宝宝哮喘？

Kriss

LatteI 发表于 2017-12-26 21:20
现在6岁多点 她是6岁前确认的哮喘

六岁应该活动量很大了啊，我还以为六七岁都会好....健康的时候运动有帮助吗？测过过敏源什么的吗？

LatteI

Kriss 发表于 2017-12-27 09:42
六岁应该活动量很大了啊，我还以为六七岁都会好....健康的时候运动有帮助吗？测过过敏源什么的吗？ ...

她没有过敏史 我估计是花粉症引起的 目前是没有好

Kriss

这些天有时间在网上找了GINA 2016年的guidance,分享给大家
Recurrent wheezing occurs in a large proportion of children 5 years and younger, typically with viral upper
respiratory tract infections. Deciding when this is the initial presentation of asthma is difficult.
• Previous classifications of wheezing phenotypes (episodic wheeze and multiple-trigger wheeze; or transient wheeze, persistent wheeze and late-onset wheeze) do not appear to identify stable phenotypes, and their clinical
usefulness is uncertain.
• A diagnosis of asthma in young children with a history of wheezing is more likely if they have:
o Wheezing or coughing that occurs with exercise, laughing or crying in the absence of an apparent
respiratory infection
o A history of other allergic disease (eczema or allergic rhinitis) or asthma in first-degree relatives o Clinical improvement during 2–3 months of controller treatment, and worsening after cessation.

hyl427

MD，我都奔40去了，都这样。现在就胸闷着呢，气上不来......

Kriss

hyl427 发表于 2017-12-28 17:38
MD，我都奔40去了，都这样。现在就胸闷着呢，气上不来......

大人可以去查是否有哮喘的。如果真的确认有需要控制的。

Kriss

以下是GINA给出的asthma是否得到有效控制的标准：
在过去的四周里：1.白天孩子的哮喘症状一周出现过几次；（1-2次为部分控制，3-4次为没有控制）；2.有没有任何因为哮喘引起的活动限制，如易劳累，活动量变小（1-2次为部分控制，3-4次为没有控制）；3. Ventolin的使用次数（1-2次为部分控制，3-4次为没有控制）4；有没有因为咳嗽而夜间醒来（1-2次为部分控制，3-4次为没有控制）；如果评估为没有控制就要考虑下一步治疗方法了，因为长期不治疗的哮喘容易引起气道受损。
下次再更新下GINA推荐的治疗步骤。

Kriss

GINA 对儿童的确诊标准
Box 6-2. Features suggesting a diagnosis of asthma in children 5 years and younger
Feature Characteristics suggesting asthma
Cough Recurrent or persistent non-productive cough that may be worse at night or
accompanied by some wheezing and breathing difficulties
Cough occurring with exercise, laughing, crying or exposure to tobacco smoke
in the absence of an apparent respiratory infection
Wheezing Recurrent wheezing, including during sleep or with triggers such as activity,
laughing, crying or exposure to tobacco smoke or air pollution
Difficult or heavy breathing or
shortness of breath
Occurring with exercise, laughing, or crying
Reduced activity Not running, playing or laughing at the same intensity as other children; tires
earlier during walks (wants to be carried)
Past or family history Other allergic disease (atopic dermatitis or allergic rhinitis)
Asthma in first-degree relatives
Therapeutic trial with low dose
inhaled corticosteroid (Box 6-5,
p.109) and as-needed SABA
Clinical improvement during 2–3 months of controller treatment and worsening
when treatment is stopped

Kriss

GINA 2016版本的3 step治疗方案：
对于仅仅是在病毒感染后的症状，以及一年之间发作极少且严重程度不是非常厉害的，可以就仅靠Ventolin这样的气管扩张剂；对于确诊为哮喘一年之内发作大于三次或只是有wheezing但是每6-8周发作一次的，建议给予低剂量激素治疗3个月，并在逐渐停药后观察效果；对于低剂量激素仍无法控制的，需要加倍给予激素治疗。

Kriss

希望各位有经验的妈妈说说看一般是多久停药的，停药后复发情况。