Diagnosis, evaluation and monitoring of asthma.
Diagnosis, evaluation and monitoring of asthma.
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哮喘的诊断、评估和监测。
DOI：
10.2332/allergolint.12-ed-0483
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发表时间：
2012
影响因子：
6.8
通讯作者：
H. Saito
中科院分区：
文献类型：
--
作者：
J. Tamaoki;H. Saito
哮喘是一种常见的疾病，诊断、严重程度和疾病的控制可以主观和客观地确定。在初级保健中假设反复呼吸困难是由于哮喘引起的是很重要的。在没有明确诊断和仔细监测疾病的情况下进行治疗可能会产生不必要的副作用和成本，并且可能无法识别和解决真实的问题。对患者进行体格检查是诊断哮喘的最初步骤之一，其中异常肺音包括喘息和干啰音是特征性的。在本期《国际变态反应学》中，Nagasaka 1描述了肺音频率和/或强度的增加与中央气道中的气道壁振荡和涡旋脱落相关，并且这种变化可能对气道狭窄比喘息和干啰音的出现更敏感。[2]他还强调了用力呼气喘息的重要性，这是轻度哮喘患者气道阻塞的早期迹象，并指出最近开发的计算机化和自动化肺音分析在疾病管理中可能有用。3有充分的证据表明，内源性一氧化氮（NO）在调节气道功能中起作用，并且通过气道中的炎性细胞因子和介质可以容易地在呼出气中监测NO的上调。Munakata 4在这个问题中暗示呼出的NO（FeNO）是气道炎症的非侵入性标志物。在哮喘中，FeNO升高适度反映了嗜酸性粒细胞介导的炎症通路，并预测对吸入性皮质类固醇治疗的良好反应。5
Asthma is a common condition, and diagnosis, severity, and control of the disease can be determined both subjectively and objectively. It is important to assume that recurrent breathlessness is due to asthma in primary care. Treatment without a definite diagnosis and a careful monitoring of the disease risks unnecessary side effects and costs, and may fail to identify and address the real issue. Physical examination of the patient is one of the initial steps to diagnose asthma, where abnormal lung sounds including wheezing and rhonchi are characteristic. In this issue of Allergology International, Nagasaka 1 describes that an increase of the frequency and or intensity of lung sounds is associated with airway wall oscillation and vortex shedding in central airways, and that this change may be more sensitive to airway narrowing than the appearance of wheezing and rhonchi. 2 He also emphasizes the importance of a forced expiratory wheeze, which is an early sign of airway obstruction in patients with mild asthma, and points out possible usefulness of a recently developed computerized and automated analysis of lung sound in the management of the disease. 3 There is ample evidence that endogenous nitric oxide (NO) plays a role in regulating airway function and that upregulation of NO by inflammatory cytokines and mediators in the airways can be monitored easily in exhaled air. Munakata 4 implicates in this issue that exhaled NO ( FeNO ) is a non-invasive marker of airway inflammation. In asthma, increased FeNO reflects eosinophil-mediated inflammatory pathways moderately well and predicts good responses to treatment with inhaled corticosteroid. 5