哮喘大课_培训课件.ppt

哮喘的综合防治 环境控制 药物治疗 特异性免疫治疗 病人教育 Masoli M, et al. Allergy 2004. 哮喘患者：中国2800万；全球3亿 在一年中，因 哮喘而需要住 院或急诊治疗 的患者 33% 因哮喘而失去 就业机会的患者 58% 因哮喘而无法进行 运动和休闲活动 的患者 79% 因哮喘而有睡 眠障碍的患者 68% 因哮喘而改变自己 原来生活方式 的患者 63% 因哮喘而无法进行 正常的体力活动 的患者 74% Lai et al. J Allergy Clin Immunol 2003; 111(2) 263-268 亚太地区哮喘的现状 哮喘管理的目标—— 达到并维持哮喘临床控制 无（或≤2次/周）白天症状 无日常活动（包括运动）受限 无夜间症状或因哮喘憋醒 无（或≤2次/周）需接受缓解药物治疗 肺功能正常或接近正常 无哮喘急性加重 GINA 吸入组织胺累积剂量7.8mmol或乙酰甲胆碱浓度8mg/ml以内，肺通气功能（FEV1）下降20％者为气道高反应性 These tests are sensitive for a diagnosis of asthma, but have limited specificity25. This means that a negative test can be useful to exclude a diagnosis of persistent asthma in a patient who is not taking inhaled glucocorticosteroid treatment, but a positive test does not always mean that a patient has asthma26. This is because airway hyperresponsiveness has been described in patients with allergic rhinitis27 and in those with airflow limitation caused by conditions other than asthma, such as cystic fibrosis28, bronchiectasis, and chronic obstructive pulmonary disease (COPD)29. 这是电镜下的螨虫图片。 60年代中期，研究学者就已经发现了尘螨是引起支气管哮喘的主要变应原。其大量存在于床上、沙发和地毯中，以人体脱落的皮屑为食物，分泌物及死虫体均有很强的致敏性。 * ， In treatment-na?ve patients with persistent asthma, treatment should be start at Step 2, or, if very symptomatic (uncontrolled), at step 3. All patients with persistent asthma require one or more regular controller medications (Steps 2 through 5). Step 2 is the initial treatment for most treatment-na?ve patients with persistent asthma symptoms. If symptoms at the initial consultation suggest that asthma is poorly controlled, initial treatment may be commenced at step 3. The scheme presented in Figure is based upon these principles, but the range and sequence of medications used in each clinical setting will vary depending on local availability (for cost or other reasons), acceptability and preference. To include GINA 2006 update guide for step-up and step-down dosing as part to maintain asthma control * * 3 气道高反应性(airway hyperresponsiveness, AHR) 气道对多种刺