"Reactive airways disease". A lazy term of uncertain meaning that should be abandoned.
"Reactive airways disease". A lazy term of uncertain meaning that should be abandoned.
复制标题
“反应性气道疾病”。
DOI：
10.1164/ajrccm.163.4.2005049
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发表时间：
2001
期刊：
影响因子：
--
通讯作者：
O'Byrne,PM
中科院分区：
文献类型：
--
作者：
Fahy,JV;O'Byrne,PM
近年来，术语“反应性气道”和“反应性气道疾病”已经悄悄进入临床词汇。它们被用作哮喘的同义词。这些术语广泛用于门诊和住院患者，甚至重症监护病房的病例介绍。它们特别常用于儿科环境。问题是“反应性气道”和“反应性气道疾病”是高度非特异性的术语，没有临床意义。因此，我们认为这些术语没有帮助，而且可能有害，我们建议不要使用它们。如果患者有咳嗽、咳痰、喘鸣或呼吸困难的病史，则通常标记为“反应性气道”。然而，有时候，诊断为“反应性气道疾病”的唯一提示是患者拥有某种吸入器。大多数情况下，使用这些术语的医生没有患者的肺功能测试结果。当然，很少有患者测量气道对乙酰甲胆碱、组胺或高渗盐水的反应性。因此，仅配备与气道相关的症状或吸入器使用史，医生将在查房时或在图表中，在信件中或在出院总结中说明患者患有“反应性气道疾病”。不幸的是，这种诊断往往没有受到质疑。事实上，这个词越来越多地被肺部医学专家所使用。术语“反应性气道疾病”需要与反应性气道功能障碍综合征（RADS）和气道高反应性区分开来，这两个术语在肺部医学中具有价值和意义。RADS是布鲁克斯及其同事（1）于1985年创造的一个特定术语，用于描述单次暴露于高水平刺激性蒸汽、烟雾或烟雾后发生的哮喘样疾病。RADS患者有乙酰甲胆碱气道高反应性，但其他肺功能检查可能异常，也可能不异常。症状和气道高反应性可以持续数年后，定罪暴露。RADS与职业性哮喘的不同之处在于，它通常发生在单次暴露之后，而没有之前的致敏期。值得注意的是，并非所有专家都同意RADS是一种真实的临床综合征（2），他们认为该实体是基于缺乏对照组的病例报告，通常缺乏暴露前肺功能评估。然而，当前科学证据的重要性支持RADS是一种独特的临床实体，并且该疾病目前被美国胸科学会和美国胸科医师学院认为是独特的（3）。气道高反应性也是一个特定术语，意味着气道对各种刺激物反应过度，包括醋甲胆碱、组胺、高渗盐水、蒸馏水、运动、或正常碳酸血症性换气过度（4）。在这种情况下，高反应性是指在通常没有支气管收缩作用的“剂量”下的支气管收缩反应。气道高反应性实际上包括气道敏感性（FEV 1开始下降的激动剂剂量）和气道高反应性（此后剂量-反应曲线的斜率）。气道高反应性是哮喘的一个特征，慢性阻塞性肺疾病（COPD）的程度较轻（5），但也在过敏性鼻炎（6）患者中有描述，但没有哮喘，囊性纤维化（7），甚至在肠易激综合征（8）。因此，尽管气道高反应性是一个具有明确含义的高度特异性术语，但它不是疾病诊断;相反，它代表气道的生理异常。然而，它是一个重要的组成部分...
The terms “reactive airways” and “reactive airways disease” have crept into the clinical lexicon in recent years. They are being used as synonyms for asthma. The terms are widely used in case presentations involving outpatients and inpatients, and even patients in intensive care units. They are in particular commonly used in the pediatric setting. The problem is that “reactive airways” and “reactive airways disease” are highly nonspecific terms that have no clinical meaning. As such, we view these terms as unhelpful and potentially harmful, and we recommend that they not be used. Patients are usually labeled with “reactive airways” if they have a history of cough, sputum production, wheeze, or dyspnea. Sometimes, however, the only prompt for a diagnosis of “reactive airways disease” is the possession by the patient of an inhaler of some sort. Most often, physicians who use the terms do not have pulmonary function test results for the patient. Certainly, it is very rare that patients have had measurement of airway reactivity to methacholine, histamine, or hypertonic saline. Therefore, armed only with symptoms referable to the airway, or with a history of inhaler use, the doctor will present on rounds or write in the chart, in letters, or in discharge summaries that the patient has “reactive airways disease.” Unfortunately, this diagnosis often goes unchallenged. In fact, increasingly the term is being commonly used among specialists in pulmonary medicine. The term “reactive airways disease” needs to be distinguished from reactive airways dysfunction syndrome (RADS) and from airway hyperreactivity—two terms that have value and meaning in pulmonary medicine. RADS is a specific term coined by Brooks and coworkers (1) in 1985 to describe an asthma-like illness developing after a single exposure to high levels of an irritating vapor, fume, or smoke. Patients with RADS have methacholine airway hyperreactivity, but other pulmonary function tests may or may not be abnormal. Symptoms and airway hyperreactivity can persist for years after the incriminating exposure. RADS differs from occupational asthma in that it typically occurs after a single exposure without a preceding period of sensitization. It should be noted that not all experts agree that RADS is a real clinical syndrome (2), arguing that the entity is based on case reports that lack control groups and that usually lack preexposure pulmonary function assessment. However, the weight of current scientific evidence supports RADS as a distinct clinical entity, and the disorder is currently recognized as distinct by the American Thoracic Society and the American College of Chest Physicians (3).Airway hyperreactivity is also a specific term that means that the airways are hyperreactive to a variety of stimuli including methacholine, histamine, hypertonic saline, distilled water, exercise, or eucapnic hyperventilation (4). Hyperreactivity in this context means a bronchoconstrictor response at “doses” that normally have no bronchoconstrictor effect. Airway hyerreactivity actually encompasses both airway sensitivity (the dose of agonist at which the FEV1 begins to fall) and airway hyperresponsiveness (the slope of the dose–response curve thereafter). Airway hyperreactivity is a characteristic of asthma and to a lesser extent of chronic obstructive pulmonary disease (COPD)(5), but has also been described in patients with allergic rhinitis (6), but no asthma, in cystic fibrosis (7), and even in irritable bowel disease (8). Thus, although airway hyperreactivity is a highly specific term with definite meaning, it is not a disease diagnosis; rather it represents a physiological abnormality of the airway. It is, however, an important component …