Intervention in the diagnosis and assessment of asthma
林口長庚紀念醫院胸腔二科 王圳華醫師
Asthma is characterized by airways inflammation,which is mediated by a series of celluar and immunologic mechanisms,and a resulting increased recruitment of inflammatory cells from the hemato Poietic system.Among the inflammatory cells,eosinophils play an important role in the pathogenesis of asthma.There is an activation of eosinophils with subsequent production of inflammatory cytokines and other protein products,such as ECP and MBP.
Especially,serum level of ECP is believed to be a inflammatory marker of asthmatic severity.Monitoring serial serum level of ECP may represent the index of asthma. control. In adddition, pulmonary function tests are also available to diagnose and assess the severity of airflow limitation of asthmac linically. To achieve a better control of asthma,triggering facfors,such as environmental or food allergens,should be identified to prevent the exposure of allergen which may be contributing to acute exacerbation of asthrna. It is thought that early diagnosis and trement of asthma may help to prevent the development of irreversible airway obstruction in asthmatics﹒ lnhaled corticosteroids are typically used for long-term asthma control. In fact,as asthma treatment guideline ofa stepwise approach to pharmacologic therapy is applied to chronic asthma，the addition of a second long-term control medication (long-acting beta-2 agonist) to lnhaled cortcosteroids therapy is recommended. Most of patientscan notbe well adherent to the medication in treatment of chronic asthma. These patients should receive an intensive education for optimal control. Daily peak expiratory flow (PEF) record is developed to monitor the variation of asthma control and advise the asthmaticshow to adjustthe medications and take care of the potential risks in acute exacerbation.It is prudentto believe that the prognosis of patients with asthma can be improved by implementing monitor and treatment of the underlying pathogenetic process．