重视哮喘诊断中的功能性疾病

Differential diagnosis of asthma and dysfunctional breathing and vocal cord dysfunction

支气管哮喘的临床表现复杂多变,极易和其他疾病相混淆,误诊漏诊的情况并不鲜见。在进行哮喘鉴别诊断时,最常考虑的是左心功能不全、慢性阻塞性肺疾病、上气道阻塞等器质性疾病,但对非器质性病变认识不足。实际上,2018—2020年全球哮喘防治创议提出的居于前列的需要鉴别的病种,更多的是功能性疾病比如呼吸调节紊乱/过度通气综合征、声带功能障碍,而不是器质性疾病。本文就呼吸调节紊乱和声带功能障碍的概念及与哮喘的鉴别进行综述。

The clinical manifestations of bronchial asthma are complex and variable,which can easily be confused with other diseases.So misdiagnosis and missed diagnosis of asthma are common.In the differential diagnosis of asthma,organic diseases such as left ventricular dysfunction,chronic obstructive pulmonary disease,and upper airway obstruction are most often considered,but the understanding of functional disease is insufficient.In fact,GINA guidelines suggested that the differential diagnosis in adult patients with suspected asthma needed to prioritize functional diseases such as dysfunctional breathing(DB)/hyperventilation syndrome(HVS)and vocal cord dysfunction(VCD),rather than organic disease.Here we review the concepts of DB and VCD and their differentiation from asthma.