Pediatric asthma

Introduction to Pediatric Asthma Bronchial asthma (bronchialasthma), a reversible, obstructive respiratory disease with recurrent cough, wheezing and difficulty breathing, associated with airway hyperresponsiveness, is a common cause of serious harm to children's health. Chronic respiratory diseases, the incidence of high, often manifested as recurrent chronic disease, seriously affecting the learning, life and activities of children, affecting the growth and development of children and adolescents, many children with asthma due to treatment is not timely or improper treatment Development of adult asthma and prolonged unhealed, impaired lung function, some patients even completely lost physical activity, severe asthma attacks, can be fatal if not treated promptly, related to asthma definition, etiology, pathogenesis, immunology Children, adults and adults are basically similar, pathophysiology and principles of diagnosis and treatment, but there are still differences in some aspects of childhood and adult asthma. Children with asthma are in the process of growing, developing, mental, psychological and immune systems, especially in immunology and pathophysiology. Children's asthma has its own special aspects. basic knowledge The proportion of illness: 0.005% Susceptible people: young children Mode of infection: non-infectious Complications: emphysema, pulmonary heart disease, pneumothorax, respiratory failure

Pediatric asthma cause

(1) Causes of the disease

The incidence of asthma in the world is between 0.1% and 32%, the difference is close to 300 times, the reason may be related to genetics, age, geographical location, climate, environment, ethnicity, industrialization, urbanization, interior decoration, living standards, diet Habits and so on.

The factors that induce bronchial asthma are multifaceted. Common factors include the following:

Allergies (10%):

Allergic substances are roughly divided into three categories:

1 Infectious pathogens and their toxins, asthma attacks in children are often closely related to respiratory infections. More than 95% of infant asthma is caused by respiratory infections. The main pathogens are respiratory viruses, such as syncytial virus (RSV), adenovirus, Influenza, parainfluenza virus, etc., have shown that syncytial virus infection can cause wheezing due to specific IgE-mediated type I allergic reaction. Other local infections such as sinusitis, tonsillitis, dental caries may also be predisposing factors.

2 inhalation: usually inhaled from the respiratory tract, domestic application skin test shows that the main allergens causing asthma are dust mites, house dust, mold, multi-valent pollen (Artemisia, ragweed), feathers, etc., also reported to contact silkworm hair Asthma, especially as an inhalation allergen, plays an important role in allergic diseases of the respiratory tract. In childhood, allergies to ticks are more than adults. Spring and autumn are the shortest suitable season for cockroaches, so dust mites Asthma occurs in spring and autumn, and is common in nighttime cases. In addition, asthma attacks caused by inhalation of allergens are often related to the season, region and living environment. Once the contact is stopped, the symptoms can be alleviated or disappeared.

3 food: mainly heterosexual proteins, such as milk, eggs, fish and shrimp, spices, etc., food allergies are common in infancy, gradually decreasing after 4 to 5 years old.

Non-specific stimulating substances (20%):

Such as dust, smoke (including cigarettes and mosquito coils), odor (industrial irritating gas, cooking oil smell and oily knee taste), etc. These substances are non-antigenic substances that can stimulate the bronchial mucosal sensory nerve endings and vagus nerve, causing reflexes Sexual cough and bronchospasm, long-term persistence can lead to high airway responsiveness, and sometimes inhalation of cold air can also induce bronchospasm. Some scholars believe that air pollution is becoming more and more serious, and it may be one of the important reasons for the increased prevalence of bronchial asthma.

Climate factors (5%):

Children who are sensitive to climate change, such as sudden cooling or lowering of air pressure, can often trigger asthma attacks. Therefore, the incidence of children in spring and autumn is generally increased.

Mental factors (5%):

Children's asthma caused by asthmatic factors is not as obvious as adults, but asthmatic children are often affected by emotions, such as crying or anger and fear can cause asthma attacks. Some scholars have proved that they often accompany emotional agitation or other mental activity disorders. There is vagus nerve excitement.

Genetic factors (10%):

Asthma is hereditary, and the prevalence of family and personal allergies, such as asthma, infant eczema, urticaria, and allergic rhinitis, is higher than that of the general population.

Sports (40%):

Foreign reports about 90% of children with asthma, exercise can often stimulate asthma, also known as exercise induced asthma (EIA), more common in older children, violently sustained (5-10 minutes or more) after running, the most likely to induce asthma, Its mechanism of action is 100-immunity.

Drugs (10%):

Drug-induced asthma is also more common, mainly two types of drugs, one is aspirin and similar antipyretic analgesics, can cause so-called endogenous asthma, such as accompanied by sinusitis and nasal polyps, it is called For aspirin triad, other similar drugs have indomethacin, mefenamic acid, etc., the mechanism of asthma may be aspirin inhibits prostaglandin synthesis, resulting in decreased cAMP content, release of chemical mediators causing asthma, such asthma often Decreased with age, less incidence after puberty, another type of drug for the heart, such as propranolol, equal experience can block the beta receptor and cause asthma, in addition to many spray inhalers can also stimulate throat reflex Sexually induced bronchospasm, such as sodium cromoglycate, phlegm and so on, other such as lipiodol angiography, sulfa drug allergy can also often induce asthma attacks.

(two) pathogenesis

Bronchial asthma is a complex disease caused by a variety of factors, and the pathogenesis is still unknown. The currently recognized mechanisms have the following three aspects.

1. Type I allergic reaction and IgE synthesis regulation disorder

After the antigen (allergen) enters the human body for the first time, it acts on B lymphocytes and becomes plasma cells to produce IgE. IgE is adsorbed on mast cells or basophils, and its Fc segment binds to specific receptors on the cell membrane surface. IgE is firmly adsorbed on the cell membrane, causing the body to be in a sensitized state. When the corresponding antigen re-enters the sensitized body, it adsorbs on the mast cells and the basophilic membrane and binds to IgE, causing degranulation of the cell membrane and releasing a series of chemical media. Including histamine, slow-reacting substances, bradykinin, serotonin and prostaglandins, these biologically active substances can cause telangiectasia, enhanced permeability, smooth muscle tendon and glandular hypersecretion and other biological effects, causing bronchial asthma .

In recent years, many studies have shown that the increase of IgE is also related to cellular immune dysfunction. A large number of studies have shown that T cells not only have quantitative changes, but also may have functional defects. In addition, high IgE may also be associated with delayed T cell maturation.

2, airway inflammation changes

Biopsy of asthmatic animal models and asthma patients by fiberoptic bronchoscopy and bronchoalveolar lavage (BAL) demonstrated that airway tissue showed varying degrees of inflammatory changes.

3, airway hyperresponsiveness

Airway hyperresponsiveness, that is, the airway responds abnormally to various specific or non-specific stimuli, and asthmatic children have airway hyperresponsiveness, airway hyperresponsive immediate response (type I allergic reaction), and continuous response. It is believed that persistent airway hyperresponsiveness is mainly related to airway inflammation, and the mechanism of airway hyperresponsiveness during inflammation is mainly related to inflammatory mediators. Studies have found that airway response to histamine, acetylcholine and severity of asthmatic children Parallel, which in turn is associated with neuromodulation disorders, particularly autonomic dysfunction.

It is known that bronchial smooth muscle is dominated by sympathetic and parasympathetic nerves and maintains a dynamic balance under the regulation of brain-lower hypothalamus-pituitary. Normal human bronchial smooth muscle tone depends on the excitatory state of cholinergic receptors, and asthmatic children No, its parasympathetic tone is increased, alpha adrenergic nerve activity is enhanced, adrenergic nerve function is low or partially blocked. Because of these abnormalities, airway hyperresponsiveness in asthmatic children is the pathophysiology of asthma attacks. One of the foundations.

The main pathological changes of asthma are bronchial smooth muscle spasm, inflammatory cell infiltration, upper basement membrane thickening and airway mucosal edema, epithelial shedding mixed cell debris, increased mucus secretion, mucociliary dysfunction, and then bronchial mucosal hypertrophy and endobronchial Mucus embolism, the result of the above pathological changes caused airway lumen stenosis, resulting in increased airway resistance and asthma.

Pediatric asthma prevention

Repeated episodes of bronchial asthma have a great impact on the growth and life of children, and should be prevented as soon as possible.

Avoid contact with allergens and identify predisposing factors. To understand the predisposing factors and the details of the onset of each disease, pay attention to prevent respiratory infections, eliminate the lesions (such as timely treatment of sinusitis, nasal polyps, tonsillitis, dental caries, etc.), avoid overwork Stimulation, rain, running and mental stimulation should try to avoid contact and timely treatment of known allergens, such as contact with pollen, application of aspirin and other drugs, conditions can improve the environment or easy to live.

Pediatric asthma complications Complications emphysema, pulmonary heart disease, pneumothorax respiratory failure

In the course of bronchial asthma, due to the effects of long-term disease, pathophysiological disorders during acute attacks, or improper use of certain drugs, acute, chronic and therapeutic complications can occur, and some complications occur. , often can make the disease worse, or difficult to control, and some complications can directly cause life-threatening, here are some complications:

(1) emphysema and pulmonary heart disease

In the onset of asthma, the patient's chest is raised, his shoulders are high, and there is a noticeable shortness of breath in a little activity. When the chest is transparent, the transmittance is increased. The patient thinks that he has had emphysema, but this is actually not the case. Difficulty breathing, and even a lot of air in the lungs can not come out, forming a clinical manifestation similar to emphysema, but once the attack is relieved, these performances can disappear. Some scholars believe that if there is no chronic bronchitis, there is After decades of illness, people can still have no obvious emphysema. There are statistics: about 80% of patients with emphysema have chronic bronchitis, and 1/3 of chronic bronchitis with emphysema. However, only about 1/10 of asthma patients have emphysema.

As with emphysema, whether or not secondary heart disease is a concern for patients. In fact, even in advanced asthma, secondary pulmonary heart disease is rare, especially in pediatric patients.

(2) respiratory arrest and respiratory failure

Respiratory arrest refers to the sudden stop of the patient's breathing. Most of the time, when the patient has had a meal and cough after a few days of continuous onset, it can also be mild after the serious complications occur. Heavy, there is no warning, so most of the patients are at home, the timely treatment of family members is very important, if the recovery does not recover after 2 to 3 minutes after the stop, and no timely artificial respiration, etc., often before the hospital Following the sudden cardiac arrest and death, the cause of respiratory arrest is unclear, and may be related to neurological reflexes at the time of onset. Although there are few opportunities for such complications, people who have had a sudden arrest often have a second. The possibility of a second occurrence should be especially vigilant!

Respiratory failure occurs much more slowly than respiratory arrest, mostly in the development of asthma to a later stage, manifested as changes in consciousness and obvious purpura, should be sent to hospital for treatment.

(3) Pneumothorax and mediastinal emphysema

When breathing, because of the movement of the chest wall, like the bellows, the gas can enter and leave the lungs. In the asthma attack, due to the obstruction of the small trachea, the pressure in the alveoli can be higher when coughing, and some weaker alveoli will rupture. Possibly, the ruptured alveoli can be connected together to form a large bullae, or the gas can travel along the pulmonary interstitium to the mediastinum to form mediastinal emphysema. The more common condition is that the gas runs to the pleural cavity outside the lung, causing pneumothorax.

(4) Heart rhythm disorder and shock

Severe asthma persistence can itself cause heart rhythm disorders and shock due to hypoxia, however, the chances of clinical complications due to improper treatment are more common.

(5) atresia syndrome

The so-called "lock-up syndrome" of asthma refers to the asthma attack that has been clinically discovered in the past decade. Although the degree of the lesion is not necessarily severe, it persists all day long and has no obvious effect on various drugs, just as the respiratory tract is "closed". Or "locked" up.

The main cause of the atresia syndrome is the excessive use of isoproterenol or the inappropriate use of propranolol during treatment due to rapid heartbeat.

(6) Thoracic deformity and rib fracture

Thoracic deformities in asthmatic lesions are quite common, mainly in patients with asthma or long-term onset.

Rib fractures occur mainly during coughing or wheezing during a severe attack, and the airway is blocked due to the violent contraction of the diaphragm, causing the ribs to break.

(7) Growth retardation

General asthma has little effect on the growth and development of children. However, the perennial or long-term application of adrenal cortex hormone may have a great impact on children's growth and development due to hypoxia or corticosteroid inhibitory protein synthesis.

Asthma symptoms in children Common symptoms Nasal fanatic bronchial smooth muscle spasm Hypoxemia Dry cough breath sounds weakened wheezing words can not be continuous airy face pale pale airway high reactivity

Pediatric asthma examination

The diagnosis of asthma in children generally does not require special laboratory tests, but further identification of exogenous, endogenous or mixed asthma and further understanding of its etiology and pathogenesis, and assessment of efficacy, assessment of prognosis, so do some targeted Laboratory tests are necessary.

1, eosinophils sensitive

In most children with allergic rhinitis and asthma, the blood eosinophil count exceeds 300 × 106L (300 / mm3), and eosinophilia and Colesmann's spirochete and Charcot's crystal can also be found in the sputum.

2, blood routine

Red blood cells, hemoglobin, total white blood cells and neutrophils are generally normal, but the total number of white blood cells can be increased after the application of receptor agonists, and both are increased if combined with bacterial infection.

3, chest X-ray examination

Most of the remission period is normal. In the attack period, most of the sick children may be simply over-inflated or accompanied by increased hilar vascular shadows; in the case of co-infection, pulmonary infiltration may occur, and other complications may occur, but chest X The line helps to rule out asthma caused by other causes.

4, skin allergen check

The purpose of examining allergens is to understand the pathogenesis of asthmatic children and to select specific desensitization therapy. The skin test is an induction test performed on the skin by an allergen. Generally, it is carried out on the extension side of the upper arm. There are mainly three methods: Test: used to determine the sensitizer of exogenous contact dermatitis; 2 scratch test: mainly used to detect the sensitizer of the rapid reaction, drop a test agent at the test site, and then scratch, scratch depth No bleeding is observed, and the reaction is observed after 20 minutes. The positive reaction is characterized by redness and wheal. The advantage of this method is safety and does not cause violent reaction, but the disadvantage is not as sensitive as the intradermal test; 3 intradermal test: high sensitivity, It is easy to operate and does not require special equipment. It is the most commonly used method for specificity test. It is generally used to observe the rapid reaction and delay reaction. The amount of allergen infusion in the intradermal test is 0.01~0.02ml. The liquid concentration is 1:100 (W/V), but the pollen is used in a concentration of 1:1000 to 1:10000.

The purpose of the skin test is to clarify the allergens that cause asthma. Therefore, sympathomimetic, antihistamines, theophylline, and corticosteroids should be discontinued 24 to 48 hours before the skin test to avoid interference.

5, lung function test

Pulmonary function tests are important for estimating the severity of asthma and judging the efficacy. They generally include lung volume, lung ventilation, diffusion function, flow rate-capacity map and respiratory mechanics test, but all require more sophisticated instruments and cannot be monitored at any time. Children often show an increase in total lung volume (TLC) and functional residual capacity (FRC), while residual gas (RV), vital capacity (VC) can be normal or decreased; more important change is the change in respiratory flow rate, expressed as force Vital capacity (FVC), a small forced expiratory flow rate (FEF25-75%) and maximum expiratory flow rate (PF).

In recent years, domestic and foreign scholars recommend using the micro-flow rate to measure the maximum expiratory flow rate (PEFR) to monitor the changes of children's condition at any time. The method is to take the position of the subject, hold the peak flow meter right, and take a deep breath. The instrument bite into the inlet cavity, the lip should contain a tight mouth device, not leaking, use the maximum strength and the fastest speed to exhale the air, repeat 3 to 4 times, select the highest value record evaluation, check the child Do not hold your breath during inhalation and exhalation. Repeat the test before the examination. Also measure the height and compare it with the normal children's standard values in the area. If it is lower than normal, inhale bronchodilators such as salbutamol aerosol 2, its value can be increased by 15%, it is diagnostic. The peak flow meter test can not only diagnose asthma, but also monitor the condition of children with asthma and measure airway hyperresponsiveness. Its biggest feature is that it can be carried around for parents and The child self-monitored the condition, recorded in the asthma diary, adjusted the treatment plan, and achieved the purpose of controlling the asthma attack for a long time, but in critically ill children, due to systemic failure, or sudden decrease in airway ventilation , Should not be repeated often to test.

6, blood gas analysis

Blood gas analysis is an important laboratory test for measuring asthma conditions, especially for severe cases with hypoxemia and hypercapnia. It can be used to guide treatment. Some scholars divide the asthma attack into three degrees based on blood gas results, 1 mild :pH is normal or slightly higher, PaO2 is normal, PaCO2 is slightly lower, suggesting that asthma is in the early stage, mild hyperventilation, bronchospasm is not serious, oral or aerosol inhalation antiasthmatic drugs can relieve it; 2 moderate: normal pH PaO2 is low, PaCO2 is still normal, it indicates that the patient is under-ventilated, bronchospasm is obvious, the condition is heavier, and intravenous anti-asthmatic drugs can be added if necessary. 3 severity: pH value decreases, PaO2 decreases, PaCO2 rises, prompt Severe ventilation, bronchospasm and severe obstruction often occur in the persistent state of asthma, requiring active treatment or monitoring.

7. Other laboratory inspections

Including inhalation of different concentrations of methacholine or histamine, exercise tests for children with suspected asthma and normal lung function tests, and application of radioimmunoassay, enzyme-linked immunosorbent assay, histamine release test, alkalophilic In vitro tests such as granulocyte degranulation test to detect allergens have been reported to have a deficiency of trace element zinc in children with asthma.

Diagnosis of asthma in children

diagnosis

Detailed medical history (including the cause of the disease, the number of episodes, the duration of each episode, the regularity and seasonality of the episodes, previous treatments and response to treatment, etc.) to understand the history of allergies in the family and the family, combined with the onset of the child Gas dyspnea, prolonged expiration of the lungs, smelling and snoring, no difficulty in diagnosis, pulmonary ventilation function test, airway responsiveness test or bronchiectasis test contributes to the diagnosis and severity of asthma Judgment, but young children are difficult to cooperate, so it is subject to certain restrictions, in addition to the skin allergen test can also aid diagnosis.

1. Diagnostic criteria for childhood asthma (a pilot program developed by the National Childhood Asthma Prevention and Coordination Group in 1998)

(1) Diagnostic criteria for asthma in infants and young children: 1 age <3 years old, asthma attack 3 times. 2 When the attack occurs, the lungs smell and the gasping wheezing sound, and the expiratory phase is prolonged. 3 has atopic physical, such as allergic eczema, allergic rhinitis and so on. 4 parents have an allergic history such as asthma. 5 Except for other diseases that cause wheezing.

Anyone with the above 1, 2, 5 can diagnose asthma, such as wheezing 2 times, and has 2, 5, diagnosed as suspected asthma or asthmatic bronchitis, if there are also 3 and/or 4 When considering a therapeutic diagnosis of asthma.

(2) Diagnostic criteria for childhood asthma: 1 age 3 years old, wheezing is repeated authors (or can be traced to an allergen or stimuli). 2 At the time of the attack, the lungs smelled with a gasping sound mainly due to the expiratory phase, and the expiratory phase was prolonged. 3 bronchodilators have obvious curative effect. 4 Except for other diseases that cause wheezing, chest tightness and cough.

For patients with suspected asthma in all ages and wheezing in the lungs, any of the following bronchiectasis tests may be performed: 1 Inhalation of an aerosol or solution with a 2 receptor agonist (dose and method refer to the above bronchodilation test) 21; 21 adrenaline subcutaneous injection of 0.01ml / kg, the maximum amount of each time does not exceed 0.3ml, 15min after any of the above tests, if the wheezing is significantly relieved and the lung wheezing is significantly reduced, or FEV1 improved 15 %, positive for bronchiectasis test, can be used for asthma diagnosis.

(3) Cough variant asthma (CVA) diagnostic criteria: 1 cough persistent or recurrent episodes > 1 month, often at night and / or early morning attacks, less, and smelling irritating, climate change, exercise, etc. . 2 clinical signs of no infection, or more effective than longer-term antibiotic treatment. 3 Have a history of personal allergies or family allergies, positive allergen skin test can aid diagnosis. 4 There is airway hyperresponsiveness (positive bronchial provocation test), positive bronchiectasis test or daily mutation rate or weekly mutation rate of 15%. 5 bronchodilator and / or glucocorticoid treatment can relieve the onset of cough (basic diagnostic conditions).

2. Asthma staging and severity grade Asthma staging: Asthma course can be divided into acute attack period and remission period. Acute asthma attack refers to sudden onset or aggravation of symptoms such as shortness of breath, cough, chest tightness, and often has difficulty breathing and wheezing. With reduced expiratory flow, remission period refers to treated or untreated symptoms, signs disappear, lung function returns to pre-existing levels, and maintained for more than 4 weeks.

Evaluation of asthma conditions: The evaluation of asthma patients should be divided into two parts:

(1) Total evaluation of non-acute episodes: Many asthmatic patients have no symptoms of frequent onset and/or varying degrees of symptoms (wheezing, coughing, chest tightness) for a long period of time, even if there is no acute attack at the time of the visit. Therefore, it is necessary to make a general evaluation of the condition based on the frequency of episodes before the visit, the severity, and the need for drugs and lung function.

When the patient is already in the standardized graded treatment period, the severity of the asthma condition should be judged according to the current clinical manifestations and the current level of the daily treatment plan. The classification method reflects the response of the asthma patients to the treatment plan used, that is, reflects The condition of the disease is controlled to adjust (upgrade or downgrade) the selected treatment plan at the right time.

(2) Evaluation of severity of acute asthma attack: A correct assessment of the severity of asthma exacerbation is the basis for timely and effective treatment. The understanding of severe asthma is the key to avoiding asthma-induced death.

Differential diagnosis

Because the clinical manifestations of asthma are not specific to asthma, it is necessary to eliminate wheezing, chest tightness and cough caused by other diseases while establishing a diagnosis.

1. Cardiac asthma: Cardiac asthma is common in left heart failure, and the symptoms at the time of attack are similar to those in asthma. However, cardiogenic asthma has many history and signs such as rheumatic heart disease and congenital heart disease, and coughing. Often coughing out pink foam sputum, both lungs can smell a wide range of blisters and wheezing sounds, the left heart is enlarged, the heart rate is increased, the apex can be heard, and the chest is X-ray, the heart is enlarged, the lungs are visible. Congestion signs, cardiac B-ultrasound and cardiac function tests can help identify, if it is difficult to identify nebulizable selective 2 receptor agonists or small doses of aminophylline to relieve symptoms after further examination, avoid epinephrine or morphine, So as not to cause danger.

2. Tuberculosis: can be expressed as repeated cough, cough, shortness of breath, etc., such as airway endometrial tuberculosis can appear obvious asthma, need to be differentiated from bronchial asthma, the main identification points are: TB exposure history; TB chronic poisoning symptoms; PPD test Positive; bronchial provocation test negative or PEF mutation rate <15%; sputum smear found acid-fast bacilli, sputum TB-PCR positive, chest X-ray, chest CT examination, if necessary, fiberoptic bronchoscopy can confirm the diagnosis.

3. Bronchiolitis: Mostly caused by respiratory syncytial virus, more common in infants under 3 years old, especially under 6 months, no history of recurrent episodes, this time the onset is acute, first symptoms of upper respiratory tract infection, gradually appearing wheezing Expiratory dyspnea, main signs: exhalation prolongation, expiratory wheezing sound and fine wet voice, chest radiograph: diffuse emphysema and patchy shadow, inhaled 2 receptor agonist and systemic use of hormone The efficacy is not exact, and the viral pathogen test can confirm the diagnosis.

4. Mycoplasma pneumoniae pneumonia: Pulmonary inflammation caused by Mycoplasma pneumoniae, the main clinical manifestation is irritating dry cough, generally no obvious dyspnea, symptoms can last for 2 to 3 months, mainly identified with CVA, the main identification point: no previous iteration Cough, history of asthma, this time often with nasal congestion, runny nose, fever, cough and other symptoms of respiratory infections, and then cough prolonged unhealed, chest radiographs can be seen patchy or cloud-like shadows, can be migratory, condensation test 1/64 positive or positive for Mycoplasma pneumoniae, and macrolide antibiotics are effective.

5. Airway foreign body: There is no history of repeated cough and asthma. This time, there is often a history of coughing or clearing foreign body inhalation during the onset of illness. Physical examination often has asymmetry of respiratory sounds, weakened respiratory sounds on the disease side, weakened tactile tremors and local Wheezing and other signs, chest X-ray, chest CT can assist in diagnosis, fiberoptic bronchoscopy can be clearly diagnosed and at the same time for foreign body removal.

6. Gastric-esophageal reflux (GOR): GOR is caused by the anti-inflow of gastric contents into the esophagus to cause a peristaltic or persistent cough in the lower end of the esophagus. GOR can be the only or main cause of chronic cough. Patients may have Reflux symptoms such as heartburn, upper abdominal fullness, etc., but 75% of patients may have no typical reflux, only chronic cough, bronchial provocation test negative or PEF mutation rate <15%, anti-asthma treatment is not good, 24h esophageal pH monitoring showed that the Demeester score of the esophageal electrode was 14.72, and the symptom associated with reflux and cough was 95%. Anti-reflux therapy was effective in diagnosis.

7. Postnasal drip syndrome (PNDs) can be characterized as paroxysmal or persistent cough, which is one of the common causes of chronic cough. It should be differentiated from CVA. PNDs often have rhinitis, a history of sinusitis, and a postnasal drip. (or) adhesion of mucus in the posterior pharyngeal wall, examination revealed mucus adhesion in the posterior pharyngeal wall, cobblestone-like view, sinus sinus or sinus CT showed sinus mucosa thickening >6mm or sinus cavity blurred or liquid level, Treatment (such as nasal inhalation of glucocorticoids, nasal vasoconstrictors, sinusitis plus antibiotics) relieved cough symptoms.

8. Eosinophilic bronchitis (EB): At present, the early manifestations of EB as a single disease or asthma are not clear. The main clinical manifestations are chronic cough, no special findings on chest X-ray, and normal pulmonary ventilation function. The bronchial provocation test was negative, the PEF mutation rate was normal, and the eosinophils in the sputum were induced to be >3%. The oral or inhaled corticosteroid treatment was effective in the diagnosis.

9. Allergic alveolitis is a pulmonary granulomatous inflammatory disease caused by inhalation of allergens such as organic dust, which can be manifested as recurrent cough, difficulty in breathing, etc., chest X-ray examination is non-specific, mainly as double Lower lung invasive changes, decreased lung diffusion function, negative bronchial provocation test or diastolic test, normal PEF mutation rate, no increase in eosinophils and IgE, special environmental or occupational exposure history, positive allergen-specific antibody in serum Can help diagnose.

10. Diffuse bronchiolitis: is a diffuse disease mainly involving respiratory bronchioles, which can be caused by inhalation injury (toxic gases, smoke, mineral particles, etc.), infections, drugs, etc. Sexually, clinical manifestations of cough, cough, wheezing, shortness of breath, symptoms often persist, extensive wheezing sounds and sputum sounds in both lungs, negative bronchiectasis test or PEF mutation rate <15%, the effect of asthma therapy is not exact.

11. Hysteria (hysteria): a functional disorder caused by temporary dysfunction of the cerebral cortex, often with a "hysteria" personality (emotional change, self-centered, strong desire for expression, rich fantasy, exaggeration of words and deeds often Dramatic color, more common in women, diverse clinical manifestations, including mental and/or physical symptoms, sudden onset, can be expressed as paroxysmal "shortness" or "asthma" often after mental stimulation, family Excessive care or excessive stress can induce or aggravate symptoms. There are no abnormal signs in the lungs during the attack, no abnormalities in chest radiographs, and negative bronchial provocation test or PEF mutation rate <15%, which may be suggested by treatment.

12. Bronchiectasis: In the case of secondary infection, increased secretion and blockage of bronchiectasis may also cause asthma-like dyspnea and hearing wheezing, generally according to previous severe pulmonary infection, repeated atelectasis and A history of a large number of purulent sputum is identified, and chest X-ray and bronchography or CT examination can be diagnosed if necessary.

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