[医学]婴幼儿喘息诊断和治疗.pptVIP

* * * Natural History of Childhood Asthma Childhood asthma often persists or recurs in adulthood, with up to 90% of children with asthma experiencing symptoms as adults. The occurrence of wheezing and other respiratory symptoms in children aged 3-4 years is significantly associated with future asthma. Most infants who wheeze have no increased risk of asthma or allergies later in life. However, for a minority of infants, early wheezing episodes may be related to future asthma. These children have elevated IgE levels during the first months of life and have lung function deficits by 6 years of age. Development of asthma may also be related to allergen sensitivity. Children who wheeze at age 6 years and who are skin-test positive to asthma-related allergens are more likely to have persistent symptoms and show hyperresponsiveness to methacholine beyond that age (and up to age 11 years). In contrast, children who wheeze at age 6 years and who are skin-test negative to allergens are much less likely to show persistent wheezing beyond the early school years. Martinez FD. Present and future treatment of asthma in infants and young children. J Allergy Clin Immunol 1999;104:S169-S174. 5岁以下儿童哮喘的长期治疗方案(图2)：对于5岁以下儿童哮喘的长期治疗，最有效的治疗药物是ICS，对于大多数患儿推荐使用低剂量ICS(第2级)作为初始控制治疗。如果低剂量ICS不能控制症状，增加ICS剂量是最佳选择。无法应用或不愿使用ICS、或伴过敏性鼻炎的患儿可选用白三烯受体拮抗剂(LTRA)。口服缓释茶碱在5岁以下儿童哮喘长期治疗中具有一定疗效，临床不应完全摒弃该药的使用，但是茶碱的疗效不如低剂量ICS，而不良反应却更显著。LABA或联合制剂尚未在5岁以下儿童中进行充分的研究。 5岁及以上儿童哮喘的长期治疗方案(图1)：我国地域广，社会经济发展很不平衡，因此联合治疗方法的选择除了考虑疗效外，还需要同时考虑地区、经济的差异。必须强调，任何年龄都不应将吸人型长效β2受体激动剂(LABA)作为单药治疗，只能在使用适量吸入糖皮质激素(ICS)时作为联合治疗使用。 * * 与口服强的松龙相比，雾化吸入布地奈德可显著改善急性哮喘患儿肺功能 随机双盲对照试验： n=80, 2-12y, 急诊就诊 A组: 沙美特罗雾化(0.15mg/kg/次)+ BUD雾化(0.8mg/次), 间隔30min1次X3次 B组:沙美特罗雾化(0.15mg/kg/次)+口服强的松龙(2mg/kg) * 与口服强的松龙相比，雾化吸入布地奈德显著降低患儿住院率及急诊室停留时间 雾化BUD口服强的松龙 * 雾化吸入布地奈德治疗儿童哮喘急性发作——小结 普米克令舒能快速有效缓解哮喘急性发作的症状 改善肺功能(PEF、FEV1等) 非危及生命急性发作，大剂量普米克令舒可替代或部分替代全身用激素 危及生命急性发作，强调使用全身激素 * 雾化吸入激素在儿童急性咳喘治疗中的应用 哮喘急性发作 婴幼儿急性喘息（包括急性毛支炎） 毛支炎后反应性气道疾病（RAD) 发作性病毒诱发喘息 感染相关咳嗽 急性