素的情况，因为超过1/3的老年哮喘患者报告有运动引发的哮喘症状，1/2报告动物接触、粉尘或烟气暴露诱发了呼吸系统症状，超过2/3的患者报告其呼吸系统症状存在季节性恶化[2,17]。哮喘的危险因素及其诱发因素将会单独详细讨论。 (参见“哮喘的危险因素”和“控制诱发因素以加强哮喘管理”)

                                 

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