在成年人中诊断和治疗喘:一篇综述
Jennifer L McCracken1, Sreenivas P Veeranki2, Bill T Ameredes3
1Division of Allergy and Clinical Immunology, University of Texas Medical Branch, Galveston.
JAMA
|July 19, 2017
概括
有效的喘诊断,监测和治疗对于改善成人患者的状况至关重要
科学领域:
- 肺病学
- 过敏和免疫学
- 临床医学
背景情况:
- 喘影响7.5%的成年人,呈现为异质呼吸综合征,有喘息,呼吸困难和咳.
- 诊断包括症状评估和精神测量以确认可逆性气道阻塞.
- 鉴定过敏原敏感性对于个性化喘治疗具有临床意义.
研究的目的:
- 总结目前基于证据的成人喘诊断,监测和治疗策略.
- 突出个性化治疗对改善患者结果的重要性.
- 从标准护理到先进的生物药物提供可用的治疗方案.
主要方法:
- 对目前有关喘管理的医学文献和临床指导方针的审查.
- 诊断标准的分析,包括精神测量和过敏原敏感性测试.
- 治疗干预措施的评估,包括吸入的皮质类固醇,长效支气管扩展剂和生物药物.
主要成果:
- 持续性喘的标准治疗包括吸入性皮质类固醇 (ICS) 和短效β-激动剂 (SABA) 以缓解症状.
- 当单独的ICS不足时,组合治疗 (ICS + 长效β- 激动剂) 是有效的.
- 不建议单独使用长效β激动剂 (LABA);其他控制剂包括tiotropium和生物药物,如奥马利祖马布,梅波利祖马布和reslizumab.
结论:
- 喘治疗需要解决呼吸道阻塞,过度反应和炎症.
- 一致的每日控制药物,避免环境因素,及时缓解症状是关键.
- 严重的喘病例需要专家咨询,并考虑先进的治疗方法,包括生物药物.
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