Journal of Tuberculosis and Lung Disease ›› 2023, Vol. 4 ›› Issue (2): 93-97.doi: 10.19983/j.issn.2096-8493.20230022
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| 学科人员 | 专业技术手段 | 治疗分工 |
|---|---|---|
| 哮喘专科医师 | 专业知识、领导力、评估、教育、优化、诊断、研究 | 组织多学科讨论 |
| 变态反应科医师 | 过敏原检测:IgE/sIgE,SPT,斑贴试验等 | 抗过敏治疗、脱敏治疗 |
| 耳鼻喉科医师 | 鼻咽镜和喉镜,覆盖鼻、咽、喉部 | 鼻炎、鼻窦炎的规范治疗,包括手术治疗、单克隆抗体治疗 |
| 心理科医师 | 心理问卷评估 | 心理科治疗 |
| 言语病理学医师 | VCD诊断 | VCD的言语病理治疗 |
| 护理专家 | 评估吸入技术、依从性、PEF、哮喘日记、行动计划 | 患者教育、家庭雾化治疗、生物靶向药物家庭使用 |
| 辅助管理人员 | 患者各项评估的安排 | 会诊专家的联络,资料准备 |
| 临床评估问题 | 评估内容 | 主要实施者 |
|---|---|---|
| 1.哮喘的诊断是否正确? | 全面采集病史、症状和肺功能随时间变化的客观证据;全面评估上、下气道炎症 | 哮喘专科医师 |
| 2.哮喘的严重程度如何? | 上、下气道炎症程度;哮喘控制情况;气流限制;频繁急性发作;危及生命的事件 | 哮喘专科医师 |
| 3.目前的治疗是否合适? | 高剂量ICS和LABA或其他控制药物;民间药粉土方;民间疗法如穴位注射;自行口服激素 | 哮喘专科医师 |
| 4.患者是否有自我管理技能? | 优化:吸入器装置技术;依从性;自我监测;疾病知识;书面行动计划;提供哮喘急性发作时的处理方法;科普知识来源 | 护士/药师/医师 |
| 5.是否识别和管理诱发发作的因素? | 过敏原;香烟烟雾;呼吸道病毒感染;情绪压力;霉菌和潮湿环境 | 哮喘专科和变态反应科医师 |
| 6.是否识别和管理合并症? | 声带功能障碍;阻塞性睡眠呼吸暂停;焦虑和/或抑郁;胃食管反流病;肥胖 | 耳鼻喉科医师/言语治疗师/心理科医师等 |
| 7.哮喘的表型是什么类型? | 嗜酸性粒细胞(诱导痰、血液中的嗜酸性粒细胞); 明确过敏原;FENO | 哮喘专科和变态反应科医师 |
| 8.最合适的个体化治疗方案? | 医生与患者共同讨论后决策,针对多维度评估中确定的临床问题,考虑患者的偏好和药物可及性 | 全体成员 |
| 特征评估 | 治疗 |
|---|---|
| 上呼吸道 | |
| 鼻窦炎、鼻息肉 | 药物治疗、洗鼻治疗、手术治疗、生物靶向治疗 |
| 下呼吸道 | |
| 气流受限 | 支气管扩张剂(维持:LABA/LAMA;急救: SABA/SAMA/快速LABA) |
| 气道高反应性 | 增加ICS、LABA |
| 气道平滑肌增生 | OCT,BT治疗 |
| 支气管扩张 | 物理疗法、大环内酯类药物、肺部康复、疫苗接种 |
| 肺气肿 | 戒烟,LABA/LAMA |
| 下呼吸道感染 | 根据病原学选择抗生素 |
| 血氧饱和度下降 | 家庭氧疗评估 |
| 合并症/并发症 | |
| 声带功能障碍 | 言语病理干预,加巴喷丁/普瑞巴林,心理干预 |
| 胃食管反流 | 消化内镜介入、手术或抗反流治疗 |
| 阻塞性呼吸睡眠暂停 | 持续气道正压通气,体位治疗,减肥 |
| 抑郁和/或焦虑 | 认知行为疗法,药物疗法 |
| 骨质疏松症 | 骨密度评估,药物治疗:补充钙和维生素D |
| 风险因素或行为 | |
| 依从性不佳 | 自我管理教育 |
| 吸入装置技术不过关 | 自我管理教育,包括反复观摩视频、现场示范和评估 |
| 雾化机及雾化药物 | 哮喘自我管理教育 |
| 没有书面哮喘行动计划 | 提供书面行动计划,并进行教育和共同决策 |
| 吸烟 | 戒烟计划、尼古丁替代疗法 |
| 全身 | |
| 哮喘发病年龄 | 早发性哮喘多为过敏性哮喘,晚发性哮喘多为嗜酸性粒细胞性哮喘 |
| BMI | 肥胖者建议限制热量,增加运动,实施减肥手术,进行药物治疗 |
| 是否频繁加重 | 书面活动计划、疫苗接种、教育、生物靶向药物 |
| 是否OCS依赖 | 抗IL-4/13和IL-5/5R单克隆抗体治疗 |
| 1-2-3分型 | |
| 1型过敏性疾病(Ⅰ型变态反应) | 脱敏治疗,抗IgE单克隆抗体治疗 |
| 2型炎症 | 全身糖皮质激素,抗IgE、IL-4/13和IL-5/5R单克隆抗体治疗 |
| 3型外周血嗜酸性粒细胞增高 | 排除ABPA、EGPA等原因后,全身糖皮质激素,抗IL-5/5R单克隆抗体治疗 |
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