儿童哮喘诊断和监测幻灯片.ppt

* * * Slide 8. Onset of Symptoms in Children With Asthma More than 30% of children who experience respiratory symptoms by age 4 are diagnosed with asthma in childhood.7 Approximately 10% of young children are affected by asthma. Of these children, 30% will have an onset of symptoms within the first year of life.8 Approximately 50% of children with asthma experience symptom onset by age 2 years, and 70% do by age 3 years.9 但是如何才能尽早识别哮喘呢？难题在于确定哮喘真正的起病时间。 我们知道，大多数5岁以下儿童会出现反复发作的喘息，1年大概6-8次，通常还可能伴随着典型的病毒性上呼吸道感染。由于喘息在该年龄段儿童中具有较高的异质性，并非所有的喘息均会提示哮喘诊断，我们也难以确定伴随病毒感染的喘息是否就是哮喘的早期表现。 * * Interrupter resistance (Rint)，脉冲振荡（impulse oscillometry. IOS） * * FeNO水平与过敏状态密切相关，但不能有效区分不同种类过敏性疾病人群(如过敏性哮喘、变应性鼻炎、变应性皮炎)，且哮喘与非哮喘儿童FeNO水平有一定程度重叠，因此FeNO是非特异性的哮喘诊断指标。 * ABSTRACT Background and objective: Fractional exhaled nitric oxide (FeNO) has been used as a marker for airway inflammation. We evaluated the association between FeNO levels and asthma exacerbations (AEs) in Thai children and young adults. Methods: This was a prospective cohort study in patients with atopic asthma aged 7–20 years. Asthma control level and management were evaluated every 3 months for 1 year. Spirometry and FeNO measurements were performed at baseline, and 6 and12 months.Results: In all, 70 patients (median age: 12.6 (7.2–19.8)years) were enrolled, of whom 18% had an AE during the study period. Median FeNO levels were significantly higher in patients with an AE than in those without an AE (35.6 ppb vs 16.5 ppb; P = 0.012). FeNO of 31 ppb provided optimal sensitivity (92.3%) and specificity (75.4%) for AE prediction. Sensitivity and specificity of FeNO levels were higher than those of forced expiratory volume in 1 s and forced expiratory flow at 25–75% of forced vital capacity bronchodilator reversibility for the prediction of an AE, but the difference was not significant (P = 0.121). None of the patients with FeNO level of 0–20 ppb had an AE within 12 months. Percentage of patients with FeNO of 21–40 pp