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Must know!Summary of 6 special types of asthma diagnosis and treatment

Asthma is a chronic airway inflammatory disease involved in multiple cells and cell components. The clinical manifestations are recurrent asthma, anxiety, accompanied by or not with chest tightness or cough. The restricted airflow can cause the airway structure to change with the extension of the disease, that is, the airway reshape. Asthma is a heterogeneous disease with different clinical phenomena.

Curchia (asthma) is a common chronic respiratory disease. In recent years, its prevalence has increased globally year by year. The results of clinical research and practice show that the standardized diagnosis and treatment of asthma, especially effective management, has an important role in improving the level of control of asthma and improving the quality of life of patients [1].

Cough mutant asthma

Cough variant Asthma (CVA) refers to a kind of unprecedented asthma with chronic cough as the unique or main clinical manifestation, without obvious asthma, shortness of breath and other symptoms, but there is a high -reactivity of airway. A number of domestic and foreign studies show that CVA is a common cause of chronic cough in adults. The results of domestic multi -center surveys show that it accounts for one -third of the cause of chronic cough [2].

The main manifestations of CVA are irritating dry cough, usually coughing more intense, and cough at night is an important feature. Some patients are seasonal. In the severe cough, it can be accompanied by poor breathing, chest tightness, and difficulty breathing. Allergic rhinitis is often accompanied by allergic rhinitis. Colds, odor, oil fume and cold air are easy to induce or aggravate cough, but this clinical characteristics do not have diagnostic value.

Positive bronchial stimulation test is the most important condition for diagnosis of CVA, but clinically pay attention to possibility of false positive and false negatives. It needs to be combined with treatment reactions. Anti -asthma treatment is effective to confirm the diagnosis. Patients with chronic cough patients who cannot conduct bronchial stimulation tests clinically, there is no characteristics of other chronic cough causes. Consid by CVA for experience treatment, but further examination should be checked when treatment is invalid. Some airway diseases such as adenoma and bronchial tuberculosis sometimes have repeated cough symptoms. They may be misdiagnosed as CVA. Pay attention to identification clinically.

The treatment principles of CVA are the same as asthma treatment. Most patients inhaled sugar corticosteroids (ICS) or ICS+long -acting β2 receptor agonist (LABA) treatment and the treatment time is more than 8 weeks. Some patients can relapse after stopping the drug and need long -term treatment. White tritenyne receptor antagonists (LTRA) treatment is effective. Oral hormone therapy is rarely required. When the CVA or ICS treatment is not effective in the inflammation of the airway, you can consider upgrading the treatment, add white trisine receptor antagonist treatment, or use low -dose oral hormone therapy for short -term use.

Chest tightness and mutant asthma

In recent years, experts in my country have found that there are unprecedented asthma with chest tightness as the unique symptoms. It is named “Chest Tightness Variant Asthma (CTVA) [3] [3]. It can be induced after the activity. Some patients have more frequent attacks at night, without repeated asthma, such as asthma, and other typical asthma performance, which is often accompanied by anxiety. There is no eccatuarous sound in the lung auscultation, which has the pathophysiological characteristics of airway high reactivity, reversible air flow, and typical asthma [4], and is effective for ICS or ICS+LABA.

Peridity period of surgery

Perioperative Period is from the beginning of the patient’s decision to undergo surgical treatment, until the surgical treatment is basic until the basic recovery, about 5 ~ 7 d to 7 ~ 12 days after surgery. Sweet asthma management goals: reduce the risk of acute asthma during perioperative surgery, reduce the risk of anesthesia and surgical operational airway adverse events.

1. Preparatory preparation: Complete preoperative assessment and preparation and good control of asthma are the key to ensuring the safety of perioperative surgery. Evaluation should include symptom evaluation and acute risk assessment during surgery. For futures surgery, asthma assessment should be performed at least one week before surgery. The 2019 version of the GINA Guide recommends that all asthma patients should be performed after reaching good asthma control; for emergency surgery, the patient’s pneumatic risk and surgical necessity should be fully weighing. For all asthma patients, the perioperative surgery should be used regularly to maintain drugs. Varic hormone therapy may be more suitable for patients with emergency surgery.

2. Management during surgery: Neuromus blockers are the most common drugs that induce allergic reactions, such as Aqukakium ammonium, macarium bromide, etc., which can induce histamine release effects, and Rockel bromide is suitable for fast asthma patients to be fast. Tube intubation. As a inhaled anesthesia induction agent, seventeen fluorine has good tolerance and has the effect of bronchus diastolic effects.

3. Postoperative management: good analgesic after surgery, strengthening respiratory training, and controlling gastroesophageal reflux may help reduce the risk of acute asthma. Non -invasive positive pressure permeability may benefit for patients with asthma patients who continue to pneumatic spasm after the trachea.

Aspirin and drugs induce sexual asthma

A asthma attacks caused by certain drugs are called drug -induced asthma (DIA). Common drugs include non -steroidal anti -inflammatory drugs (NSAIDS), and other drugs include antihypertensive drugs, β -blockers, antibroxine, antibiotics, and certain biological agents.

Asthma patients can induce acute asthma after taking aspirin for a few minutes or hours. This is an incompetent phenomenon of NSAIDS represented by aspirin, called aspirin induced Asthma (AIA). After taking NSAIDS drugs such as aspirin 10 ~ 120 min, severe asthma attacks occur, often accompanied by hay, conjunctival congestion, sweating, sitting breathing, irritability or cough. Nearly 40%of AIA patients have abnormal rhinitis, nasal polyps, parathyrya, and abnormal smell. The most effective way to prevent DIA is to avoid applying this type of drug again. For those who need large dose of glucocorticoids to control the symptoms of asthma, or it is difficult to improve nasal inflammation and polyp lesions, or to take aspirin aspirin due to other diseases Asthma patients can be treated with desensitization. Controlling nasal diseases and LTRA treatment can help improve the symptoms of aspirin asthma. When clinical needs need to use NSAIDS drugs, it is recommended to consider using COX2 inhibitors.

Gestation and menstrual period asthma during pregnancy and menstrual period

Shilidal asthma during pregnancy

Sweet asthma during pregnancy refers to asthma occurred during pregnancy. About 4%~ 8%of pregnant women suffer from asthma [4], 1/3 patients with asthma are aggravated due to pregnancy, and most of them occur in the 24th to 36th weeks of pregnancy [5]; the weight increase of more than 5 kg and asthma acute in the first three months of pregnancy; The risk is positively correlated, and the risk will increase further with weight increase [6].

Pregnancy asthma not only affects pregnant women, but also affects the fetus; uncontrolled pregnancy asthma can cause pregnancy or pregnancy hypertrophic disease, but also increase the incidence of mortality, premature birth and low weight children perimage. The status quo of control management is not optimistic.

The principle of asthma treatment during pregnancy is the same as typical asthma. Based on pregnancy safety considerations, drug selection should be cautious; discontinued ICS during pregnancy can lead to acute asthma. LTRA can reduce symptoms and does not increase the risk of premature birth. Supplementing an appropriate amount of vitamin D in the early pregnancy can reduce the occurrence of asthma and occurrence of children with high -risk descendants. Folic acid supplements that are rich in folic acid during pregnancy diet and take recommendation levels at the same time and above will slightly improve future generations. The risk of periodic asthma.

▌ Menstrual asthma

Menstrual asthma refers to women’s asthma attacks are related to their menstrual cycle. At present, menstrual asthma and menstrual asthma are currently referred to as “menstrual asthma” [7]. diagnosis.

The principle of menstrual asthma treatment is similar to typical asthma.月经前易发作哮喘的,可在周期性哮喘发作前数天口服预防药物,如酮替芬(2次/d,每次1mg)或孟鲁司特(10 mg,1次/d);月经The internal injection of luteum muscle in a timely manner can prevent the sudden decline in the level of progesterone level; the use of hydroxyl hydroxylne is effective for those who are tight in the early stage.

Asthma combined with chronic obstructive pulmonary disease

In 2014, the Global Initiated Global Initiative (GILD) Guide to the Globe Prevention (GINA) and chronic obstructive pulmonary disease (GOLD) also proposed the concept of asthma ‐ chronic obstructive pulmonary disease syndrome (Asthma‐copd Overlap syndrome). It is characterized by clinical characteristics related to asthma and chronic obstructive pulmonary. It was later referred to as ACO. GINA 2019 believes that ACO is not a kind of disease name. It is a descriptive term that clinically has the characteristics of asthma and slow pulmonary blocks at the same time. The prevalence is 15%to 20%.

At present, ACO has no recognized diagnostic standards. Patients who meet the following standards need to consider ACO diagnosis: (1) patients with diagnosis of slow lung blocking, such as reversible airflow restrictions, exhale gas nitric oxide scores (FENO) to increase, induce induction Acids of eosinophilia granulocytes and have a history of asthma in the past, you need to consider ACO diagnosis; (2) patients who have diagnosed asthma, after 3 to 6 months of standardized treatment, there are still constant restrictions on air flow, and there is a history of harmful gas or material exposure. , High -resolution CT (HRCT) determines that there is a decline in the existence of emphysema and the dispersing function of lung function tests. The diagnosis of ACO needs to be considered.

According to the current research, ACO is not an independent disease, but coexistence of two diseases: asthma and slow lung block. ACO’s treatment recommendation combined with ICS 的Laba‐lama. At the same time, ACO treatment should include smoking quit, lung rehabilitation, vaccination and complications.

Reference materials:

[1] Chinese Medicine Society of Activity Diseases Branch. Asthma Asthma Study Group. Circini asthma prevention guide (2020 edition) [J]. Chinese tuberculosis and respiratory magazine, 2020, 43 (12): 1023-1048.doi: 10.3760/CMA.J.j.j.j.j.j.j.j.j .cn112147-20200618-00721.

[2] Lai K, Chen R, Lin J, ET Al.a Prospective, MulticeNa Survey on Causes of Chronic Cough in China [J] .Chest, 2013,143 (3): 10.1378/Chest.. 12‐0441. [3] SHEN H, HUA W, WANG PL, ET Al.a New Phenotype of Asthma: Chest Tightness as the Sole Presenting Manifestation [J] .ann Allergy Asthma Immunol 227.DOI: 10.1016/J.ANAI.2013.06.016.

[4]National Heart,Lung,Institute aB,National Asthma Education and Prevention Program Asthma and Pregnancy Working Group.NAEPP expert panel report.Managing asthma during pregnancy:recommendations for pharmacologic treatment‐2004 update[J].J Allergy Clin Immunol,2005 , 115 (1): 34 146.doi: 10.1016/j.jaci.2004.10.023.

[5] K? Llén B, Rydhstroem H, Aberg A.Asthma During Pregnancy‐‐a Popuration Based Study [J] .eur J EPIDEMIOL, 2000, 16 (2): 167‐171.doi: 10.1023/A: 1007678404911.

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[6]Ali Z,Nilas L,Ulrik CS.Excessive gestational weight gain in first trimester is a risk factor for exacerbation of asthma during pregnancy:A prospective study of 1283 pregnancies[J].J Allergy Clin Immunol,2018,141(2 ): 761‐767.doi: 10.1016/j.jaci.2017.03.040.

[7] vrieze a, postma ds, kerstjens ha.perimenstrual asthma: a syndrome with known cause or cure [j] .j allergy clin immunol, 2003, 112 (2): 271‐282.doi: 10.1067/MAI.2003.2003.2003.13.2003.2003.2003.2003.1003.1003.2003.1003.2003.2003.1003.2003.2003.1003.1003.13.2003.13.2003.13.2003.13.2003.13.2003.2003.2003.1,

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