老年起病的支气管哮喘
临床需要使用口服糖皮质激素时（或者规则使用或者用于控制病情恶化），监测可能出现的副作用较重要。必要时预防糖皮质激素引起的骨质疏松症，并有规律地考查治疗方案以防止不必要地使用皮质激素。应使规则应用糖皮质激素的老年支气管哮喘病人了解糖皮质激素的所有副作用，并制定相应的糖皮质激素使用卡。在治疗老年哮喘病人中，应尽量使病人及其亲属、护理人员了解病人的病情，这将有助于提高疗效。没有证据表明，老年病人没有能力实施个体化治疗方案。而越来越多的研究表明，对于老年病人更应采取个体化的治疗方案。在判断和治疗哮喘急性加重方面，最新的英国国家哮喘治疗指南对于老年患者颇为适用。该指南强调对于老年患者，评介严重度的客观指标尤为重要。由于老年病人对支气管痉挛的反应性较低，常在病情较严重后才就医。该指南所引用的预后不良标准同样适用于老年病人。除记住该指南外，临床医师在诊疗老年患者哮喘急性发作时，由于老年患者哮喘和COPD（特别是病情早期）诊断易混乱，高浓度给氧时，还应有规律地进行血气分析。过度依靠经皮氧饱和度监测可导致临床处置延迟，并可加重COPD病人的Ⅱ型呼衰。决定是否需行机械通气（无论是无创性或侵入性）时，不应只基于年龄来考虑，还应考虑到病人的呼吸功能状况，机械通气的并发症，先前机械通气情况以及病人及其家属的愿望［17，18］。
5 结论
综上所述，老年起病的支气管哮喘无论是诊断还是治疗，都有一定的难度，特别是与COPD难以鉴别诊断，容易混淆。因此，有许多老年起病的支气管哮喘病人被误诊，从而导致了治疗失败。笔者认为，提高老年起病的支气管哮喘的检出率，是提高治疗成功率的根本办法。目前，最佳的诊断方法就是行肺功能测定，若临床表现符合，加上肺功能测定PEF的变异率＞25%，或支气管扩张试验后FEV1增加15%，即可做出诊断。据笔者观察，目前临床上肺功能测定已经比较普遍，但用于诊断老年起病的支气管哮喘并不多，这与老年病人不太配合和医生对正确诊断该病的重要性认识不够有关［19，20］。上海现已进入老龄化社会，关爱老年人的健康是我们医生的职责，临床医生应提高对老年起病的支气管哮喘的认识，积极动员有条件的老年病人行肺功能测定，从而提高该病的检出率和治愈率。
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