《儿科学精品教学资料》4 Childhood Asthma BAOYIXIAO.pptVIP

幻灯片4 年幼儿哮喘的吸入性治疗中存在很多挑战。定量吸入器（MDIs）常被用作哮喘吸入性治疗，但是与很多主要问题有关。包括不正确的吸入技巧，诸如吸入前没有呼气，没有充分的深吸气，以及吸气末没有屏气。2，6 5岁及以下的小儿给予皮质激素吸入治疗时，推荐使用带有面罩的储雾罐/延长器。2这种方法较单用MDI容易，但仍需要喷药和吸药的协调，装置亦庞大，装置的不同药物的输出量也不同。雾化器与其它装置相比，较少依赖于病人的协调或合作，因此推荐给予幼龄儿色甘酸时使用。雾化器也常常用于β2激动剂的给药。这些装置昂贵，庞大，药物的输出量不一。2 由于雾化吸入的过程沉闷而且时间长，有时不为幼儿所接受。7 这些困难因为限制了药物达到肺部的数量而达不到治疗效果，因此很重要6 Ref 2, p 67B Ref 6, pp 544A,B, 548A Ref 2, pp 96A, 69A, 69B Ref 7, p 1060D Ref 6, p 542A 美国跳水名将洛加尼斯的跳水身姿。 美国田径七项全能冠军乔伊娜同样是哮喘患者。 Diagnostic Criteria of Childhood Asthma Children older than 3 years, recurrent wheezing Prolongation of the expiratory phase and expiratory wheezing Disease improvement after the use of inhaled bronchodilators Excluded are other diseases which can also cause wheezing, dyspnea and cough Diagnostic Criteria of Infant’s Asthma Children younger than 3 years, more than three episodes of wheezing （ 2 scores ） Acute asthma exacerbation （ 1 score ） Prolongation of the expiratory phase and wheezing can be heard by chest auscultation （ 2 scores ） A history of allergic disease, such as allergic rhinitis and atopic dermatitis （ 1 score ） A family history of allergic disease （ 1 score ） ≥5 scores is assigned to diagnose asthma ≤4 scores or just two episodes of wheezing is assigned to diagnose suspicious asthma or asthmatic bronchitis Wheezing decreases or disappears following bronchodilators use scored 2 Categories of Asthma Severity The most severe asthma may be categorized for patients who present with all the features above. Step Severity Symptoms Nighttime symptoms Lung function FEV1/PEF % predicted PEF variability 1 Mild intermittent ≤2 times per week ≤2 times per month ≥80% 20% 2 Mild persistent 2 times per week 2 times per month ≥80% 20%-30% 3 Moderate persistent Daily symptoms 1 times per week 60%-80% 30% 4 Severe persistent Continuous symptoms Limited physical activity Frequent ≤60% 30% Differential diagnosis Viral bronchiolitis Tuberculosis of trachebronchial lymph nodes Foreign body Co