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1、GINA guide reading,- 2014 content related to childhood asthma,The definition of asthma:,Asthma is a heterogeneous disease characterized by chronic airway inflammation. With breathing, shortness of breath, chest tightness and cough history of respiratory symptoms, with variable constrained, expirator
2、y flow intensity of respiratory symptoms and may change over time,Classification of asthma,Allergic asthma No allergic asthma Late onset asthma With fixed limited airflow of asthma With obesity asthma,Allergic asthma:,It Is the most easy to recognize asthma phenotypes, usually begins in childhood, w
3、ith personal or family history of allergic diseases, such as eczema, allergic rhinitis, food or drug allergies.This part of the patients before treatment induced sputum examination, often hint eosinophilic airway inflammation.This part of patient response to inhaled corticosteroids (ICS) therapy is
4、better.,No allergic asthma:,refers to some occur in adults, has nothing to do with allergic asthma.Induced sputum examination may be neutrophils, eosinophils, or only a few inflammatory cells of ICS poor response to treatment.,Late onset asthma:,some adults, adult women, in particular, for the first
5、 time in adulthood of asthma. This part of the patients have no allergy, and requires high dose of ICS therapy or ICS relative refractory.,With fixed limited airflow of asthma:,some long-term asthma patients, limited development for fixed air, may be associated with airway remodeling.,With obesity a
6、sthma:,some obese patients with asthma, have obvious respiratory symptoms,but almost no eosinophilic airway inflammation.,The diagnosis of asthma,Asthma diagnosis is still a difficult problem, GINA2014 version will asthma diagnosis according to the age, is divided into 5 years old and under, and 6 y
7、ears old and above two parts.,About 6 years old and above the diagnosis of childhood asthma,For more than 6 years of age and the diagnosis of childhood asthma, shows the flow chart of initial diagnosis of asthma, the author thinks that, the flow chart is of great help to the diagnosis of childhood a
8、sthma.In diagnostic highlights the two points, namely “variable respiratory symptoms“ and “variable limited expiratory flow“, and combined closely with the definition of asthma. First, symptoms to fits a pattern of asthma symptoms, and can change history of respiratory symptoms, including with the c
9、hange of time and the change in intensity. Second, the determination of the expiratory flow constrained variable, mainly reflected in the lung function index (FEV1 and PEF) response to bronchodilator and bronchial provocation tests.At the same time puts forward the childrens daytime PEF variation ra
10、te 13%, can be used as diagnostic variable limited the airflow of one of the indicators.Bronchial provocation tests positive for undiagnosed asthma, because its can be seen in diseases such as allergic rhinitis, cystic fibrosis, BPD.,On the diagnosis of children under 5 years of age and asthma 1,Chi
11、ldren under the age of five asthma diagnosis is still very difficult, is the difficulty in the diagnosis of asthma children.The new guidelines will children under the age of five the diagnosis and management of asthma as a chapter expounds separately, is first proposed in 2009 2 “5 years of age and
12、children under the age of five the diagnosis and management of asthma“ for the first time update, emphasizes the children asthma with virus induced breathing to identify and diagnose, long-term management plan was formulated.Breathing is children under the age of five years one of the most common re
13、spiratory symptoms, and have certain heterogeneity, and most associated with viral infection, so to identify the virus infection after first or recurrent wheeze and asthma are still very difficult.In 2009, on the basis of the new guidelines proposed model support the diagnosis of asthma symptoms, sy
14、mptoms of the model is not appear at the same time, but over time, dynamic observation is needed.,On the diagnosis of children under 5 years of age and asthma 2,For after virus infection symptoms (cough, wheezing, heavy breathing) less than 10 d, 1 year 2 3 times, attack interphase asymptomatic, mor
15、e inclined to the diagnosis of virus induced breathing.Symptoms and more than 10 d, 1 year attacks more than 3 times and (or) the night is aggravating, interphase movement or laugh after onset symptoms, and with atopic constitution or family history of asthma, more inclined to the diagnosis of asthm
16、a.On the basis of this model, according to the response against asthma therapy, can be further clear diagnosis.Previous guidelines for children under the age of five in lung function description is less, the new guidelines for special shows for children aged 4 5, under the guidance of experienced te
17、chnicians can complete pulmonary function testing, to determine limited airflow, emphasized the importance of lung function testing in the diagnosis of childhood asthma.For 1 5 years old children, and under the feasible humidity breathing the breath of nitric oxide (FeNO) detection, and studies have shown that repeated wheezing and coughing symptoms of pre-school children, if increased FeNO persists for more than 4 weeks after the upper respiratory tract infection, predictable school-age asthma.,
