课件：全球哮喘防治创议.ppt

谢 谢 ! * Slide 2 - Asthma pathophysiology involves smooth muscle dysfunction, airway inflammation and airway remodelling. These processes are both independent and interdependent. * Slide 6 - The pathophysiogical consequences of airway inflammation is remodelling and airway narrowing, increased bronchial reactivity and reduced reversibility. This leads to the clinical manifestations of the disease - intermittent symptoms and prolonged periods of exacerbations. * Asthma is a chronic inflammatory disease with episodic attacks, involving acute inflammation on top of chronically persistent inflammation Acute inflammation in asthma is associated with bronchoconstriction, plasma exudation / oedema, vasodilatation and mucus hypersecretion Chronic inflammation in asthma is associated with subepithelial fibrosis, smooth muscle hyperplasia / hypertrophy, mucus gland hyperplasia and new vessel formation If asthma remains uncontrolled or poorly controlled, the underlying persistent inflammation in the airways leads to structural changes (remodelling) that reduce the extent of FEV1 response to short courses of steroids * 大多数患者可以达到哮喘控制 GOAL研究证实，大多数（80％）患者可以实现哮喘的治疗目标，即达到哮喘的临床控制（包括良好控制和完全控制） Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention 2005. * 2006 GINA (Page 16) Clinical control of asthma is defined as: - No (twice or less/week) daytime symptoms - No limitations of daily activites, inlcuding exercise - No nocturnal symptoms or awakening because of asthma - No (twice or less/week) need for reliever treatment - Normal or near-normal lung function - No exacerbations * 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 a