婴幼儿期哮喘的早期诊断思路及治疗策略2012,6,济南新.pptVIP

A simple tool to identify infants at high risk of mild to severe childhood asthma: the persistent asthma predictive score Three parameters independently predicted persistent asthma: — family history of asthma, — personal atopic dermatitis, — multiple allergen sensitizations. 42% sensitivity, 90% specificity, 67% positive predictive value, 76% negative predictive value for the prediction of persistent asthma. Stepwise Management in Children Less Than 5 Years 难治性哮喘的新分类 1. Untreated severe asthma （未治疗的重度哮喘） 2. Difficult-to-treat severe asthma （难治疗的重度哮喘） 3. Treatment-resistant severe asthma （治疗抵抗的重度哮喘） asthma that is easily controlled once the appropriate medication and adequate adherence and technique are set in place. This may enable them to achieve a less severe form of asthma in the presence of adequate therapy to which they respond. characterized by a partial or poor response to treatment that reflects the presence of factors other than asthma alone, such as —poor access to treatment, — poor adherence, — poor inhalation technique, — environmental exposures, — psychosocial issues. （1) Those who are partially or poorly controlled despite high-dose inhaled corticosteroid or a high-dose inhaled corticosteroid/long-acting β-adrenergic agonist combination and frequent or chronic use of systemic corticosteroids.(previously called refractory or severe asthma). * 3~5岁儿童 （1）首选吸入糖皮质激素，布地奈德（budesonide）100–200μg×2，或氟替卡松（fluticasone）50–125μg×2； （2）短效β2-激动剂沙丁胺醇（salbutamol）0.1 mg/喷，或特布他林（terbutaline） 0.25 mg/喷，每4h一次，每次1–2喷； （3）对于间歇或轻度持续性哮喘儿童，LTRA可替代ICS单独给予； PRACTALL consensus report. Allergy, 2008, 63(1):5–34. * 3~5岁儿童 (4）如果ICS控制不理想，需加用LTRA（montelukast）4 mg/d。 （5）如上述治疗仍未控制，则需要考虑以下措施： ①增加LABA（至少是间歇性使用；虽然在该年龄组