哮喘联盟

   摘要
   前言：很多近来研究结果表明，相当一部分哮喘患者的病情并没有得到很好地控制。虽然我们讨论过一些哮喘患者治疗失败的原因，但是，关于哮喘是否诊断准确这一基本的问题却很少被关注。随访研究显示，虽然很多哮喘患者表现出持续的症状，但他们并没有被明确诊断为哮喘。除支气管阻塞外的其它机制可能是其未被及时诊断的原因。目前对于哮喘的定义除了与支气管阻塞这个典型相关的症状外，可能还包括了其它与机制相关的症状表现。
   目的：基于对哮喘四大基石炎症反应、气道高反应性、支气管阻塞、临床症状的回顾，-本研究旨在（提出一些与成年非过敏性哮喘诊断相关的新的观点和建议。
   结论：最近的一些研究表明，“经典”意义上的哮喘有时候会与一些类似哮喘的疾病混淆，如气道敏感性增高、小气道疾病、呼吸功能障碍、非阻塞性呼吸困难、过度通气和声带功能异常等。这种混淆可能是哮喘误诊和治疗失败的主要原因之一。目前对于诊断哮喘的诊断依据侧重于支气管阻塞方面，这个限定可能太过于狭隘。我们建议将哮喘相关机制扩展到一些非阻塞性障碍，表现为哮喘症状。而该策略的实施需要额外的诊断流程，比如对报道的相关症状进行定性研究、开发不费力的肺功能检测试验、利用辣椒素试验评估气道高反应性、皮质类固醇在诊断和治疗效果的仔细评估以及对现有建议性理论测试的评估等。
 

（杨冬 审校）
J Asthma. 2014 Dec 5:1-17. [Epub ahead of print]

 

Diagnosis of asthma - new theories.
 

Löwhagen OT1.
 

ABSTRACT
INTRODUCTION：Recent studies have shown a remarkably high frequency of poorly controlled asthma. Several reasons for this treatment failure have been discussed, however, the basic question of whether the diagnosis is always correct has not been considered. Follow-up studies have shown that in many patients asthma cannot be verified despite ongoing symptoms. Mechanisms other than bronchial obstruction may therefore be responsible. The current definition of asthma may also include symptoms that are related to mechanisms other than bronchial obstruction, the clinical hallmark of asthma.
AIM：Based on a review of the four cornerstones of asthma - inflammation, hyperresponsiveness, bronchial obstruction, and symptoms - the aim was to present some new aspects and suggestions related to the diagnosis of adult non-allergic asthma.
CONCLUSION： Recent studies have indicated that "classic" asthma may sometimes be confused with asthma-like disorders such as airway sensory hyperreactivity, small airways disease, dysfunctional breathing, non-obstructive dyspnoea, hyperventilation, and vocal cord dysfunction. This confusion may be one explanation for the high proportion of misdiagnosis and treatment failure. The current diagnosis, focusing on bronchial obstruction, may be too "narrow". As there may be common mechanisms a broadening to include also non-obstructive disorders, forming an asthma syndrome, is suggested. Such broadening requires additional diagnostic steps, such as qualitative studies with analysis of reported symptoms, non-effort demanding methods for determining lung function, capsaicin test for revealing airway sensory hyperreactivity, careful evaluation of the therapeutic as well as diagnostic effect of corticosteroids and testing of suggested theories.
 

J Asthma. 2014 Dec 5:1-17. [Epub ahead of print]