支气管激发试验临床应用中国专家共识(2024版)

Chinese expert consensus on the clinical applications of bronchial provocation test(2024 edition)

支气管激发试验是评估气道高反应性的检查,主要用于诊断第一秒用力呼气容积(FEV 1)≥70%预计值的哮喘和不典型哮喘,如咳嗽变异性哮喘和胸闷变异性哮喘。该试验有助于鉴别哮喘与其他慢性气道疾病,也用于评估治疗效果。然而,由于认识不足以及基层缺乏人力物力资源等原因,其使用率较低。为此,中华医学会呼吸病学分会哮喘学组专家发布专家共识,提高医师对此试验的认识与应用。共识重点关注直接激发剂乙酰甲胆碱,全文从试验原理和分类出发,阐述支气管激发试验的适应证、禁忌证和临床应用范围,着重阐述结果解读,并分析假阳性及假阴性可能原因及对策,最后强调可能存在的安全性问题并给出应急措施。

The bronchial provocation test(BPT)is an important clinical examination to detect airway hyperresponsiveness,primarily in diagnosing asthma with FEV 1≥70%of predicted value,including typical asthma and atypical asthma such as cough variant asthma and chest tightness variant asthma.BPT is a valuable tool in differentiating asthma from other chronic airway diseases and assessing the efficacy of asthma treatment.Despite its clinical significance,BPT remains largely underused in clinical practice,primarily due to limited knowledge of its importance and inadequate availability of medical professionals,equipment and medications in primary care settings.In response to this gap,the China Asthma Group of Chinese Thoracic Society has drafted this expert consensus to enhance knowledge and application of BPT among clinical practitioners.This expert consensus specifically focuses on the classic direct provocation agent methacholine,covering general principles and classification of BPT;indications,contraindications,and clinical applications;result interpretation;analyzing potential reasons and coping strategies for false positive and false negative test results;and finally,providing safety precautions and emergency measures.The aim of this expert consensus is to promote the standardized application of BPT.