复旦大学课件—难治性哮喘治疗的研究进展

1、2021/8/61难治性哮喘难治性哮喘的诊断和治疗的诊断和治疗复旦大学附属华山医院呼吸科复旦大学附属华山医院呼吸科陈小东陈小东2021/8/62哮喘的定义支气管哮喘(bronchial asthma,哮喘)是由多种细胞（如嗜酸性粒细胞、肥大细胞、T淋巴细胞、中性粒细胞、气道上皮细胞等）和细胞组份（cellular elements）参与的气道慢性炎症性疾患。这种慢性炎症导致气道高反应性的增加，通常出现广泛多变的可逆性气流受限，并引起反复发作的喘息、气急、胸闷或咳嗽等症状，常在夜间和（或）清晨发作、加剧，多数患者可自行缓解或经治疗缓解。 2021/8/632021/8/642021/8/6520

2、21/8/662021/8/672021/8/682021/8/692021/8/610Zainudin BMZ etal, Respirology 2005;10:5792021/8/6112021/8/6122021/8/613*in children 6yrs:moderate-dose ICSOral glucocorticosteroid (lowest dose)anti-IgE antibodiesas needed rapid-acting 2-agonist2021/8/6142021/8/6152021/8/6162021/8/6172021/8/6182021/8/619

3、2021/8/620Newman KB, AJRCCM 1995 152:13822021/8/621Figure 1: FOL view of inspiratory adduction of the vocal cordsFigure 2A: normal inspiratory curveFigure 2B: attenuated inspiratory curve2021/8/6222021/8/6232021/8/6242021/8/6252021/8/6262021/8/6272021/8/628Very mildMildModerateSevereStep 3Step 4Step

4、 5Poor Control ContinuesTrial of Add on TherapiesOCSLTRAMTXGoldPoor Control ContinuesDACand OmalizumabStep 6Step 1Confirm diagnosisOptimisation of Therapy and EducationPoor Control ContinuesDACongoingStep 2Triggers and aggravating factors Removed or Managed2021/8/6292021/8/6302021/8/6312021/8/6322021/8/6332021/8/634Simpson J etal Respirology2021/8/635PlaceboCAM 1000mgt=-4t=0t=8t=12RFollow UpScreeningV1V2V3V4V52021/8/636ACTIVEPLACEBO* p= 0.0046 versus visit 22021/8/637Macrolide TreatmentPlacebo* p=0.016 versus placebo*2021/8/6382021/8/6392021/8/640Oba Y J Allergy