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青少年及成年人重症哮喘的评估

Author
Sally Wenzel, MD
Section Editor
Bruce S Bochner, MD
Deputy Editor
Helen Hollingsworth, MD

引言

虽然重症哮喘患者仅占哮喘患者总数的5%-10%，但它造成了绝大多数的发病并耗费了大量治疗成本[1]。临床医生必须首先确定，具有提示重症哮喘的严重和/或频繁的呼吸道症状患者已得到了正确诊断。其他可能的情况包括：

  • 由未被控制的触发因素引起的哮喘发作
  • 因不依从所致的哮喘控制不佳
  • 类似于哮喘的另外一种疾病
  • 合并症引起的哮喘发作

本专题将总结对具有提示重症哮喘症状的患者的评估方法。哮喘诊断和治疗的一般方法和哮喘表型及其对治疗的影响将单独讨论。(参见“青少年及成人哮喘的诊断”和“哮喘管理概述”和“重症哮喘表型”和“青少年及成人重症哮喘的治疗”)

定义

我们将“重症哮喘”这一分类仅用于需要大剂量吸入性或近似持续地口服糖皮质激素来维持哮喘控制的患者。美国胸科学会提出的重症哮喘的工作定义对其描述为，需要存在1个或2个主要标准以及至少2个次要标准(表 1)[2]。此外，还必须评估并排除其他疾病、纠正潜在的加重因素，并且需确定缺乏依从性并不是哮喘控制差的明显促发因素。

2007年美国哮喘教育和预防项目(National Asthma Education and Prevention Program, NAEPP)指南把最初没有使用哮喘控制药物的患者归为“重症哮喘”(表 2)[3]。有些这类患者在治疗之前采用中等剂量的糖皮质激素能够控制哮喘，因此不符合重症持续性哮喘的标准。在重症持续性哮喘患者中，尝试降低糖皮质激素剂量会导致哮喘控制恶化(表 3)[3]。

              

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Literature review current through: 2017-07 . | This topic last updated: 2017-01-17.
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