FeNO指导临床治疗支气管哮喘及慢性咳嗽思考演示课件

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,#,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,#,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,#,Klik for at redigere i masteren,Klik for at redigere teksttypografierne i masteren,Andet niveau,Tredje niveau,Fjerde niveau,Femte niveau,#,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2019/4/28,#,#,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,#,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,#,#,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,#,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,#,#,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,#,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,#,Klik for at redigere i masteren,Klik for at redigere teksttypografierne i masteren,Andet niveau,Tredje niveau,Fjerde niveau,Femte niveau,Klik for at redigere i masteren,Klik for at redigere teksttypografierne i masteren,Andet niveau,Tredje niveau,Fjerde niveau,Femte niveau,Klik for at redigere i masteren,Klik for at redigere teksttypografierne i masteren,Andet niveau,Tredje niveau,Fjerde niveau,Femte niveau,Klik for at redigere i masteren,Klik for at redigere teksttypografierne i masteren,Andet niveau,Tredje niveau,Fjerde niveau,Femte niveau,Klik for at redigere i masteren,Klik for at redigere teksttypografierne i masteren,Andet niveau,Tredje niveau,Fjerde niveau,Femte niveau,4/28/2019,#,Klik for at redigere i masteren,Klik for at redigere teksttypografierne i masteren,Andet niveau,Tredje niveau,Fjerde niveau,Femte niveau,Klik for at redigere i masteren,Klik for at redigere teksttypografierne i masteren,Andet niveau,Tredje niveau,Fjerde niveau,Femte niveau,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2019/4/28,#,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,28/04/2019,#,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,2019/4/28,#,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2019/4/28,#,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2019/4/28,#,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2019/4/28,#,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,#,FeNO,指导临床治疗支气管哮喘及慢性咳嗽思考,杨 继 兵,江苏省中医院呼吸科,2016-11-15,案 例,(,一,),第一次就诊时间,:2016-08-14,李,XX,女,53,岁,主诉,:,反复咳嗽气喘,2,年,加重,1,周,.,现病史,:,2,年来间断咳嗽气喘,在春季及秋季显著,遇烟雾及油漆汽车尾气等会加重,有时夜间,发作,有明显喉鸣音,初曾在当地社区医院予服氨茶碱,咳喘宁可缓解,未重视,.,1,年前因夜间咳喘症状加重曾在军区总医院查体两肺哮鸣音,，,全胸片阴性,，,查肺功能,+,支气管舒张试验,，,提示轻度阻塞性肺通气功能障碍,，,支气管舒张试阳性,，,诊断考虑支气管哮喘,，,予信必可都保,(,布地奈德福莫特罗粉吸入剂规格,:160/4.5ug)2,吸,BID，,应用。使用不规则,。1,月后自行停药到今,。1,周前进食海鲜后咳喘症状加重,同时皮肤荨麻疹,复来就诊,.,不发热,无咯血,无头痛,无腹痛,无肢体关节疼痛,，,畏风，不发热，食欲一般,，,睡眠不安,，,二便调。舌质淡红,，,苔薄白,，,脉浮紧,。,查体,:,轻度喘促貌,，,四肢及胸部皮肤散在潮红之荨麻疹,，,搔痒,，,有抓痕,。,唇无紫绀,，,两肺可闻及散在哮鸣音,，,心率,82,次,/,分,，,律齐,。,诊断 中医,:,哮病,(,风痰证,),西医,:,支气管哮喘急性发作,因患者不同意住院,予查血常规，查,FENO；,先临时处理,:,予呼吸科门诊综合治疗室吸氧并予以雾化,布地奈德雾化液,.3mg,特布他林雾化液,5mg,雾吸,st,异丙托溴铵,500ug,雾化治疗后喘促改善,血常规提示,EOS 7%；FENO:223PPB.,患者不服中药,.,同时路远不同意每天来门诊持续雾化,。,予信必可都保,(,布地奈德福莫特罗粉吸入剂规格,:160/4.5ug)2,吸,BID,，嘱必要时临时加吸,。,枸地氯雷他定,8.8mg,口服,QN.,服用,1,周,；,嘱症情加重及时住院治疗,上述药物吸入持续,3,月,。,避免接触各种吸入性或食入性可疑过敏原,。,2016-11-09,复诊,.,症情明显改善,，,询问,3,月期间,，,均规律使用吸入剂,(,常在普通门诊取药或外院取药,),皮疹在此次发病,1,周内消退,，,平时吸入剂偶有加吸到一天,5,次到,6,次,(,含正常的,4,次,)，,发病,1,月后基本无白天症状,，2,月来,，,仅夜间偶有胸闷气短,偶有喉鸣,.,平时无鼻塞流涕等,.,自认为完全控制,。,本次就诊目的想停吸入用药物,。,查体,:,两肺呼吸音稍粗,，,未闻啰音,。,予复查,FENO,、,血常规,结果,:198PPB,，,血常规：,EOS 6.9%,。,治疗选择,:,信必可都保,(,布地奈德福莫特罗粉吸入剂规格,:160/4.5ug)2,吸,BID?,案例,(,二,),第一次就诊时间,:2016-08-30,黄,XX,女,45,岁,.,主诉,:,反复咳嗽,6,月,.,现病史,:,6,月来,，,反复咳嗽,，,咽痒,，,咽干,，,常在接触冷空气,(,空调风,),油烟,，,灰尘后咳嗽加剧，无痰,，,无咯血,，,同时近,3,月来有夜间咳嗽,偶有喉鸣音,，,气短,，,胸闷。外院查胸部,CT,阴性,，,按支气管炎输液抗生素,1,周,，,咳嗽未缓解,。,平时在车间工作,，,灰尘亦大,，,尽管戴口罩但仍不能控制咳嗽,。,回家后稍安,，,夜间咳嗽更剧,，,常不能入睡,。,不发热,，,无盗汗,，,食纳一般,，,平时畏风,，,舌体胖大,，,边有齿印,，,舌尖红,，,苔薄白,，,脉细弦,。,查体,:,一般情况可,咽充血（,+），,扁桃体不肿大，两肺呼吸音稍粗,未闻干湿性啰音,.,心率,78,次,/,分,律齐,。,予查血常规：,EOS 6%；FENO:68,PPB.,螨过敏原试验,.,粉尘螨,(+),屋尘螨,(+),；查肺功能示小气道功能减退,支气管舒张试验阳性,。,诊断 中医,:,咳嗽病,(,风痰脾虚证,),西医：咳嗽变异性哮喘,予信必可都保,(,布地奈德福莫特罗粉吸入剂规格,:160/4.5ug)1,吸,BID,嘱必要时临时加吸,.,地氯雷他定,5 mg,口服,QN.,服用半月,.(,患者不同意脱敏治疗,),中药方治标以祛风化痰解痉止咳,治本以益气固卫调运脾胃,;,半月后复诊调整中药,.,避免接触各种吸入性或食入性可疑过敏原,.,症情加重及时住院治疗,.3,月后复查,FENO.,患者辞工回家治疗,坚持每半月复诊一次,中药调整,症状在第一周后控制,1,月后夜间症状明显不著,信必可都保上述剂量再吸,2,月,准备复查,FENO,后决定是否停吸，,2,月来中药以改治本为主。,2016-11-01,复诊,.,患者无咳嗽,偶有气短,胸闷,无咽痒。,查体：咽充血（,），,扁桃体不肿大，双肺呼吸清,予复查,FENO：20 PPB,；,血常规：,EOS 4.6%,因患者无法坚持服中药，需要停服中药。,治疗选择：信必可都保是否需继续应用？可否单独予孟鲁司特钠口服？。,案例,(,三,),第一