哮喘联盟

   摘要 
   反复喘息常见于学龄前儿童，往往被认为是哮喘。通过集中采集病史、检查和排除其他可能会表现为喘息的严重疾病以区分学龄前喘息和哮喘是很重要的。两种不同的实用临床表型，即病毒诱发喘息（EVW）和多触发喘息（MTW）虽然种类并不保持固定并且在临床实践中经常出现交叉，但都已经被描述过。当喘息发作的时候，使用吸入型支气管扩张剂如沙丁胺醇，是一些如避免烟草烟雾环境和家长教育等非药物措施相伴的主要治疗方法。吸入糖皮质激素是对MTW维持治疗的第一选择，然而当考虑对EVW维持治疗时，孟鲁司特可能是有用的。任何维持治疗都应被看作是一个试验，当没有任何益处时，应被中止。短期全身性类固醇治疗应为喘息症状需要住院治疗时保留。即使过敏性MTW往往没有得到缓解，并且后一组孩子进而发展为哮喘，轻度复发性EVW的预后良好。
 

（苏楠 审校） 
Indian J Pediatr.2014 Jun 13. [Epub ahead of print]

 

Preschool Wheeze is Not Asthma: A Clinical Dilemma.
 

Paul SP1, Bhatt JM.
 

ABSTRACT
Recurrent wheezing is common in preschool children and often gets labelled as asthma. It is important to differentiate preschool wheeze from asthma through focused history, examination and exclusion of other serious conditions that may present as wheeze. Two different pragmatic clinical phenotypes viz. episodic viral wheeze (EVW) and multi-trigger wheeze (MTW) have been described although categories do not remain fixed and cross over is often seen in clinical practice. Episodic use of inhaled bronchodilators such as salbutamol when wheezy, is the mainstay of treatment along with non-pharmacological measures such as avoidance of environmental tobacco smoke and parental education. Inhaled corticosteroids are the first choice for maintenance therapy in MTW whereas montelukast may be useful when maintenance therapy is considered in EVW. Any maintenance therapy should be viewed as a trial and need to be discontinued in cases where no benefit has been demonstrated. Short term systemic steroid therapy should be reserved for excaerbation of wheezy symptoms where hospitalization is necessary. Prognosis is good in recurrent mild EVW although remission in atopic MTW is often not achieved and the children in the latter group go on to develop asthma.
 

Indian J Pediatr.2014 Jun 13. [Epub ahead of print]