DefinitionofAsthma文档格式.docx

DefinitionofAsthma文档格式.docx

《DefinitionofAsthma文档格式.docx》由会员分享，可在线阅读，更多相关《DefinitionofAsthma文档格式.docx（4页珍藏版）》请在冰豆网上搜索。

investmentinpreventionmedicationlikelytoyieldcostsavingsinemergencycareWorldwideVariationinPrevalenceofAsthmaSymptomsInternationalStudyofAsthmaandAllergiesinChildren（ISAAC）Lancet1998;

351:

1225IncreasingPrevalenceofAsthmainChildren/Adolescents051015202530351992198219891975199219821994198919921982199219821991197919891966Finland（Haahtelaetal）Sweden（Abergetal）Japan（Nakagomietal）Scotland（Ronaetal）UK（Omranetal）USA（NHIS）NewZealand（Shawetal）Australia（Peatetal）{Prevalence（%）{{{{{{{Theprevalence,hospitalizationratesandmortalityinUSA.70605040302085868788899091929394Rate/1,000PersonsYear1818-4445-6465+Total（AllAges）Age（years）TrendsinPrevalenceofAsthmaByAge,U.S.,1985-1996959680HospitalizationRatesforAsthmabyAge,U.S.,1974-19974035302520157476788082848688Rate/100,000Persons10509092941515-4445-6465+96Year4311980Rate/100,000PersonsYear201985199019952019BlackMaleWhiteFemaleWhiteMaleBlackFemaleDeathRatesforAsthmaByRace,Sex,U.S.,1980-19985RiskFactorsforAsthmaHostfactors:

predisposeindividualsto,orprotectthemfrom,developingasthmaEnvironmentalfactors:

influencesusceptibilitytodevelopmentofasthmainpredisposedindividuals,precipitateasthmaexacerbations,and/orcausesymptomstopersistFactorsthatExacerbateAsthmaAllergensAirPollutantsRespiratoryinfectionsExerciseandhyperventilationWeatherchangesSulfurdioxideFood,additives,drugsRiskFactorsthatLeadtoAsthmaDevelopmentHostFactorsGeneticpredispositionAtopyAirwayhyper-responsivenessGenderRace/EthnicityEnvironmentalFactorsIndoorallergensOutdoorallergensOccupationalsensitizersTobaccosmokeAirPollutionRespiratoryInfectionsParasiticinfectionsSocioeconomicfactorsFamilysizeDietanddrugsObesityAsthmaDiagnosisHistoryandpatternsofsymptomsPhysicalexaminationMeasurementsoflungfunctionMeasurementsofallergicstatustoidentifyriskfactorsClassificationofSeverityCLASSIFYSEVERITYClinicalFeaturesBeforeTreatmentSymptomsNocturnalSymptomsFEV1orPEFSTEP4SeverePersistentSTEP3ModeratePersistentSTEP2MildPersistentSTEP1IntermittentContinuousLimitedphysicalactivityDailyAttacksaffectactivity1timeaweekbut1timeaday1timeaweekAsymptomaticandnormalPEFbetweenattacksFrequent1timeweek2timesamonth2timesamonth60%predictedVariability30%60-80%predictedVariability30%80%predictedVariability20-30%80%predictedVariability20%Thepresenceofonefeatureofseverityissufficienttoplacepatientinthatcategory.Six-PartAsthmaManagementProgram1.Educatepatientstodevelopapartnershipinasthmamanagement2.Assessandmonitorasthmaseveritywithsymptomreportsandmeasuresoflungfunctionasmuchaspossible3.Avoidexposuretoriskfactors4.Establishmedicationplansforchronicmanagementinchildrenandadults5.Establishindividualplansformanagingexacerbations6.Provideregularfollow-upcareSix-partAsthmaManagementProgramGoalsofLong-termManagementAchieveandmaintaincontrolofsymptomsPreventasthmaepisodesorattacksMaintainpulmonaryfunctionasclosetonormallevelsaspossibleMaintainnormalactivitylevels,includingexerciseAvoidadverseeffectsfromasthmamedicationsPreventdevelopmentofirreversibleairflowlimitationPreventasthmamortalitySix-partAsthmaManagementProgramControlofAsthmaMinimal（ideallyno）chronicsymptomsMinimal（infrequent）exacerbationsNoemergencyvisitsMinimal（ideallyno）needforasneededuseof2-agonistNolimitationsonactivities,includingexercisePEFcircadianvariationoflessthan20percent（Near）normalPEFMinimal（orno）adverseeffectsfrommedicineSix-PartAsthmaManagementProgramThemosteffectivemanagementistopreventairwayinflammationbyeliminatingthecausalfactorsAsthmacanbeeffectivelycontrolledinmostpatients,althoughitcannotbecuredThemajorfactorscontributingtoasthmamorbidityandmortalityareunder-diagnosisandinappropriatetreatment.Six-PartAsthmaManagementProgramAnyasthmamoreseverethanintermittentasthmaismoreeffectivelycontrolledbytreatmenttosuppressandreverseairwayinflammationthanbytreatmentonlyofacutebronchoconstrictionandsymptomsTypicalSpirometric（FEV1）Tracings1Time（sec）2345FEV1VolumeNormalSubjectAsthmatic（AfterBronchodilator）Asthmatic（BeforeBronchodilator）Note:

EachFEV1curverepresentsthehighestofthreerepeatmeasurementsASimpleIndexofPEFVariationPEF（L/min）300400500600700800Days7014LowestmorningPEF（570）HighestPEF（670）MorningPEFEveningPEFMinimummorningPEF（%recentbest）:

570/670=85%（FromReddel,H.K.etal.1995）Six-partAsthmaManagementProgramPart3:

AvoidExposuretoRiskFactorsMethodstopreventonsetofasthmaarenotyetavailablebutthisremainsanimportantgoalMeasurestoreduceexposuretocausesofasthmaexacerbations（e.g.allergens,pollutants,foodsandmedications）shouldbeimplementedwheneverpossibleSix-partAsthmaManagementProgramPart3:

AvoidExposuretoRiskFactorsReduceexposuretoindoorallergensAvoidtobaccosmokeAvoidvehicleemissionIdentifyirritantsintheworkplaceExploreroleofinfectionsonasthmadevelopment,especiallyinchildrenandyounginfantsPart4:

Long-termAsthmaManagementPharmacologicTherapyControllerMedications:

InhaledglucocorticosteroidsSystemicglucocorticosteroidsCromonesMethylxanthinesLong-actinginhaled2-agonistsLong-actingoral2-agonistsLeukotrienemodifiersPart4:

Long-termAsthmaManagementPharmacologicTherapyRelieverMedications:

Rapid-actinginhaled2-agonistsSystemicglucocorticosteroidsAnticholinergicsMethylxanthinesShort-actingoral2-agonistsPart4:

Long-termAsthmaManagementStepwiseApproachtoAsthmaTherapy-AdultsReliever:

Rapid-actinginhaled2-agonistprnController:

DailyinhaledcorticosteroidController:

DailyinhaledcorticosteroidDailylong-actinginhaled2-agonistController:

DailyinhaledcorticosteroidDailylongactinginhaled2-agonistplus（ifneeded）Whenasthmaiscontrolled,reducetherapyMonitorSTEP1:

IntermittentSTEP2:

MildPersistentSTEP3:

ModeratePersistentSTEP4:

SeverePersistentSTEPDownOutcome:

AsthmaControlOutcome:

BestPossibleResultsAlternativecontrollerandrelievermedicationsmaybeconsidered（seetext）.Controller:

None-Theophylline-SR-Leukotriene-Long-actinginhaled2-agonist-OralcorticosteroidRecommendedAsthmaMedicationsStep1:

AdultsSeverityDailyControllerMedicationsOtherOptions（inorderofcost）Step1:

IntermittentNoneNoneRelieverMedication:

Rapid-actinginhaled2-agonistprn,notmorethan3-4timesaday.Oncecontrolisachievedandmaintainedforatleast3months,gradualreductionoftherapyshouldbetried.RecommendedAsthmaMedicationsStep2:

AdultsSeverityDailyControllerMedicationsOtherOptions（inorderofcost）Step2:

MildPersistentInhaledglucocorticosteroid（500gBDPorequivalent）Sustained-releasetheophylline,orCromone,orLeukotrienemodifierRelieverMedication:

Rapid-actinginhaled2-agonistprn,notmorethan3-4timesaday.Oncecontrolisachievedandmaintainedforatleast3months,gradualreductionoftherapyshouldbetried.RecommendedAsthmaMedicationsStep3:

AdultsSeverityDailyControllerMedicationsOtherOptions（inorderofcost）Step3:

ModeratepersistentInhaledglucocorticosteroid（2001000gBDPorequivalent）pluslong-actinginhaled2-agonistInhaledglucocorticosteroid（5001000gBDPorequivalent）plussustained-releasetheophylline,orInhaledglucocorticosteroid（5001000gBDPorequivalent）pluslong-actinginhaled2-agonist,orInhaledglucocorticosteroidathigherdoses（1000gBDPorequivalent）,orInhaledglucocorticosteroid（5001000gBDPorequivalent）plusleukotrienemodifierRelieverMedication:

Rapid-actinginhaled2-agonistprn,notmorethan3-4timesaday.Oncecontrolisachievedandmaintainedforatleast3months,gradualreductionoftherapyshouldbetried.RecommendedAsthmaMedicationsStep4:

AdultsSeverityDailyControllerMedicationsOtherOptionsStep4SeverepersistentInhaledglucocorticosteroid（1000gBDPorequivalent）pluslong-actinginhaled2-agonistplusoneormoreofthefollowing,ifneeded:

-Sustained-releasetheophylline-Leukotrienemodifier-Long-actingi