Asthma is a complex chronic disease, characterised by intermittent respiratory symptoms, airway inflammation and reversible airflow obstruction, without the availability of a single confirmatory diagnostic test. Management of this disease involves many challenges for primary care physicians. These include diagnosis, monitoring, identifying risk and chronic as well as acute management; furthermore, it is challenging to maintain up to date knowledge of asthma to facilitate good quality patient education. Primary care clinicians with their limited availability of routine appointments, plus the vast spectrum of medical conditions they manage, are generalists and cannot be experts in every clinical condition. Although these health professionals develop skills in quickly assessing patients and making decisions for urgent or delayed management, the initial challenge is to accurately diagnose chronic diseases and second having the confidence and knowledge to manage these complex diseases in the community. In the case of asthma, diagnosis and monitoring are frequently based on reporting of symptoms, which are limited by their lack of specificity and patient recall. Considerable controversy1 2 surrounds the recent UK recommendations3 that primary care physicians should include spirometry and fractional exhaled nitric oxide (FeNO) in diagnosing asthma in the UK. Neither quality assured spirometry nor FeNO is widely available in primary care. This is further complicated because asthma patients may have normal spirometry when tested and this would potentially need to be repeated on a number of occasions to demonstrate reversible airflow obstruction, which is totally impractical in primary (or secondary) care settings. Peak flow diaries are a practical alternative in these cases.4 5 In their prospective …

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儿童哮喘评论：我们学到了什么？

哮喘是一种复杂的慢性疾病，以间歇性呼吸道症状、气道炎症和可逆性气流阻塞为特征，没有单一的确诊测试。这种疾病的管理涉及初级保健医生的许多挑战。这些包括诊断、监测、识别风险以及慢性和急性管理；此外，保持对哮喘的最新知识以促进高质量的患者教育具有挑战性。初级保健临床医生常规预约的可用性有限，加上他们管理的医疗条件范围广泛，是通才，不能成为每种临床条件的专家。尽管这些卫生专业人员培养了快速评估患者并为紧急或延迟管理做出决定的技能，最初的挑战是准确诊断慢性病，其次是要有信心和知识来管理社区中的这些复杂疾病。在哮喘的情况下，诊断和监测通常基于症状的报告，由于缺乏特异性和患者回忆而受到限制。相当多的争议 1 2 围绕英国最近的建议 3，即初级保健医生在英国诊断哮喘时应包括肺活量测定法和呼出气一氧化氮 (FeNO)。质量有保证的肺活量测定法和 FeNO 在初级保健中都没有广泛使用。这更加复杂，因为哮喘患者在测试时可能具有正常的肺活量测定，并且可能需要多次重复以证明可逆的气流阻塞，这在初级（或二级）医疗机构中是完全不切实际的。在这些情况下，峰值流量日记是一种实用的替代方法。4 5 在他们的预期中……