支气管哮喘的治疗

Treatment

of

BronchialAsthma

支气管哮喘的治疗周德训北京大学人民医院呼吸与危重症医学科，医师北京大学第二临床医学院内科学教研室，教师Outline前情提要：哮喘的本质哮喘治疗：前人的方法针对本质：如何控制炎症直达靶点：现代的控制方案Howdidpeopletreatasthmainancienttime?HistoryReviewTheonlypossiblewayofapplyingmedicinesdirectlytothelungisthroughthewindpipe.--PhilipStern,1764Sanders

M.PrimaryCareRespiratoryJournal.2007;16(2):71-81R.Dalbyetal.InternationalJournalofPharmaceutics283(2004)1-9直达靶点，快速起效减少剂量，减少不良反应避免肝脏代谢的首关效应HistoryReviewSanders

M.PrimaryCareRespiratoryJournal.2007;16(2):71-81HistoryReviewSanders

M.PrimaryCareRespiratoryJournal.2007;16(2):71-81165417781858What’sthemostpowerfuldrugtostopinflammation?GlucocorticoidHydrocortisoneCortisonePrednisonePrednisoloneMethylprednisoloneDexamethasoneBarnesPJ,AdcockIM.Annalsofinternalmedicine,2003,139(5_Part_1):359-370.EffectsofGC控制炎症反应降低血管通透性修复内皮功能……内分泌代谢紊乱心血管功能障碍免疫抑制骨质疏松胃溃疡肌病…………Howcanwedeliverthedrugsafely?InhaledTherapy国际哮喘联盟指南（GINA）推荐直达靶点，快速起效减少剂量，减少不良反应避免肝脏代谢的首关效应InhalerpMDIDPI--AccuhalerDPI--TurbuhalerInhaledCorticosteroid(ICS)布地奈德、氟替卡松等等首关效应显著代谢产物活性低生物利用度低PJBarnes,N.Eng.J.Med.1995请欣赏视频

SummaryInhaledCorticosteroid(ICS)isaneffectiveandsafemedicinetocontrolthechronicairwayinflammationinasthma.WhatsideeffectcouldhappenduringICStreatment?NextTimeonAsthmaReferenceFromtheGlobalStrategyforAsthmaManagementandPrevention,

GlobalInitiativeforAsthma(GINA)2014.Availablefrom:/.陆再英、钟南山，内科学，人民卫生出版社，第7版。BarnesPJ,AdcockIM.Howdocorticosteroidsworkinasthma?[J].Annalsofinternalmedicine,2003,139(5_Part_1):359-370.BarnesPJ.Inhaledglucocorticoidsforasthma[J].TheNewEnglandjournalofmedicine,1995,332(13):868-875.SandersM.Inhalationtherapy:anhistoricalreview[J].