哮喘预防及舌下脱敏的体会_培训课件.ppt

* 理想的吸入激素应具备的特点 * 吸入激素的药物代谢与传统的口服激素不同，独特的代谢途径体现出极低的口服生物利用度。 * It may be helpful to look at the results of the GOAL study in light of observations by Woolcock, who looked at the proportional improvement over time of various aspects of asthma. In phase I of GOAL, we expected marked reduction in some of the more sensitive endpoints of asthma, night-time symptoms and modification of lung function (measured with either FEV1 or peak expiratory flow). However, we still needed to consider the treatment effects during the second, maintenance phase. Perhaps these are the more resistant components of asthma, such as decreasing use of short-acting b2-agonist. As Professor Woolcock indicated, improvement of one of the very essential ingredients of disease, airway hyper-responsiveness takes a long time to achieve. So what we may be seeing with the sustained maintenance with Seretide is that it is more likely to modify these elements of the disease, and one of the outcomes of this may be the reduction in risk of having asthma exacerbations. It is important to remember that the components of asthma are sensitive to both the dose and the time of treatment. Therefore, aspects of asthma such as night-time symptoms are readily responsive at lower doses for shorter periods of time, but components such as the intrinsic abnormality of airway hyper-responsiveness may require prolonged and sustained treatment to modify this, before we can achieve the benefits that we are aiming for. * 让患者由低剂量开始接触变应原制剂，剂量逐渐增加，达至维持量后持续足够疗程，刺激机体免疫系统产生对该变应原的耐受，当患者再次接触该变应原时，不再产生过敏症状或过敏症状明显减轻。 日本学者Ohashi在1998发表的一篇文献中提出药物治疗短期疗效优于特异性免疫治疗，长期疗效明显不及特异性免疫治疗。 * * 1986年Scadding和Brostoff首先使用舌下含服变应原制剂来治疗变应性鼻炎。经过20年的发展史，至今为止有大量的文献证实舌下含服疗效明确，目前已被欧洲各国广泛使用。 与皮下注射相比舌下含服增加了服用频率，降低了浓度梯度，出现不良反应时易于调节，安全性高； 舌下含服用药方便，不受用药时间、场所的限制。 由于舌下脱敏的疗效和安全性，2001年WHO正式推荐舌下脱敏为可替代传统注射方式的脱敏方法。 * 畅迪有5种浓度，从1-5号蛋白总浓度依次递增，分别为1 ， 10，100 ，333，和1000μg/ml。1-3号为递增期用药，4号或5号为维持期用药。 儿童患者使用1-4号制剂，其中4号作为维持治疗剂量。 成人患者使用1-5号制剂，其中5号作为维持治疗剂量。 * 一般在