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hej The diagnosis and management Asthma 黄尔炯 浙江大学医学院临床医学三系0403 Definition Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. The chronic inflammation is associated with airway hyperresponsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing，particularly at night or in the early morning. These episodes are usually associated with widespread, but variable, airflow obstruction within the lung that is often reversible either spontaneously or with treatment. Asthma Diagnosis A clinical diagnosis of asthma is often prompted by symptoms such as episodic breathlessness, wheezing, cough, and chest tightness. Measurements of lung function (spirometry or peak expiratory flow) provide an assessment of the severity of airflow limitation, its reversibility, and its variability, and provide confirmation of the diagnosis of asthma. Measurements of allergic status can help to identify risk factors that cause asthma symptoms in individual patients. For patients with symptoms consistent with asthma, but normal lung function, measurement of airway responsiveness may help establish the diagnosis. Asthma Diagnosis 1.反复发作性喘息、呼吸困难、胸闷或咳嗽，多与接触变应原、冷空气、物理化学剌激、病毒感染、运动等有关 2.发作时双肺可闻及散在或弥漫性，以呼气相为主的哮鸣音，呼气相延长。 3.上述症状可经治疗或自行缓解 4.症状不典型者(如无明显喘息和体征)至少应有下列三项中的一项阳性∶（1）支气管激发试验或运动试验阳性；（2）支气管舒张试验阳性；（3）呼气流量峰值（PEF）日内变异率或昼夜波动率≥20％ 5.除外其他疾病所引起的喘息、胸闷和咳嗽 符合1～4条或4、5条者，可诊断 Asthma Severity Asthma has been classified by severity in previous reports. However, asthma severity may change overtime, and depends not only on the severity of the underlying disease but also its responsiveness to treatment. To aid in clinical management, a classification of asthma by level of control is recommended. ASTHMA MEDICATIONS Medications to treat asthma can be classified as controllers or relievers. Controllers are medications taken daily on a long-term basis to keep asthma under clinical control chiefly through their anti