哮喘诊断：一个新的切入点
2012/10/16
目前哮喘的定义包括4个主要方面：炎症、气道高反应性、支气管收缩及症状。在研究中，对于症状的关注是最少的。根据国际指南，哮喘的症状是阵发性的呼吸急促、喘息、咳嗽、胸闷，以及呼吸困难。尽管这里包含了若干症状，一个最基本的问题就是它们是怎样与哮喘最主要的临床特征，即支气管收缩相关联的呢？症状及肺功能通常被用来评估临床健康状况及治疗的效果。然而，这两个变量之间没有或仅存在极少的联系，这也就意味着它们代表着不同的机制。简易的肺功能，例如一个低的第一秒用力呼气容积代表着支气管收缩，而那些症状又代表着什么呢？某些症状（如喘息和呼吸困难）似乎并不是哮喘的确诊症状。考虑到哮喘发作的潜在危险性，关注支气管阻塞是重要的，但是非阻塞性的症状频繁发生可能也会引起不适和生活质量下降。将所有的症状解释为哮喘支气管收缩的标志可能会导致对于健康状态及治疗效果的错误评估。尽管是一个“软性”的变量，症状的优势就在于其代表了不同的机制。在诊断的过程中一定要考虑到生理学中对于呼吸系统预防与控制的先决条件，而不是炎症、过敏、心理状态或者其他的病因。基于在心肺疾病包括哮喘和哮喘类似疾病中的关于呼吸困难的研究，似乎在一个单一的哮喘症状中即存在一个类似连续波谱的、互相整合在一起的机制。
（房娟 首都儿科研究所 100020 摘译）
Allergy2012;67:713-717
Allergy2012;67:713-717
Diagnosis of asthma – a new approach
O.Lowhagen
Sahlgrenska Academy, Instit Medicine , University of Goteborg , Sweden
Abstract
Current definition of asthma involves four cornerstones : inflammation, hyperresponsiveness , bronchoconstriction , and symptoms. In research , the symptonms have had the slightest attention. According to international guidelines, the asthma symptoms are episodic breathlessness , wheeze, cough, tightness of the chest ,and shortness of breath . As there are several symptoms , a primary question is how they are related to bronchoconstriction ,the main clinical feature of asthma. Symptoms and lung function tests are regularly used for the evaluation of clinical health status and effect of treatment . However , there is no or poor correlation between these two variables ,which means that they represent different mechanisms. Reduced lung function ,such as a low FEV1,represents bronchial constriction ,what do the symptoms represent ? Some symptoms such as breathlessness and shortness of breath seem not to be evidence-based asthma symptoms. Focusing on bronchial obstruction is important in view of the potential risk of asthma attacks ,but nonobstructive symptoms occur frequently and may also cause severe discomfort and poor quality life . Interpreting all symptoms as signs of bronchoconstriction (asthma) may lead to misintepretation when assessing health status and effect of treatment . Although a ‘soft ’ variable ,the strength of symptoms is that they are representing various mechanisms. The physiological preconditions for control and defense of respiration must be considered in the diagnostic process , regardless of inflammation ,allergy ,psychology, or other etiological factors. Based on studies on dyspnea in cardiopulmonary diseases, including asthma and asthma-like disorders, there seems to be a continuous spectrum and mechanism integrated in a single asthma syndrome.
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中重度顽固性哮喘患者中非嗜酸粒细胞升高型哮喘患者比例调查
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监测奥玛珠单抗治疗的严重哮喘患者血清游离IgE
