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《2010BC哮喘-診斷和管理》內容預覽

Scope
This guideline provides recommendations for the recognition, diagnosis, and management of asthma in patientsage 6 and older, in an office setting.
Care Objectives
The objectives of this guideline are to assist the practitioner caring for a patient with asthma to:improve diagnostic accuracyprovide effective treatment and monitoring planscreate a long-term plan of management, evaluation and care.Diagnostic Code: 493 (Asthma)Diagnosis/Investigation of AsthmaAsthma is a syndrome that is characterized by paroxysmal or persistent symptoms such as breathlessness,chest tightness, wheezing and cough. It is associated with variable airflow limitation and airwayhyperresponsiveness in response to endogenous and exogenous stimuli. Inflammation and its resultant effectson airway structure are considered to be the main mechanisms leading to the development and persistence ofasthma.
When asthma is suspected from clinical features, and other disorders have been considered and ruled out (e.g.tumours in **s, foreign body in children; don’t assume the presence of wheeze means asthma), confirm thediagnosis by objective measures of variable airflow obstruction and assess severity. In most cases the followingcriteria would suffice as objective evidence of variable airflow obstruction:Spirometry:
FEV1- A 12 % or greater improvement in forced expiratory volume (FEV) in children and **s, and> 200 ml in **s from the baseline 15 minutes after use of an inhaled short-acting betaagonist.? PEF - Serial measures of peak expiratory flow (PEF): A > 20% change after administration of abronchodilator; a 20% change in values over time. Typically pulmonary function normalizes afteradministration of a bronchodilator in asthmatic patients.
When there is some probability of asthma and the above tests are non-diagnostic, the following tests may beused to help in the diagnosis of asthma:
Methacholine challenge
Exercise challenge
Inhaled corticosteroid trial: appropriate doses of inhaled steroids for 4-6 weeks
(Refer Table 4 and Appendix A)

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