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喘息在婴儿期时治疗,为什么?_Shahid Sheikh_Ohio州立大学医学院,美国
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哮喘是一个长期的肺部疾病。这导致炎症和缩小你的航空公司,很难呼吸。严重哮喘很难会说或者是活跃的。你可能会听到医生称之为慢性呼吸道疾病。有些人将哮喘称为“支气管哮喘”。儿童哮喘是一种常见的慢性疾病。仅在美国,哮喘影响大约500万名儿童,据估计每年超过40亿美元的成本,和哮喘发病率正在增加。采用和坚持哮喘指南还远不够理想。策略改善临床结果严重依赖初级护理医师的培训。在繁忙的初级护理实践,医生缺乏时间去让父母了解预防哮喘管理计划。 It is therefore important that in addition to doctors, other medical personnel such as nurses and nurse practitioners are involved in patient / family education to improve asthma self-management. Once trained, they can help implement preventive clinical management plans, educate patients and their families, and ensure patients are receiving appropriate treatment to achieve adequate asthma control. We have been working on this model for four years in our establishment and I can share the results and the results. The relationship between silent gastroesophageal reflux disease (GERD) and respiratory problems such as persistent wheezing in infants is not well established. Between January 1994 and June 1997, we assessed the incidence of GERD in 84 otherwise healthy infants referred to the Pediatric Pulmonary Medicine Division at Kosair Children's Hospital for daily wheezing assessment, and we monitored their clinical course for 18 months. All underwent 24-hour esophageal pH studies to assess GERD. The pH probe study was performed at an average age of 8.74 ± 4.6 months. Infants with a positive GER study were treated with an H2 receptor antagonist (H2RA) and a prokinetic agent for a mean duration of 5.6 +/- 2.4 months. At the first follow-up visit 3 weeks after the oesophageal pH studies, infants treated with H2RA and those who did not have GERD but continued with daily wheezing started with flunisolide nasal solution (0.025%) administered by nebulizer (125 mcg tid). Infants in both groups were followed every 1 to 2 months for an average of 18 months and, if clinically improved, attempts to decrease their daily asthma medication were made. Fifty-four of 84 (64%) had studies of esophageal pH positive (GER-positive group), and 24 of them (44%) had no gastrointestinal symptoms suggestive of GERD. Thirty patients had studies of normal esophageal pH (GER negative group). Twenty-two of these 30 infants (73%) without GERD required nebulized flunisolide, compared to 13 of 54 infants (24%) with GERD (P <0.0005). Thirty-five of the 54 infants (64.8%) with GERD were able to stop all daily asthma medications within 3 months of starting anti reflux therapy, while none of the infants without GERD were able to stop daily asthma medication during the follow-up period (P <0.0005). We conclude that silent GERD is common in infants who wheeze daily, and that controlling GERD improves morbidity and decreases the need for daily asthma medication
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