监测是哮喘管理必不可少的一部分。监测指标构成涉及临床方面（哮喘控制的症状）、肺功能检查、急性发作的预防。越来越多的数据表明，哮喘控制良好并不等同于控制哮喘急性发作；然而哮喘控制不佳的患者更易出现频繁急性发作，急性发作的风险增加可能与哮喘控制无关。[12]Wu AC, Tantisira K, Li L, et al; Childhood Asthma Management Program Research Group. Predictors of symptoms are different from predictors of severe exacerbations from asthma in children. Chest. 2011;140:100-107.http://journal.publications.chestnet.org/article.aspx?articleid=1088012http://www.ncbi.nlm.nih.gov/pubmed/21292760?tool=bestpractice.com[268]Horner CC, Mauger D, Strunk RC, et al; Childhood Asthma Research and Education Network of the National Heart, Lung, and Blood Institute. Most nocturnal asthma symptoms occur outside of exacerbations and associate with morbidity. J Allergy Clin Immunol. 2011;128:977-982.e2.http://www.jacionline.org/article/S0091-6749%2811%2901090-6/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/21855126?tool=bestpractice.com
呼气流量峰值 (PEFR) 监测最初局限于慢性哮喘儿童中对症状感知较差的大龄哮喘患儿。虽然在大部分哮喘治疗中心，5 岁以上儿童可以进行肺功能检查，不过更年长的儿童才能取得重复再现性的测试。在开始治疗时，应每隔 2-6 周进行一次肺功能监测以确保对哮喘进行充分控制。随访间隔取决于哮喘控制水平，可为 1-6 个月不等。如果预期治疗减量，建议每 3 个月一次进行随访。在患儿病情稳定至少 3 个月后才可对治疗进行减量，且不能在高危时期进行（例如，冬天、学期开始时）。[269]Gionfriddo MR, Hagan JB, Rank MA. Why and how to step down chronic asthma drugs. BMJ. 2017 Oct 16;359:j4438.http://www.ncbi.nlm.nih.gov/pubmed/29038166?tool=bestpractice.com[71]Global Initiative for Asthma. Global strategy for asthma management and prevention (2018 update). March 2018 [internet publication].http://ginasthma.org/2018-gina-report-global-strategy-for-asthma-management-and-prevention/总体来说，虽然证据有限，但治疗减量应按照与治疗增量相反的顺序进行。[269]Gionfriddo MR, Hagan JB, Rank MA. Why and how to step down chronic asthma drugs. BMJ. 2017 Oct 16;359:j4438.http://www.ncbi.nlm.nih.gov/pubmed/29038166?tool=bestpractice.com 每日2次通过移动电话对患者的症状、药物使用情况和峰流速进行监测的效果与标准治疗的效果几乎一样。[270]Ryan D, Price D, Musgrave SD, et al. Clinical and cost effectiveness of mobile phone supported self monitoring of asthma: multicentre randomised controlled trial. BMJ. 2012;344:e1756.http://www.bmj.com/content/344/bmj.e1756http://www.ncbi.nlm.nih.gov/pubmed/22446569?tool=bestpractice.com
峰流量检测动画演示
非侵入性气道炎症监测方法包括呼出气一氧化氮、呼出气冷凝液收集检测、诱导痰液嗜酸粒细胞计数及气道高反应性，这些对哮喘控制的益处较小或是中等，[271]Petsky HL, Kew KM, Chang AB. Exhaled nitric oxide levels to guide treatment for children with asthma. Cochrane Database Syst Rev. 2016 Nov 9;11:CD011439.http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD011439.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/27825189?tool=bestpractice.com[272]Petsky HL, Li A, Chang AB. Tailored interventions based on sputum eosinophils versus clinical symptoms for asthma in children and adults. Cochrane Database Syst Rev. 2017 Aug 24;8:CD005603.http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD005603.pub3/fullhttp://www.ncbi.nlm.nih.gov/pubmed/28837221?tool=bestpractice.com不过一项系统评价发现，根据 FeNO 的水平调整治疗可能对频繁发作的这一亚类患儿有所帮助。[271]Petsky HL, Kew KM, Chang AB. Exhaled nitric oxide levels to guide treatment for children with asthma. Cochrane Database Syst Rev. 2016 Nov 9;11:CD011439.http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD011439.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/27825189?tool=bestpractice.com 不过，还没有有力的证据支持推荐其用于治疗所有儿童患者。一项随机对照试验使用诱导痰液嗜酸性粒细胞监测儿童哮喘，并未显示出获益，[272]Petsky HL, Li A, Chang AB. Tailored interventions based on sputum eosinophils versus clinical symptoms for asthma in children and adults. Cochrane Database Syst Rev. 2017 Aug 24;8:CD005603.http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD005603.pub3/fullhttp://www.ncbi.nlm.nih.gov/pubmed/28837221?tool=bestpractice.com 但在成人中，此方法在减少发作的频率方面优于‘标准护理’。[272]Petsky HL, Li A, Chang AB. Tailored interventions based on sputum eosinophils versus clinical symptoms for asthma in children and adults. Cochrane Database Syst Rev. 2017 Aug 24;8:CD005603.http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD005603.pub3/fullhttp://www.ncbi.nlm.nih.gov/pubmed/28837221?tool=bestpractice.com 这些方法在哮喘管理中的作用依然未确定，与以临床症状及肺量测定法为基础的监测有略微的差异。[271]Petsky HL, Kew KM, Chang AB. Exhaled nitric oxide levels to guide treatment for children with asthma. Cochrane Database Syst Rev. 2016 Nov 9;11:CD011439.http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD011439.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/27825189?tool=bestpractice.com[272]Petsky HL, Li A, Chang AB. Tailored interventions based on sputum eosinophils versus clinical symptoms for asthma in children and adults. Cochrane Database Syst Rev. 2017 Aug 24;8:CD005603.http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD005603.pub3/fullhttp://www.ncbi.nlm.nih.gov/pubmed/28837221?tool=bestpractice.com [ 
]For children with asthma, can exhaled nitric oxide levels help to guide treatment?https://www.cochranelibrary.com/cca/doi/10.1002/cca.1621/full显示答案
