304.2 🩺 國考版

304.2.1 高頻考點

304.2.1.1 GINA 2024 + 2025 Key Changes

  • All asthma should have ICS-containing reliever (ICS-formoterol preferred)
  • SABA-only reliever no longer recommended
  • Single inhaler maintenance + reliever (MART) for Step 3-4
  • Biologic for severe asthma

304.2.1.2 Stepwise Approach

  • Step 1-2: as-needed ICS-formoterol
  • Step 3: maintenance low-dose ICS-formoterol
  • Step 4: maintenance medium-dose ICS-formoterol
  • Step 5: high-dose + add-on (LAMA, biologic, OCS)

304.2.1.3 Asthma Phenotypes

  • Allergic (childhood, ↑ IgE)
  • Eosinophilic non-allergic (adult)
  • AERD (nasal polyps + aspirin sensitivity)
  • Exercise-induced
  • Cough-variant
  • Occupational
  • Neutrophilic / T2-low

304.2.1.4 Biologics (MEMORIZE)

  • Omalizumab: anti-IgE
  • Mepolizumab, reslizumab: anti-IL-5
  • Benralizumab: anti-IL-5R (depletes eosinophils)
  • Dupilumab: anti-IL-4Rα
  • Tezepelumab (2022): anti-TSLP — first to work in BOTH T2-high + T2-low

304.2.1.5 Acute Exacerbation

  • O2 + SABA + ipratropium + systemic steroids
  • Magnesium for severe
  • NIV or intubation for severe failure

304.2.1.6 Special Topics

  • AERD: nasal polyps + asthma + aspirin/NSAID sensitivity; aspirin desensitization can be done
  • EIB: pre-exercise SABA; ICS daily; LTRA option
  • Occupational asthma: irritant (RADS) vs allergic (sensitizer)
  • Pregnancy + asthma: ICS-formoterol safe; uncontrolled asthma worse than meds

304.2.2 易混淆比范

Feature Asthma COPD
Age Often childhood Adult (smoker)
Reversibility Yes (> 12%) No
Eosinophils Yes (some) Variable
DLCO Normal/↑ ↓
Exacerbations Variable Worse with infection
Treatment ICS-LABA + biologic LABA-LAMA ± ICS

304.2.2.1 FeNO + Eosinophils for Biologic Selection

Biomarker Threshold Biologic
Eosinophils > 300 + ↑ FeNO Dupilumab
Eosinophils > 150 + exacerbations Anti-IL-5
High IgE Perennial allergen Omalizumab
Any Severe asthma Tezepelumab