哮喘联盟

摘要
   背景：由于肺结节病常常会影响气道，因而经常将其与哮喘混淆。
   方法：本文综述了肺结节病患者气流受阻的机制、与该现象相关的症状和鉴别肺结节病与哮喘的方法。
   讨论：由于哮喘很有可能在喘息、咳嗽和胸闷患者中出现，在这种情况下通常不会考虑肺结节病，除非患者存在结节病的肺外表现或具有该疾病的家族史。如果考虑存在肺结节病，应该进行胸部影像学检查。如果哮喘患者的症状不典型或标准的哮喘治疗疗效较差，则应该进行胸部影像学检查；在这种情况下，进行胸部影像学检查，不仅要排除肺结节病，而且要排除其他可能的心肺疾病。对于确诊为肺结节病的患者，同时患有哮喘时的诊断还较为困难。因为两种疾病相关的症状常常相似。气流受阻在肺结节病患者中很常见，以致肺功能检测不太可能鉴别这两种疾病。检测气道敏感性也不太可能鉴别这两种疾病，因为肺结节病患者也存在气道敏感性增加。血清IgE、血清血管紧张素转换酶水平、痰液嗜酸性粒细胞计数和检测呼吸气一氧化氮水平可能有望作为两种疾病的鉴别检测手段，但尚未进行特异性研究。肺影像学检查的价值有限，除非已有基线状态下的影像学资料。我们认为组织学信息在鉴别两种疾病时更有价值。在确诊为肺结节病的患者中，不太可能排除或确认是否存在哮喘因素。幸运的是，两个疾病加重后的治疗常常都从全身皮质激素治疗开始。肺部症状和气流受阻存在显著变异，表明存在哮喘因素，在这种情况下可吸入皮质激素和支气管扩张剂进行治疗。
   结论：由于肺结节病常常会影响气道，因而哮喘和肺结节病存在诸多相同的症状。因此，鉴别两者较为困难。本文对两种疾病的评价和鉴别方法进行概述。

（苏楠  审校）
J Asthma. 2012 Dec 5. [Epub ahead of print]


 

Distinguishing Asthma from Sarcoidosis: An Approach to a Problem that is not Always Solvable.

Kalkanis A, Judson MA.

Source
Division of Pulmonary and Critical Care Medicine, Albany Medical Center , Albany, NY , USA.

Abstract
BACKGROUND：Because pulmonary sarcoidosis often affects the airway, it is commonly confused with asthma.
METHODS：This article reviews the mechanisms of airflow obstruction in sarcoidosis, the symptoms associated with this phenomenon, and the approach to distinguish sarcoidosis from asthma.
DISCUSSION：Because asthma is highly likely in a patient with wheeze, cough, and chest tightness, sarcoidosis is usually not considered unless the patient has extrapulmonary manifestations of sarcoidosis or a family history of the disease. When pulmonary sarcoidosis is a consideration, a chest radiograph should be performed. A chest radiograph should also be performed in an asthmatic patient when the presentation is atypical, or fails to respond to standard asthma treatment; chest radiography should be performed in this situation to consider not only pulmonary sarcoidosis but also other possible cardiopulmonary disorders. In a patient with confirmed pulmonary sarcoidosis, the diagnosis of concomitant asthma is problematic. The symptoms associated with the two disorders are often identical. Airflow obstruction is common in sarcoidosis so that pulmonary function testing is unlikely to differentiate these two diseases. Demonstration of airway hyperreactivity may fail to distinguish these disorders as this is common in sarcoidosis. Serum IgE, serum angiotensin-converting enzyme levels, sputum eosinophilia, and exhaled nitric oxide measurements show promise as distinguishing tests, although they have not been studied specifically. Pulmonary imaging is probably of limited value unless baseline studies are available for comparison. We suspect that historical information will be more useful in distinguishing these two diseases. Not infrequently, it may be impossible to exclude or confirm an asthmatic component in a confirmed pulmonary sarcoidosis patient. Fortunately, exacerbations of both these diseases are often treated with systemic corticosteroids initially. Significant variability in pulmonary symptoms and airflow obstruction suggest that an asthma component is present, and inhaled corticosteroids and bronchodilators should be considered in these cases,
CONCLUSIONS：Asthma and sarcoidosis share many of the same symptoms, as sarcoidosis commonly affects the airways. Therefore, it is problematic to distinguish these two diseases. In this article, we have outlined an approach to assess the presence of each of these diseases and an approach to therapy.

J Asthma. 2012 Dec 5. [Epub ahead of print]