中国胸闷变异性哮喘诊治实践

doi:10.16150/j.1671-2870.2023.06.001

摘要/Abstract

摘要：

胸闷变异性哮喘（chest tightness variant asthma，CTVA）是一种不典型哮喘，以胸闷作为唯一或主要症状，而没有反复发作的喘息、气促等典型的哮喘表现。自2013年在国际上首次被报道、命名以来，CTVA已经逐步被我国临床医师所认识，并开展了大量临床实践。诊断CTVA时，需综合胸闷症状和可变气流受限客观证据，并排除其他疾病所引起的胸闷，且患者按哮喘治疗有效。CTVA的治疗原则同典型哮喘，应根据患者胸闷发作的情况选择合适的初始治疗级别，并参照阶梯式治疗方案进行升、降级治疗。本文基于临床诊治实践，系统介绍了CTVA的诊断标准、诊断流程、管理评估和治疗方案，旨在为广大临床医师规范诊治CTVA提供帮助。

关键词: 胸闷变异性哮喘, 诊治实践, 吸入性糖皮质激素, 呼气流量峰值

Abstract:

Chest tightness variant asthma (CTVA) is an atypical form of asthma, characterized by chest tightness as the primary symptom, without the typical asthma symptoms， such as recurrent wheezing and shortness of breath. Since it was first reported and named internationally in 2013, CTVA has gradually been recognized by clinical physicians in China and has undergone extensive clinical practice. As for diagnosis of CTVA ，doctors should integrate symptoms of chest tightness and objective evidence of variable airflow restriction, exclude chest tightness caused by other diseases, and find effective results of asthma treatment in patients. The treatment principle of CTVA is similar to that of typical asthma. An appropriate initial treatment level should be selected based on the patient's chest tightness attack, and the stepwise treatment plan should be followed for upgrade and downgrade treatment. Based on clinical diagnosis and treatment practices, this article systematically introduces the diagnostic criteria, diagnostic procedures, management evaluation, and treatment plans of CTVA,which is to help clinical physicians in standardizing the diagnosis and treatment of CTVA.

Key words: Chest tightness variant asthma, Diagnosis and treatment, practice, Inhale corticosteroids, Peak expiratory flow

中图分类号:

华雯, 沈华浩. 中国胸闷变异性哮喘诊治实践[J]. 诊断学理论与实践, 2023, 22(06): 513-519.

HUA Wen, SHEN Huahao. Diagnosis and treatment practice of chest tightness variant asthma in China[J]. Journal of Diagnostics Concepts & Practice, 2023, 22(06): 513-519.

图/表 1

参考文献 34

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症状	肺功能	治疗选择
胸闷次数<2次/月	FEV₁占预计值≥80%	首选按需使用低剂量ICS+福莫特罗
胸闷次数≥2次/月或需使用缓解药物	FEV₁占预计值≥80%	低剂量ICS+按需SABA；或低剂量ICS+福莫特罗
大多数日子有胸闷或因胸闷觉醒>1次/周	FEV₁占预计值在60%~79%	首选低剂量ICS+LABA维持；按需治疗（ICS+福莫特罗；或SABA）
严重未控制	FEV₁占预计值<60%	初始短程口服糖皮质激素+控制药物（高剂量ICS+LABA；或中等剂量ICS+LABA）