重度哮喘患者运动期间存在喉梗阻的高发生率
2020/01/02
摘要
劳累后呼吸困难是重症哮喘的一个关键且普遍存在的的临床特征，并且尽管目前哮喘治疗的方法在不断的优化，但这种情况却仍然持续存在。喉或声带功能障碍（在呼吸周期中声门不恰当和过度关闭）存在于高达一半的重症哮喘患者中。这种不恰当的闭合可能会导致运动时及运动后短暂的气流阻塞和呼吸困难。对于喉结构而言，正常的反应是在运动时外展，但一些人的声门孔却在运动时不适当地缩小。目前，尚不能确定喉闭合是否存在，同时不能确定其是否为重症哮喘患者劳力性呼吸困难的病因，但这一发现很有可能解释上述症状的“难治性”。本研究旨在评估严重哮喘并伴有劳力性呼吸困难的患者的运动相关喉部功能。我们使用了运动中喉镜检查技术(CLE)，并假设喉部梗阻将会是普遍的，并且与肺功能、呼吸困难和运动不耐受相关。
High Prevalence of Laryngeal Obstruction during Exercise in Severe Asthma.
Hull JH, et al. Am J Respir Crit Care Med. 2018 Dec 20.
Abstract
Exertional dyspnea is a key and pervasive feature in severe asthma and often persists despite optimization of asthma treatment . Laryngeal or vocal cord dysfunction, an inappropriate and excessive closure of the glottis during the breathing cycle, is recognised to be present in up to half of severe asthmatics . This laryngeal closure can lead to transient airflow obstruction during exercise and exertional dyspnea. Whilst the normal response of the laryngeal structures is to abduct during exercise, in some individuals, the glottic aperture can narrow inappropriately during exercise. It is currently unclear whether laryngeal closure is present and contributes to the aetiology of exertional dyspnea in patients with severe asthma, yet such a finding may explain the ‘treatment refractory’ nature of this symptom and have implications for management. The aim of this study was to evaluate exercise-related laryngeal function in a cohort of patients with severe asthma and exertional dyspnoea. We utilised the technique of continuous laryngoscopy during exercise (CLE) and hypothesised that laryngeal obstruction would be prevalent and relate to lung function, dyspnoea and exercise intolerance.
劳累后呼吸困难是重症哮喘的一个关键且普遍存在的的临床特征，并且尽管目前哮喘治疗的方法在不断的优化，但这种情况却仍然持续存在。喉或声带功能障碍（在呼吸周期中声门不恰当和过度关闭）存在于高达一半的重症哮喘患者中。这种不恰当的闭合可能会导致运动时及运动后短暂的气流阻塞和呼吸困难。对于喉结构而言，正常的反应是在运动时外展，但一些人的声门孔却在运动时不适当地缩小。目前，尚不能确定喉闭合是否存在，同时不能确定其是否为重症哮喘患者劳力性呼吸困难的病因，但这一发现很有可能解释上述症状的“难治性”。本研究旨在评估严重哮喘并伴有劳力性呼吸困难的患者的运动相关喉部功能。我们使用了运动中喉镜检查技术(CLE)，并假设喉部梗阻将会是普遍的，并且与肺功能、呼吸困难和运动不耐受相关。
(中国医科大学附属一院呼吸与危重症学科 李文扬 摘译 杨冬 审校)
(Hull JH, et al. Am J Respir Crit Care Med. 2018 Dec 20..)
(Hull JH, et al. Am J Respir Crit Care Med. 2018 Dec 20..)
High Prevalence of Laryngeal Obstruction during Exercise in Severe Asthma.
Hull JH, et al. Am J Respir Crit Care Med. 2018 Dec 20.
Abstract
Exertional dyspnea is a key and pervasive feature in severe asthma and often persists despite optimization of asthma treatment . Laryngeal or vocal cord dysfunction, an inappropriate and excessive closure of the glottis during the breathing cycle, is recognised to be present in up to half of severe asthmatics . This laryngeal closure can lead to transient airflow obstruction during exercise and exertional dyspnea. Whilst the normal response of the laryngeal structures is to abduct during exercise, in some individuals, the glottic aperture can narrow inappropriately during exercise. It is currently unclear whether laryngeal closure is present and contributes to the aetiology of exertional dyspnea in patients with severe asthma, yet such a finding may explain the ‘treatment refractory’ nature of this symptom and have implications for management. The aim of this study was to evaluate exercise-related laryngeal function in a cohort of patients with severe asthma and exertional dyspnoea. We utilised the technique of continuous laryngoscopy during exercise (CLE) and hypothesised that laryngeal obstruction would be prevalent and relate to lung function, dyspnoea and exercise intolerance.
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肥大细胞蛋白酶在哮喘中的新作用
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欧洲血统个体的中-重度哮喘：一项全基因组关联研究
