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青少年及成人哮喘的诊断

Author
Christopher H Fanta, MD
Section Editors
Peter J Barnes, DM, DSc, FRCP, FRS
Bruce S Bochner, MD
Deputy Editor
Helen Hollingsworth, MD
Translators
熊玮, 主任医师，教授

引言

哮喘的“经典”体征和症状为间歇性呼吸困难、咳嗽和哮鸣音。虽然这些症状是哮喘的典型特征，但均为非特异性的，因此有时难以将哮喘与其他呼吸系统疾病相区分。哮喘的确诊需要存在符合哮喘的呼吸道症状或具有符合哮喘的呼吸道症状病史，并需证实存在可变的呼气气流阻塞[1,2]。

诊断哮喘的方法包括病史采集、体格检查、肺功能测定和其他实验室评估。本专题将介绍这些方法以及几种诊断青少年和成人哮喘的具体策略。

儿童和老年人哮喘的诊断及哮喘治疗的概述将单独讨论。 (参见“12岁以下儿童的哮喘：初始评估和诊断”和“老年哮喘的诊断与管理”和“哮喘管理概述”)

定义

尽管医生在患者出现哮喘经典表现(即，由典型触发因素引起且能通过支气管扩张药缓解的间歇性咳嗽、喘鸣和呼吸急促)时能容易识别出哮喘，但很难提供一个鉴别哮喘与类似及重叠情况的定义。在无确定性的实验室检查或生物标志物的情况下，哮喘没有一个所有学科(包括临床医生、生理学家和病理学家)都接受的精确定义。在临床上，其症状是非特异性的。在生理学上，哮喘的特征为支气管高反应性(即多种刺激诱发的气道过度变窄的趋势，而这类刺激在无气道疾病的个体中不引发或引发程度极小的支气管收缩)，但支气管高反应性并不是哮喘所特有的。从病理学角度看，哮喘可能被大致被描述为“一种气道的慢性炎症性疾病”[1]。然而，这种描述忽略了哮喘中气流阻塞的时重时轻的特点，也未能将哮喘与其他气道炎症性疾病(如慢性支气管炎或细支气管炎)相区分。

将炎症及支气管高反应性的关键作用与特征性临床症状相结合的定义更加精确。为此，哮喘被美国国家哮喘教育和预防项目专家组报告3定义为“一种常见的慢性气道疾病，较为复杂，其特征为可变且反复出现的症状、气流阻塞、支气管高反应性及基础炎症。哮喘这些特征的相互作用决定了哮喘的临床表现和严重程度及其对治疗的反应”[1]。该定义描述了这种疾病的关键特征，但对患者和临床医生来说缺乏实用性。

                          

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Literature review current through: 2017-07 . | This topic last updated: 2017-03-06.
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References
Top
  1. National Asthma Education and Prevention Program: Expert panel report III: Guidelines for the diagnosis and management of asthma. Bethesda, MD: National Heart, Lung, and Blood Institute, 2007. (NIH publication no. 08-4051) www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm (Accessed on December 04, 2014).
  2. Global Initiative for Asthma. Global strategy for asthma management and prevention (Updated 2015). http://www.ginasthma.org/local/uploads/files/GINA_Report_2015_Aug11.pdf (Accessed on March 01, 2016).
  3. Fahy JV, O'Byrne PM. "Reactive airways disease". A lazy term of uncertain meaning that should be abandoned. Am J Respir Crit Care Med 2001; 163:822.
  4. Yunginger JW, Reed CE, O'Connell EJ, et al. A community-based study of the epidemiology of asthma. Incidence rates, 1964-1983. Am Rev Respir Dis 1992; 146:888.
  5. Pratter MR, Hingston DM, Irwin RS. Diagnosis of bronchial asthma by clinical evaluation. An unreliable method. Chest 1983; 84:42.
  6. Irwin RS, Curley FJ, French CL. Chronic cough. The spectrum and frequency of causes, key components of the diagnostic evaluation, and outcome of specific therapy. Am Rev Respir Dis 1990; 141:640.
  7. Pratter MR, Curley FJ, Dubois J, Irwin RS. Cause and evaluation of chronic dyspnea in a pulmonary disease clinic. Arch Intern Med 1989; 149:2277.
  8. Tarlo SM, Lemiere C. Occupational asthma. N Engl J Med 2014; 370:640.
  9. Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry. Eur Respir J 2005; 26:319.
  10. Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests. Eur Respir J 2005; 26:948.
  11. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: Revised 2011. Global Initiative for Chronic Obstructive Lung Disease (GOLD). www.goldcopd.org (Accessed onSeptember 10, 2012).
  12. Enright PL, Lebowitz MD, Cockroft DW. Physiologic measures: pulmonary function tests. Asthma outcome. Am J Respir Crit Care Med 1994; 149:S9.
  13. Irvin, CG, Eidelman, D. Airways mechanics in asthma. In: Rhinitis and Asthma, Holgate, S, Busse, W (Eds), Blackwell Scientific Publications, Boston 1995.
  14. U.S. Department of Health and Human Services. International consensus report on diagnosis and treatment of asthma. U.S. Government Printing Office, Washington D.C. PHHS Publication No. 92-3091, 1992.
  15. Smith HR, Irvin CG, Cherniack RM. The utility of spirometry in the diagnosis of reversible airways obstruction. Chest 1992; 101:1577.
  16. Aaron SD, Vandemheen KL, Boulet LP, et al. Overdiagnosis of asthma in obese and nonobese adults. CMAJ 2008; 179:1121.
  17. Aaron SD, Vandemheen KL, FitzGerald JM, et al. Reevaluation of Diagnosis in Adults With Physician-Diagnosed Asthma. JAMA 2017; 317:269.
  18. Aguilar-Fernández AJ, Villa-Asensi JR, Castro-Codesal M, et al. Concordance between the Piko - 1 portable device and pneumotachography in measuring PEF and FEV(1) in asthmatic children. Allergol Immunopathol (Madr) 2009; 37:244.
  19. Solomon DA, Fanta CH, Levy BD, Loscalzo J. Clinical problem-solving. Whistling in the dark. N Engl J Med 2012; 366:1725.
  20. Scott S, Currie J, Albert P, et al. Risk of misdiagnosis, health-related quality of life, and BMI in patients who are overweight with doctor-diagnosed asthma. Chest 2012; 141:616.
  21. Postma DS, Rabe KF. The Asthma-COPD Overlap Syndrome. N Engl J Med 2015; 373:1241.
  22. Gaugris S, Sazonov-Kocevar V, Thomas M. Burden of concomitant allergic rhinitis in adults with asthma. J Asthma 2006; 43:1.
  23. Meltzer EO. The relationships of rhinitis and asthma. Allergy Asthma Proc 2005; 26:336.