Marik Paul E, Varon Joseph, Fromm Robert
Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15261, USA.
J Emerg Med. 2002 Oct;23(3):257-68. doi: 10.1016/s0736-4679(02)00527-9.
Asthma is a common cause of morbidity and mortality in the United States, with over two million Emergency Department (ED) visits each year. Airway inflammation is recognized as a major component in the pathophysiology of asthma. The classic presentation of asthma is that of wheezing, cough, and dyspnea, however, the severity of airflow limitation correlates poorly with clinical signs. Forced exhaled volume in 1 s (FEV(1)) and the peak expiratory flow rate (PEFR) are direct reflections of the severity of airflow obstruction and are the standard measures used in the ED to assess the severity of airflow obstruction and the response to therapy. Beta2-adrenergic bronchodilators, ipratropium bromide, and corticosteroids form the cornerstone of therapy. Inhaled corticosteroids, leukotriene modifying drugs, and noninvasive positive pressure ventilation should be considered in patients with severe disease and in those who have responded poorly to standard therapy. Mechanical ventilation is usually well tolerated and may be lifesaving in patients with refractory asthma. Precautions are required to prevent dynamic hyperinflation during assisted ventilation.
在美国，哮喘是发病和死亡的常见原因，每年有超过200万人前往急诊科就诊。气道炎症被认为是哮喘病理生理学的主要组成部分。哮喘的典型表现为喘息、咳嗽和呼吸困难，然而，气流受限的严重程度与临床体征的相关性较差。一秒用力呼气容积（FEV(1)）和呼气峰值流速（PEFR）是气流阻塞严重程度的直接反映，是急诊科用于评估气流阻塞严重程度和治疗反应的标准指标。β2-肾上腺素能支气管扩张剂、异丙托溴铵和皮质类固醇是治疗的基石。对于重症患者以及对标准治疗反应不佳的患者，应考虑使用吸入性皮质类固醇、白三烯调节剂和无创正压通气。机械通气通常耐受性良好，对于难治性哮喘患者可能挽救生命。在辅助通气期间需要采取预防措施以防止动态肺过度充气。
