Nelson H S
Department of Medicine, National Jewish Medical and Research Center, Denver, Colorado, USA.
Clin Cornerstone. 1998 Aug-Sep;1(2):57-68. doi: 10.1016/s1098-3597(98)80006-9.
The Expert Panel Report 2. Guidelines for the Diagnosis and Management of Asthma (1) begins its section on controlling factors that precipitate or worsen asthma with the statement: "For successful long-term asthma management, it is essential to identify and reduce exposures to relevant allergens and irritants and to control other factors that have been shown to increase asthma symptoms and/or precipitate asthma exacerbations." The presence of allergy to indoor allergens and certain seasonal fungal spores has been found to be a risk factor for asthma in epidemiologic studies around the world. Generally between 70% and 85% of asthmatic populations studied have been reported to have positive skin-prick tests. Exposure of allergic patients to inhalant allergens increases airway inflammation, airway hyper-responsiveness, asthma symptoms, need for medication, severe attacks, and even death due to asthma. Environmental tobacco smoke exposure has been shown to increase the prevalence of childhood asthma and to increase asthma symptoms and bronchial hyperresponsiveness while reducing pulmonary function in children chronically exposed. Exposure to other indoor irritants, largely products of unvented combustion, has also been found to increase asthma symptoms. Outdoor air pollution increases asthma symptoms; levels of specific pollutants correlate with emergency room visits and hospitalization for asthma. Rhinitis/sinusitis and gastroesophageal reflux are commonly associated with asthma, and treatment of these conditions has been shown to improve asthma. In patients sensitive to aspirin and nonsteroidal anti-inflammatory drugs or metabisulfites, exposure to these agents can precipitate severe attacks of asthma. Viral infections are common causes for exacerbations of asthma. Infections with Mycoplasma pneumoniae and Chlamydia pneumoniae contribute to acute exacerbations and perhaps to long-term morbidity, as well. This chapter will discuss preventive and therapeutic measures that have been found effective in reducing the impact of aggravating or precipitating factors in patients with asthma.
《专家小组报告2. 哮喘诊断和管理指南》(1) 在其关于控制引发或加重哮喘的因素的章节开篇指出：“对于哮喘的成功长期管理，识别并减少接触相关过敏原和刺激物，以及控制其他已被证明会增加哮喘症状和/或引发哮喘发作的因素至关重要。” 在世界各地的流行病学研究中，已发现对室内过敏原和某些季节性真菌孢子过敏是哮喘的一个危险因素。一般来说，在所研究的哮喘患者群体中，有70%至85%的人皮肤点刺试验呈阳性。过敏患者接触吸入性过敏原会增加气道炎症、气道高反应性、哮喘症状、用药需求、严重发作，甚至导致哮喘死亡。已表明，接触环境烟草烟雾会增加儿童哮喘的患病率，增加哮喘症状和支气管高反应性，同时降低长期接触的儿童的肺功能。接触其他室内刺激物，主要是无通风燃烧产物也已发现会增加哮喘症状。室外空气污染会增加哮喘症状；特定污染物的水平与哮喘急诊就诊和住院情况相关。鼻炎/鼻窦炎和胃食管反流通常与哮喘相关，对这些病症的治疗已证明可改善哮喘。对于对阿司匹林、非甾体抗炎药或偏亚硫酸氢盐敏感的患者，接触这些药物会引发严重的哮喘发作。病毒感染是哮喘发作的常见原因。肺炎支原体和肺炎衣原体感染会导致急性发作，也可能导致长期发病。本章将讨论已发现对减轻哮喘患者加重或诱发因素的影响有效的预防和治疗措施。
