动态肺量测定在支气管哮喘中的应用

Clinical Application of Portable Spirometry in Asthma

目的探讨动态肺量测定技术在支气管哮喘中的应用。方法建立动态肺量测定技术,对20例支气管哮喘患者每天清晨、下午和入睡前连续14d动态监测气道功能、症状和情绪。结果白天标准肺功能检查结果正常的支气管哮喘患者,第一秒用力呼气量(FEV1)和最大呼气峰流量(PEF)在夜间和凌晨可出现明显下降。肺功能指标与支气管哮喘症状的相关分析发现,只有7例患者(35%)支气管哮喘症状与FEV1和PEF存在相关关系。4例患者(20%)肺功能基本正常,但有很多症状,症状与FEV1和PEF无相关关系,但与负面情绪相关。另外2例患者(10%)肺功能损害严重,但几乎没有症状。结论动态肺量测定技术能客观反映支气管哮喘患者气道功能的昼夜自然变化,因此可以更准确地反映支气管哮喘的严重程度。动态肺量测定技术结合症状和情绪的同步监测,可以帮助识别出特殊症状感觉类型的支气管哮喘患者。

Objective To investigate the clinical applications of portable spirometry in asthma. Methods Twenty patients with asthma were recruited from Peking Union Medical College Hospital. Flow-volume loop, simultaneous asthma symptoms, and mood were monitored three times a day for con- secutive 14 days. Results In patients with a normal daytime spirometry, marked decline of forced expiratory volume in one second(FEV1)and peak expiratory flow(PEF)were observed at night and/or in the early morning. A within subject correlation analysis between FEV1, PEF, and asthma symptoms showed that the correlation between symptoms and airway obstruction was found only in seven out of twenty patients(35%). Four patients(20%)reported many symptoms with nearly normal portable spiro- metry. Accordingly, their symptoms were not correlated with FEV1 and PEF. This group of patients was defined as over-perceivers. On the contrary, another two patients(10%)did not report any symptoms while obvious airways obstruction was recorded by a portable spirometry. These patients were defined as under-perceivers. Conclusions Dynamic monitoring of flow-volume loop with a portable spirometry is more accurate than routine lung function test in assessment of asthma severity. In addition, combined with simultaneous monitoring of symptoms, it would be of particularly helpful in identifying two specific types of asthma patients, e.g. over-perceivers and under-perceivers.