呼吸病学-哮喘ppt课件

1、Bronchial asthma1kejian Asthma：human killer!Background of asthma Prevalence ：in the world: 1.6 hundred million in China: 13 in Shenyang: 1.24 1999 GINA: Global Initiative for Asthma1994 WHO/HLBI Bronchial asthmatic diagnosis guideline (1997 Chinese Medical Academy Definitions of asthma Chronic airwa

2、y inflammation Broncho-hyperresponsiveness, BHR Airflow limitationMechanism: allergy theory antigen antigen again atopyIgE antibodymast cells, basophils histamine inflammatory media LTs PAF ECP immediate asthmatic reaction, IAR bronchial smooth muscle spasm airway narrowMechanism: never-receptor dis

3、order theory adrenergic and cholinergic nerous systems, AC non-adrenergic and non-cholinergic nerous systems, NANC AC: 1-receptor、 、M1-、 、M3-receptors excitement NANC： ：PS-receptor bronchial smooth muscle contraction AC: -receptor、 、M2-receptor excitement NANC: VIP receptor bronchial smooth muscle d

4、ilation asthmatic airway: a1、 、M1、 、M3、 、PS/ 、 、M2、 、VIP Mechanism: airway inflammation theory antigen allergic airway inflammation, AAI ECP MBP inflammatory cells inflammatory media LTs EOS PAF neutrophils late asthmatic reaction, LAR T lymphocyte(Th1/Th2) Th2 cytokine IL-3、 、4、 、5， ，GM-CSF IgEinfl

5、ammation cells epithelium injury bronchial contractionmucous edemaairway secretionairway narrowBHRairway reversibilitysymptomsexacerbationcell proliferationexcellular baseOther mechanisms: induced factors Allergen: pollen, acarus infection: virus or mycoplasmal infection climate and physical and che

6、mical factors drugs: aspirin induced asthma, AIA -receptor inhibitor heredity Gastroesophageal reflux disease, GERD Psychological, incretion factors, sports1kejian Diagnosis standards of asthma symptoms signs recovered ways except other cardiac and pulmonary diseases lung function examinationuntypic

7、al asthma Untypical asthma Cough variant asthma, CAV Asthma with gastroesphgeal reflux Exercise induced asthma, EIA Drug induced asthma, DIA Occupational asthma, OALung functions diagnosis of asthma Obstructive ventilation insufficiency and reversibility of airway obstruction Variance rate of peak e

8、xpired flow (PEF) in 24 hours 20% Bronchial challenge is positiveLung functions diagnosis of asthma(1) FEV1 80 % pre, FEV1/FVC% 70 % FEV1 80 % pre, FEV1/FVC% 70 % bronchial dilation test is positive bronchial dilation test is positive Post FEV1 - Pre FEV1 Post FEV1 - Pre FEV1FEV1improved rate FEV1im

9、proved rate 100%100% Pre FEV1 Pre FEV1determinant standard:FEV1 improved rate15determinant standard:FEV1 improved rate15(+)(+) FEV1 improved rate200ml FEV1 improved rate200mlLung functions diagnosis of asthma(2) PEF meter PEF predicted value Lung functions diagnosis of asthma(2)PEF 80PEF 80pre and P

10、EF variance rate 20pre and PEF variance rate 20 PEF max PEF min PEF max PEF minPEF variance ratePEF variance rate 100%100% 1/2( PEF max + PEF min ) 1/2( PEF max + PEF min )Determinant standardDeterminant standard： ：PEF variance rate(24h) 20% (+)PEF variance rate(24h) 20% (+)Lung functions diagnosis

11、of asthma(3)Bronchial challenge is positivetherapeutic propertiesforbid propertiesmethods drug induce: methocholiner histamine exercise induce The steps of chronic persistent asthma分分级级 分度分度 喘息喘息发发作作 夜夜间发间发作作 日常活日常活动动 FEV1 PEF变变异率异率 或或PEF1 间间歇歇发发作作 1次次/w 2次次/m 不受限不受限 80% 2次次/m 发发作作时时受限受限 80% 20% 1次次

12、/w 发发作作时时受限受限 6080% 2030%4 重度重度继续继续 病症病症继续继续 频频繁繁 受限受限 30% Distinguishing diagnosis of asthma Cardiac asthma COPD Upper airway obstruction (lung cancer) Pulmonary eosiniphil infiltration1kejian Correlation between asthma and COPDDrugs for treating asthma Glucocorticosteroid anti-inflammation 2-agoni

13、st theophylline bronchodilators anticholinergic drug non-steroid anti-inflammationsSteroids with vein injectionmethylprednisonlone 40 4 11-hydroxide 40320Hydrocortison 100 20 11-ketone 1001000dexamethason 5 0.75 11-ketone 1030 steroid dose =dose character dose/d (mg) (mg) (mg)Inhaled steroids Baclom

14、ethason dipropionate 必可必可酮酮(BDP) 50ug200 Budesonide 普米克普米克(BUD) 100ug 100 普米克普米克 都保都保 普米克令舒普米克令舒 1mg/2ml Fluticasone propionate 辅辅舒舒酮酮(FP) 125ug 100 Fluticasone + Salmeterol 舒利迭舒利迭 100/50ug60 250/50ug60 Inhaled 2- agonists Salbutamol 万托林万托林 200ug200 万托林万托林雾雾化溶液化溶液 0.05% 20ml Terbutaline 喘康速喘康速 250ug

15、200 博利康尼都保博利康尼都保 250ug100 博利康尼博利康尼雾雾化溶液化溶液 5mg/ml Salmeterol 施立施立稳稳 50ug200 施立碟施立碟 50ug48 Formoterol 奥克斯都保奥克斯都保 4.5ug60Oral2- agonists Terbutaline 博利康尼博利康尼 2.5mg Procaterol 美喘清美喘清 50ug Formoterol 安通克安通克 40ug Salbutemol 全特宁全特宁 8mg Bambuterol 帮备帮备 4mg3 3类类起效慢起效慢 作用作用时间时间短短口服型特布他林口服型特布他林口服型沙丁胺醇口服型沙丁胺醇口

16、服型福美特口服型福美特罗罗2 2类类起效缓慢起效缓慢 作用时间长作用时间长吸入型沙美特罗吸入型沙美特罗口服型班布特罗口服型班布特罗4 4类类起效快起效快 作用作用时间时间短短吸入型特布他林吸入型特布他林吸入型沙丁胺醇吸入型沙丁胺醇1 1类类起效快起效快 作用时间长作用时间长吸入型福美特罗吸入型福美特罗Theophylline iv：aminophylline 0.25 doxofylline 0.1 po: aminophylline 0.1 short action AEA 舒氟美舒氟美 0.1 long action 葆乐辉葆乐辉 0.4Anti-cholinergic drug Ipra

17、tropium bromide 爱爱全全乐乐 20ug200 爱爱全全乐乐水溶液水溶液 20ml Ipratropium bromide 可必特可必特 20ug200 Salbutamol 可必特可必特 2mlNon-steroid anti-inflammation drugs Anti-histamine ： ：inhaler：色甘酸：色甘酸钠钠 5mg200 oral ： ： 酮酮替酚、曲尼斯特替酚、曲尼斯特 息思敏、开瑞坦等息思敏、开瑞坦等 LTs receptor inhibitor： ： 顺尔顺尔宁宁 10mg5 1kejian long therapy projects of asthma GINA 2002long therapy projects of asthma GINA 2002long therapy proj