嬰幼兒喘息.盛錦云

1、2001 2001啟動啟動健康嬰兒健康嬰兒喘鳴喘鳴消退消退哮喘哮喘遺傳性過敏遺傳性過敏癥癥預(yù)防預(yù)防惡化惡化嬰兒嬰兒病毒感染病毒感染類型類型頻率頻率/嚴(yán)重程度嚴(yán)重程度年齡年齡TH1TH1變態(tài)反應(yīng)變態(tài)反應(yīng) / 哮喘哮喘TH2 變態(tài)反應(yīng)變態(tài)反應(yīng) / 哮喘哮喘患有哮喘的兒童患有哮喘的兒童或成人或成人鼻病毒鼻病毒哮喘的惡化哮喘的惡化急診急診住院住院RVRSVPIVMartinez F et al. ERJ 1998; 12: Suppl 27, 3s-8s. Sigurs N,et al.E et al. Am J Respir Crit Care Med 2005;171:13714140353025

2、20151050正常對照正常對照RSV感染患者感染患者5.437P0.001哮喘患者比例（）哮喘患者比例（）46名嬰兒期曾因名嬰兒期曾因RSV（呼吸道合胞病毒）導(dǎo)致毛細(xì)支氣管炎的患者以及（呼吸道合胞病毒）導(dǎo)致毛細(xì)支氣管炎的患者以及92例例正常對照組，隨訪至正常對照組，隨訪至13歲。歲。 ARI ARI中更多是由于鼻病毒引起中更多是由于鼻病毒引起, , 包括包括 wLRI wLRI Spiteri M,Nicod LP,Eur Respir 2002 18;1013Spiteri M,Nicod LP,Eur Respir 2002 18;1013鼻病毒和呼吸道合胞病毒都是鼻病毒和呼吸道合胞病毒

3、都是5歲發(fā)生哮喘或持續(xù)喘息的危險因素歲發(fā)生哮喘或持續(xù)喘息的危險因素Robert F. et al J Allergy Clin mmunol 2004; 114：1023鼻病毒和呼吸道合胞病毒都是鼻病毒和呼吸道合胞病毒都是5歲發(fā)生哮喘或持續(xù)喘息的危險因素歲發(fā)生哮喘或持續(xù)喘息的危險因素Robert F. et al J Allergy Clin mmunol 2004; 114：10238.06.04.02.0OddsRatiosforAsthmaNumber wLRI in first year 0 1 2無過敏無過敏 6歲時歲時有過敏有過敏 6歲時歲時每一表型的評估應(yīng)嚴(yán)格每一表型的評估應(yīng)嚴(yán)格

4、 各表型之間存在交叉各表型之間存在交叉 * *兒童也可能是特應(yīng)質(zhì)兒童也可能是特應(yīng)質(zhì)# # 不同的病源不同的病源, , 包括刺激物的暴露至今尚未證實有過敏原包括刺激物的暴露至今尚未證實有過敏原有無需要討論的問題Wicken K etal.Clin.Exp.Allergy 1999,29(6)7662.患兒已經(jīng)喘2次，又有濕疹，以及母親年幼時喘過，應(yīng)高度重視！ PRACTALL EAACI / AAAAI Consensus ReportPRACTALL=Practicing Allergology; EAACI=European Academy of Allergy and Clinical I

5、mmunology; AAAAI=American Academy of Allergy, Asthma, and Immunology. PRACTALL EAACI / AAAAI Consensus ReportAdapted from Bacharier LB, et al. Allergy. 2008;63(1):534. INSUFFICIENT CONTROLbICS(200 g BDP equivalent)LTRAa(Dose depends on age)INSUFFICIENT CONTROLcIncrease ICS dose (800 g BDP equivalent

6、)ORAdd LTRA to ICSORAdd LABAINSUFFICIENT CONTROLcStep Up Therapy to Gain ControlStep down if appropriateStep down if appropriateConsider other options Theophylline Oral corticosteroidsaLTRA may be particularly useful if the patient has concomitant rhinitis; bCheck compliance, allergy avoidance, and

7、reevaluate diagnosis;cCheck compliance and consider referring to specialist.ICS=inhaled corticosteroids; LTRA=leukotriene receptor antagonist; BDP=beclomethasone dipropionate; LABA=long-acting 2-agonist.Adapted from Bacharier LB, et al. Allergy. 2008;63(1):534.Increase ICS dose (400 g BDP equivalent

8、)ORAdd ICS to LTRAPRACTALL EAACI / AAAAI Consensus ReportOR每一表型的評估應(yīng)嚴(yán)格每一表型的評估應(yīng)嚴(yán)格 各表型之間存在交叉各表型之間存在交叉 * *兒童也可能是特應(yīng)質(zhì)兒童也可能是特應(yīng)質(zhì)# # 不同的病源不同的病源, , 包括刺激物的暴露至今尚未證實有過敏原包括刺激物的暴露至今尚未證實有過敏原*Grimfeld A, Holgate ST, Canonica GW, Prophylactic management of children at risk for recurrent upper respiratoryinfections: t

9、he Preventia I Study. Clin Exp Allergy, 2004, 34(11): 1665-7258*Grimfeld A, Holgate ST, Canonica GW, Prophylactic management of children at risk for recurrent upper respiratoryinfections: the Preventia I Study. Clin Exp Allergy, 2004, 34(11): 1665-7259P=0.001P=0.001開瑞坦顯著減少幼兒的喘鳴次數(shù)*Grimfeld A, Holgate

10、 ST, Canonica GW, Prophylactic management of children at risk for recurrent upper respiratoryinfections: the Preventia I Study. Clin Exp Allergy, 2004, 34(11): 1665-7260*Grimfeld A, Holgate ST, Canonica GW, Prophylactic management of children at risk for recurrent upper respiratoryinfections: the Preventia I Study. Clin Exp Allergy, 2004, 34(11):