Towns Susan Joy, van Asperen Peter Paul
Department of Adolescent Medicine, The Children's Hospital at Westmead, Australia.
Clin Respir J. 2009 Apr;3(2):69-76. doi: 10.1111/j.1752-699X.2009.00130.x.
In this review we explore some of the issues surrounding the diagnosis and misdiagnosis of asthma in adolescents and suggest a management approach which might facilitate the provision of optimal treatment in order to minimise morbidity from asthma in this vulnerable and often difficult-to-manage age group.
We highlight important diagnostic traps which occur in the adolescent age group, including the misdiagnosis of asthma in young people presenting with exercise-related symptoms or cough, and stress the importance of considering alternative diagnoses, including vocal cord dysfunction. We explore how adolescence impacts on asthma management and emphasise the importance of an understanding of normal adolescent development and an awareness of high-risk indicators in developing a strategy to optimally manage a young person with asthma. We also illustrate how psychosocial functioning may impact on both perceived asthma severity and quality of life as well as interfere with optimal asthma control both directly and by increasing non-adherence. A suggested management strategy for adolescents is provided which emphasises a supportive approach to help facilitate optimal control of asthma by involving the young person in management decisions about their asthma. Specific mention is made about smoking cessation assistance and the interrelationship between physical activity, obesity and asthma. Finally we discuss the importance of an appropriate transition process to prepare the young person for transfer from child-centred care to adult-centred care.
Many different factors is of outmost importance when diagnosing adolescents with shortness of breath; furthermore, management of asthma need a supportive approach in both paediatric and adult setting.
在本综述中，我们探讨了青少年哮喘诊断和误诊的一些相关问题，并提出一种管理方法，该方法可能有助于提供最佳治疗，以将这个易受影响且通常难以管理的年龄组中哮喘的发病率降至最低。
我们强调了青少年年龄组中出现的重要诊断陷阱，包括对出现运动相关症状或咳嗽的年轻人哮喘的误诊，并强调考虑包括声带功能障碍在内的其他诊断的重要性。我们探讨了青春期如何影响哮喘管理，并强调了解正常青少年发育以及认识高风险指标在制定优化管理哮喘青少年策略中的重要性。我们还说明了心理社会功能如何可能影响感知到的哮喘严重程度和生活质量，以及如何直接并通过增加不依从性干扰最佳哮喘控制。提供了一种针对青少年的建议管理策略，该策略强调一种支持性方法，通过让年轻人参与有关其哮喘的管理决策来帮助促进哮喘的最佳控制。特别提到了戒烟援助以及体育活动、肥胖与哮喘之间的相互关系。最后，我们讨论了适当的过渡过程对于让年轻人为从以儿童为中心的护理过渡到以成人中心的护理做好准备的重要性。
在诊断呼吸急促的青少年时，许多不同因素至关重要；此外，哮喘管理在儿科和成人环境中都需要一种支持性方法。
