哮喘.ppt
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Bronchial asthma
Department of respiration
Kong Lingfei
Background of asthma
Prevalence ：in the world: 1.6 hundred million
in China: 1～3 %
in Shenyang: 1.24 %(1999)
GINA: Global Initiative for Asthma(1994)
WHO/HLBI
Bronchial asthmatic diagnosis guideline (1997)
Chinese Medical Academy
Definitions of asthma
? Chronic airway inflammation
? Broncho-hyperresponsiveness, BHR
? Airflow limitation
Mechanism: allergy theory
antigenantigen
↓↓again
atopy→IgE antibody→mast cells, basophils
↓ histamine
inflammatory mediaLTs
↓PAF
ECP
immediate asthmatic reaction, IAR
↓
bronchial smooth muscle spasm
airway narrow
Mechanism: never-receptor disorder theory
adrenergic and cholinergic nerous systems, AC
non-adrenergic and non-cholinergic nerous systems, NANC
AC: α1-receptor、M1-、M3-receptors excitement
NANC：PS-receptor ↓
bronchial smooth muscle contraction
AC: β-receptor、M2-receptor excitement
NANC: VIP receptor↓
bronchial smooth muscle dilation
asthmatic airway: a1、M1、M3、PS↑/ β 、M2、VIP↓
Mechanism: airway inflammation theory
antigen
↓
allergic airway inflammation, AAIECP
↑ MBP
inflammatory cells →inflammatory media LTs
EOS ↓PAF
neutrophils late asthmatic reaction, LAR
T lymphocyte(Th1/Th2↓)
↓
Th2 cytokine IL-3、4、5，GM-CSF →IgE↑
Other mechanisms: induced factors
? Allergen: pollen, acarus
? infection: virus or mycoplasmal infection
? climate and physical and chemical factors
? drugs: aspirin induced asthma, AIA
β-receptor inhibitor
? heredity
? Gastroesophageal reflux disease, GERD
? Psychological, incretion factors, sports
Diagnosis standards of asthma
? symptoms
? signs
? recovered ways
? except other cardiac and pulmonary diseases
? lung function examination→untypical asthma
Untypical asthma
? Cough variant asthma, CAV
? Asthma with gastroesphgeal reflux
? Exercise induced asthma, EIA
? Drug induced asthma, DIA
? Occupational asthma, OA
Lung functions diagnosis of asthma
? Obstructive ventilation insufficiency
and reversibility of airway obstruction
? Variance rate ofpeak expired flow (PEF)
in 24 hours ≥20%
? Bronchial challenge is positive
Lung functions diagnosis of asthma(1)
FEV1 < 80 % pre, FEV1/FVC% < 70 %
bronchial dilation test is positive
Post FEV1 - Pre FEV1
FEV1improved rate ＝×100%
Pre FEV1
determinant standard:FEV1 improved rate≥15%(+)
FEV1 improved rate≥200ml
Lung functions diagnosis of asthma(2)
PEF < 80%pre and PEF variance rate ≥20%
PEF max - PEF min
PEF variance rate＝×100%
1/2( PEF max + PEF min )
Determinant standard：PEF variance rate(24h) ≥20% (+)
Lung functions diagnosis of asthma(3)
Bronchial challenge is positive
? therapeutic properties
? forbid properties
? methodsdrug induce: methocholiner
histamine
exercise induce
Distinguishing diagnosis of asthma
Drugs for treating asthma
? Glucocorticosteroid -anti-inflammation
? β 2-agonist
? theophylline bronchodilators
? anticholinergic drug
? non-steroid anti-inflammations
Inhaled steroids
? Baclomethason dipropionate 必可酮(BDP)50ug×200
? Budesonide普米克(BUD)100ug ×100
普米克 都保
普米克令舒 1mg/2ml
? Fluticasone propionate 辅舒酮(FP) 125ug ×100
? Fluticasone + Salmeterol舒利迭 100/50ug×60
250/50ug×60
Using principles of inhaler steroid
? 非急性发作期哮喘长期预防用药首选
? 替代口服激素
? 季节性哮喘季节发作前二周应用
? 急性发作期与β2-激动剂伍用
? 长期预防可联合用药
Inhaled β2- agonists
? Salbutamol 万托林 200ug×200
万托林雾化溶液 0.05% 20ml
? Terbutaline 喘康速 250ug×200
博利康尼都保 250ug×100
博利康尼雾化溶液 5mg/ml
? Salmeterol 施立稳 50ug×200
施立碟 50ug×4×8
? Formoterol奥克斯都保 4.5ug×60
Oralβ2- agonists
? Terbutaline博利康尼2.5mg
? Procaterol美喘清50ug
? Formoterol 安通克40ug
? Salbutemol 全特宁8mg
? Bambuterol帮备4mg
Using principles ofβ2-agonist
? 急性发作期快速缓解哮喘症状
? 与吸入激素伍用可规律使用一周
? 缓解期按需使用,用药次数<4次/日
? 运动性哮喘运动前预防性吸入
? 夜间哮喘选用长效制剂
Theophylline
? iv：aminophylline 0.25
doxofylline0.1
? po:aminophylline 0.1 short action
AEA
舒氟美 0.1long action
葆乐辉 0.4
Using principles of theophylline
? 应用前了解近期茶碱用药史
? 与西咪替丁、喹诺酮类、大环内酯类药物
合并应用时茶碱减量
? 肝肾功能不全、心衰、妊娠、老年人减量
? 急性发作期静脉应用(治疗窗: 10～20ug/ml)
? 长期治疗用长效制剂(治疗窗: 5～10ug/ml)
? 夜间哮喘适用长效茶碱
Anti-cholinergic drug
? Ipratropium bromide 爱全乐 20ug×200
爱全乐水溶液20ml
? Ipratropium bromide 可必特20ug×200
+Salbutamol可必特 2ml
Using principles of anti-cholinergic drug
? 适用于COPD合并哮喘
? 适用于老年人有器质性心脏疾病者
? 适用于夜间哮喘
? 复合制剂适用于快速持续缓解哮喘症状
? 水溶液雾化吸入适用于哮喘急性重症发作
Non-steroid anti-inflammation drugs
? Anti-histamine ：inhaler：色甘酸钠 5mg×200
oral ： 酮替酚、曲尼斯特
息思敏、开瑞坦等
? LTs receptor inhibitor：顺尔宁 10mg×5
Using principles of other anti-inflammation
? 抗组织胺药适用于儿童Atopy 哮喘
? 季节性哮喘季节发作前二个月应用
? 白三烯受体拮抗剂可与激素联合应用
? 白三烯受体拮抗剂对阿斯匹林哮喘、运动性哮喘、过敏性鼻炎效果更好
Drug therapy of asthma
快速缓解药物 长期预防药物
? 短效吸入β 2-激动剂
? 吸入抗胆碱药
? 短效口服β 2-激动剂
? 全身性糖皮质激素
? 短效茶碱
? 吸入型糖皮质激素
? 长效吸入β 2-激动剂
? 白三烯受体拮抗剂
? 缓释茶碱
? 吸入色甘酸钠
? 尼多克罗米
? 酮替酚
Combined therapy
Bronchial asthma
Department of respiration
Kong Lingfei
Background of asthma
Prevalence ：in the world: 1.6 hundred million
in China: 1～3 %
in Shenyang: 1.24 %(1999)
GINA: Global Initiative for Asthma(1994)
WHO/HLBI
Bronchial asthmatic diagnosis guideline (1997)
Chinese Medical Academy
Definitions of asthma
? Chronic airway inflammation
? Broncho-hyperresponsiveness, BHR
? Airflow limitation
Mechanism: allergy theory
antigenantigen
↓↓again
atopy→IgE antibody→mast cells, basophils
↓ histamine
inflammatory mediaLTs
↓PAF
ECP
immediate asthmatic reaction, IAR
↓
bronchial smooth muscle spasm
airway narrow
Mechanism: never-receptor disorder theory
adrenergic and cholinergic nerous systems, AC
non-adrenergic and non-cholinergic nerous systems, NANC
AC: α1-receptor、M1-、M3-receptors excitement
NANC：PS-receptor ↓
bronchial smooth muscle contraction
AC: β-receptor、M2-receptor excitement
NANC: VIP receptor↓
bronchial smooth muscle dilation
asthmatic airway: a1、M1、M3、PS↑/ β 、M2、VIP↓
Mechanism: airway inflammation theory
antigen
↓
allergic airway inflammation, AAIECP
↑ MBP
inflammatory cells →inflammatory media LTs
EOS ↓PAF
neutrophils late asthmatic reaction, LAR
T lymphocyte(Th1/Th2↓)
↓
Th2 cytokine IL-3、4、5，GM-CSF →IgE↑
Other mechanisms: induced factors
? Allergen: pollen, acarus
? infection: virus or mycoplasmal infection
? climate and physical and chemical factors
? drugs: aspirin induced asthma, AIA
β-receptor inhibitor
? heredity
? Gastroesophageal reflux disease, GERD
? Psychological, incretion factors, sports
Diagnosis standards of asthma
? symptoms
? signs
? recovered ways
? except other cardiac and pulmonary diseases
? lung function examination→untypical asthma
Untypical asthma
? Cough variant asthma, CAV
? Asthma with gastroesphgeal reflux
? Exercise induced asthma, EIA
? Drug induced asthma, DIA
? Occupational asthma, OA
Lung functions diagnosis of asthma
? Obstructive ventilation insufficiency
and reversibility of airway obstruction
? Variance rate ofpeak expired flow (PEF)
in 24 hours ≥20%
? Bronchial challenge is positive
Lung functions diagnosis of asthma(1)
FEV1 < 80 % pre, FEV1/FVC% < 70 %
bronchial dilation test is positive
Post FEV1 - Pre FEV1
FEV1improved rate ＝×100%
Pre FEV1
determinant standard:FEV1 improved rate≥15%(+)
FEV1 improved rate≥200ml
Lung functions diagnosis of asthma(2)
PEF < 80%pre and PEF variance rate ≥20%
PEF max - PEF min
PEF variance rate＝×100%
1/2( PEF max + PEF min )
Determinant standard：PEF variance rate(24h) ≥20% (+)
Lung functions diagnosis of asthma(3)
Bronchial challenge is positive
? therapeutic properties
? forbid properties
? methodsdrug induce: methocholiner
histamine
exercise induce
Distinguishing diagnosis of asthma
Drugs for treating asthma
? Glucocorticosteroid -anti-inflammation
? β 2-agonist
? theophylline bronchodilators
? anticholinergic drug
? non-steroid anti-inflammations
Inhaled steroids
? Baclomethason dipropionate 必可酮(BDP)50ug×200
? Budesonide普米克(BUD)100ug ×100
普米克 都保
普米克令舒 1mg/2ml
? Fluticasone propionate 辅舒酮(FP) 125ug ×100
? Fluticasone + Salmeterol舒利迭 100/50ug×60
250/50ug×60
Using principles of inhaler steroid
? 非急性发作期哮喘长期预防用药首选
? 替代口服激素
? 季节性哮喘季节发作前二周应用
? 急性发作期与β2-激动剂伍用
? 长期预防可联合用药
Inhaled β2- agonists
? Salbutamol 万托林 200ug×200
万托林雾化溶液 0.05% 20ml
? Terbutaline 喘康速 250ug×200
博利康尼都保 250ug×100
博利康尼雾化溶液 5mg/ml
? Salmeterol 施立稳 50ug×200
施立碟 50ug×4×8
? Formoterol奥克斯都保 4.5ug×60
Oralβ2- agonists
? Terbutaline博利康尼2.5mg
? Procaterol美喘清50ug
? Formoterol 安通克40ug
? Salbutemol 全特宁8mg
? Bambuterol帮备4mg
Using principles ofβ2-agonist
? 急性发作期快速缓解哮喘症状
? 与吸入激素伍用可规律使用一周
? 缓解期按需使用,用药次数<4次/日
? 运动性哮喘运动前预防性吸入
? 夜间哮喘选用长效制剂
Theophylline
? iv：aminophylline 0.25
doxofylline0.1
? po:aminophylline 0.1 short action
AEA
舒氟美 0.1long action
葆乐辉 0.4
Using principles of theophylline
? 应用前了解近期茶碱用药史
? 与西咪替丁、喹诺酮类、大环内酯类药物
合并应用时茶碱减量
? 肝肾功能不全、心衰、妊娠、老年人减量
? 急性发作期静脉应用(治疗窗: 10～20ug/ml)
? 长期治疗用长效制剂(治疗窗: 5～10ug/ml)
? 夜间哮喘适用长效茶碱
Anti-cholinergic drug
? Ipratropium bromide 爱全乐 20ug×200
爱全乐水溶液20ml
? Ipratropium bromide 可必特20ug×200
+Salbutamol可必特 2ml
Using principles of anti-cholinergic drug
? 适用于COPD合并哮喘
? 适用于老年人有器质性心脏疾病者
? 适用于夜间哮喘
? 复合制剂适用于快速持续缓解哮喘症状
? 水溶液雾化吸入适用于哮喘急性重症发作
Non-steroid anti-inflammation drugs
? Anti-histamine ：inhaler：色甘酸钠 5mg×200
oral ： 酮替酚、曲尼斯特
息思敏、开瑞坦等
? LTs receptor inhibitor：顺尔宁 10mg×5
Using principles of other anti-inflammation
? 抗组织胺药适用于儿童Atopy 哮喘
? 季节性哮喘季节发作前二个月应用
? 白三烯受体拮抗剂可与激素联合应用
? 白三烯受体拮抗剂对阿斯匹林哮喘、运动性哮喘、过敏性鼻炎效果更好
Drug therapy of asthma
快速缓解药物 长期预防药物
? 短效吸入β 2-激动剂
? 吸入抗胆碱药
? 短效口服β 2-激动剂
? 全身性糖皮质激素
? 短效茶碱
? 吸入型糖皮质激素
? 长效吸入β 2-激动剂
? 白三烯受体拮抗剂
? 缓释茶碱
? 吸入色甘酸钠
? 尼多克罗米
? 酮替酚
Combined therapy
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