哮喘(英文)PPT课件

Bronchialasthma,DepartmentofrespirationKongLingfei,Asthma：humankiller!,Backgroundofasthma,Prevalence：intheworld:1.6hundredmillioninChina:13inShenyang:1.24（1999）GINA:GlobalInitiativeforAsthma（1994）WHO/HLBIBronchialasthmaticdiagnosisguideline(1997）ChineseMedicalAcademy,Definitionsofasthma,ChronicairwayinflammationBroncho-hyperresponsiveness,BHRAirflowlimitation,Mechanism:allergytheory,antigenantigenagainatopyIgEantibodymastcells,basophilshistamineinflammatorymediaLTsPAFECPimmediateasthmaticreaction,IARbronchialsmoothmusclespasmairwaynarrow,Mechanism:never-receptordisordertheory,adrenergicandcholinergicneroussystems,ACnon-adrenergicandnon-cholinergicneroussystems,NANCAC:1-receptor、M1-、M3-receptorsexcitementNANC：PS-receptorbronchialsmoothmusclecontractionAC:-receptor、M2-receptorexcitementNANC:VIPreceptorbronchialsmoothmuscledilationasthmaticairway:a1、M1、M3、PS/、M2、VIP,Mechanism:airwayinflammationtheory,antigenallergicairwayinflammation,AAIECPMBPinflammatorycellsinflammatorymediaLTsEOSPAFneutrophilslateasthmaticreaction,LARTlymphocyte(Th1/Th2)Th2cytokineIL-3、4、5，GM-CSFIgE,inflammationcellsepitheliuminjury,bronchialcontractionmucousedemaairwaysecretion,airwaynarrow,BHR,airwayreversibility,symptoms,exacerbation,cellproliferationexcellularbase,Differmechanismsinacuteandchronicasthma,Othermechanisms:inducedfactors,Allergen:pollen,acarusinfection:virusormycoplasmalinfectionclimateandphysicalandchemicalfactorsdrugs:aspirininducedasthma,AIA-receptorinhibitorheredityGastroesophagealrefluxdisease,GERDPsychological,incretionfactors,sports,Diagnosisstandardsofasthma,symptomssignsrecoveredwaysexceptothercardiacandpulmonarydiseaseslungfunctionexaminationuntypicalasthma,Untypicalasthma,Coughvariantasthma,CAVAsthmawithgastroesphgealrefluxExerciseinducedasthma,EIADruginducedasthma,DIAOccupationalasthma,OA,Lungfunctionsdiagnosisofasthma,ObstructiveventilationinsufficiencyandreversibilityofairwayobstructionVariancerateofpeakexpiredflow(PEF)in24hours20%Bronchialchallengeispositive,Lungfunctionsdiagnosisofasthma(1),FEV180%pre,FEV1/FVC%30次/分三凹征常无可有常有胸腹矛盾运动喘鸣音呼吸末期散在响亮弥漫响亮弥漫减弱或无脉率120次/分25mmHg无,呼衰用2后PEF70%5070%45mmHgSaO295%9195%90%pH降低,Distinguishingdiagnosisofasthma,CardiacasthmaCOPDUpperairwayobstruction(lungcancer)Pulmonaryeosiniphilinfiltration,CorrelationbetweenasthmaandCOPD,DiscriminationbetweenasthmaandCOPD,AsthmaCOPD症状喘息咳嗽痰呼吸困难(休息或运动)呼吸困难(伴随运动)胸闷喘息咳嗽胸闷经常出现夜间症状很少夜间症状吸烟史部分病人大多数病人肺功能可逆性好可逆性差激发试验阳性经常阴性运动后支气管收缩无支气管收缩,Drugsfortreatingasthma,Glucocorticosteroidanti-inflammation2-agonisttheophyllinebronchodilatorsanticholinergicdrugnon-steroidanti-inflammations,Steroidswithveininjection,methylprednisonlone40411-hydroxide40320Hydrocortison1002011-ketone1001000dexamethason50.7511-ketone1030,steroiddose=dosecharacterdose/d(mg)(mg)(mg),Inhaledsteroids,Baclomethasondipropionate必可酮(BDP)50ug200Budesonide普米克(BUD)100ug100普米克都保普米克令舒1mg/2mlFluticasonepropionate辅舒酮(FP)125ug100Fluticasone+Salmeterol舒利迭100/50ug60250/50ug60,Usingprinciplesofinhalersteroid,非急性发作期哮喘长期预防用药首选替代口服激素季节性哮喘季节发作前二周应用急性发作期与2-激动剂伍用长期预防可联合用药,Inhaled2-agonists,Salbutamol万托林200ug200万托林雾化溶液0.05%20mlTerbutaline喘康速250ug200博利康尼都保250ug100博利康尼雾化溶液5mg/mlSalmeterol施立稳50ug200施立碟50ug48Formoterol奥克斯都保4.5ug60,Oral2-agonists,Terbutaline博利康尼2.5mgProcaterol美喘清50ugFormoterol安通克40ugSalbutemol全特宁8mgBambuterol帮备4mg,Classificationof2-agonsts(Politiek),3类起效慢作用时间短口服型特布他林口服型沙丁胺醇口服型福美特罗,2类起效缓慢作用时间长吸入型沙美特罗口服型班布特罗,4类起效快作用时间短吸入型特布他林吸入型沙丁胺醇,1类起效快作用时间长吸入型福美特罗,起效时间,快,慢,短长作用维持时间,快速缓解,维持治疗,Politiek,etal.EurRespirJ1999,13:988,Usingprinciplesof2-agonist,急性发作期快速缓解哮喘症状与吸入激素伍用可规律使用一周缓解期按需使用,用药次数1000gBDP或等剂量)或吸入激素(500-1000gBDP或等剂量)加上白三烯调节剂,longtherapyprojectsofasthmaGINA2002,严重度Step4重度持续,每日用药吸入激素(1000gBDP或等剂量)加上长效吸入型2-受