Ducharme Francine M, Dell Sharon D, Radhakrishnan Dhenduka, Grad Roland M, Watson Wade T A, Yang Connie L, Zelman Mitchell
Can Respir J. 2015 May-Jun;22(3):135-43. doi: 10.1155/2015/101572. Epub 2015 Apr 20.
Asthma often starts before six years of age. However, there remains uncertainty as to when and how a preschool-age child with symptoms suggestive of asthma can be diagnosed with this condition. This delays treatment and contributes to both short- and long-term morbidity. Members of the Canadian Thoracic Society Asthma Clinical Assembly partnered with the Canadian Paediatric Society to develop a joint working group with the mandate to develop a position paper on the diagnosis and management of asthma in preschoolers. In the absence of lung function tests, the diagnosis of asthma should be considered in children one to five years of age with frequent (≥ 8 days/month) asthma-like symptoms or recurrent (≥ 2) exacerbations (episodes with asthma-like signs). The diagnosis requires the objective document of signs or convincing parent-reported symptoms of airflow obstruction (improvement in these signs or symptoms with asthma therapy), and no clinical suspicion of an alternative diagnosis. The characteristic feature of airflow obstruction is wheezing, commonly accompanied by difficulty breathing and cough. Reversibility with asthma medications is defined as direct observation of improvement with short-acting ß2-agonists (SABA) (with or without oral corticosteroids) by a trained health care practitioner during an acute exacerbation (preferred method). However, in children with no wheezing (or other signs of airflow obstruction) on presentation, reversibility may be determined by convincing parental report of a symptomatic response to a three-month therapeutic trial of a medium dose of inhaled corticosteroids with as-needed SABA (alternative method), or as-needed SABA alone (weaker alternative method). The authors provide key messages regarding in whom to consider the diagnosis, terms to be abandoned, when to refer to an asthma specialist and the initial management strategy. Finally, dissemination plans and priority areas for research are identified.
哮喘通常在六岁前发病。然而，对于有哮喘症状的学龄前儿童何时以及如何被诊断为哮喘，仍存在不确定性。这导致治疗延迟，并造成短期和长期发病。加拿大胸科协会哮喘临床大会的成员与加拿大儿科学会合作，成立了一个联合工作组，其任务是制定一份关于学龄前儿童哮喘诊断和管理的立场文件。在没有肺功能测试的情况下，对于1至5岁频繁出现（≥每月8天）哮喘样症状或反复（≥2次）发作（有哮喘样体征的发作）的儿童，应考虑哮喘的诊断。诊断需要有气流受限体征的客观记录或家长报告的令人信服的气流受限症状（这些体征或症状在哮喘治疗后有所改善），并且没有临床怀疑有其他诊断。气流受限的特征性表现是喘息，通常伴有呼吸困难和咳嗽。哮喘药物的可逆性定义为在急性发作期间，经过培训的医护人员直接观察到短效β2受体激动剂（SABA）（无论是否使用口服糖皮质激素）治疗后症状改善（首选方法）。然而，对于就诊时无喘息（或其他气流受限体征）的儿童，可逆性可通过家长令人信服地报告对为期三个月的中等剂量吸入糖皮质激素联合按需使用SABA治疗试验（替代方法）或仅按需使用SABA（较弱的替代方法）有症状反应来确定。作者提供了关于哪些人应考虑诊断、应摒弃的术语、何时转诊至哮喘专科医生以及初始管理策略的关键信息。最后，确定了传播计划和研究重点领域。
