胸闷变异性哮喘诊治中国专家共识

Expert consensus on the diagnosis and treatment of chest tightness variant asthma in China

胸闷变异性哮喘(CTVA)是一种不典型哮喘,以胸闷为唯一或主要临床表现,因其缺乏典型哮喘症状和体征易被漏诊或误诊。CTVA的诊断需结合胸闷症状和可变气流受限客观证据,其中支气管激发试验是诊断CTVA的重要检查。CTVA需与慢性阻塞性肺疾病、冠状动脉粥样硬化性心脏病、胃食管反流病等疾病相鉴别。CTVA治疗原则同典型哮喘,多数患者经过规范的抗哮喘治疗预后良好。基于现有研究进展,中华医学会呼吸病学分会哮喘学组组织呼吸与危重症医学科以及心血管、消化、精神、中医等多学科临床专家制定本共识,其主要内容包括:定义、流行病学、发病机制、临床表现、诊断、鉴别诊断、评估、治疗、管理教育和预防,并提出CTVA诊断流程图,以期指导临床医生规范诊治CTVA。

Chest tightness variant asthma(CTVA)is an atypical asthma,characterized by chest tightness as the only or main clinical manifestation.Due to its lack of typical asthma symptoms and signs,it is prone to misdiagnosis or missed diagnosis.Comprehensive chest tightness symptoms and objective evidence of variable airflow restriction,especially bronchial provocation test,are important criteria of diagnosing CTVA.Patients with CTVA also need to be differentiated from patients with chronic obstructive pulmonary disease,coronary atherosclerotic heart disease,gastroesophageal reflux disease and other diseases.The principle of CTVA treatment is the same as that of typical asthma,and most patients have a good prognosis after standardized asthma treatment.Based on recently research in China,the Asthma Group of the Chinese Thoracic Society organized relevant experts from various specialities,including respiratory and critical care medicine,cardiology,gastroenterology,psychiatry,and traditional Chinese medicine,to develop the expert consensus.This consensus includes:definition,epidemiology,pathogenesis,clinical manifestations,diagnosis,differential diagnosis,evaluation,treatment,management education,and prevention of CTVA,and it also proposes a flowchart for CTVA diagnosis and treatment.This expert consensus is intended to provide with expert opinion in improving the understanding and standardized diagnosis and treatment of CTVA among clinicians in China.