支气管哮喘英文幻灯片.pptx
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支气管哮喘英文幻灯片.pptx
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Asthma,ChenxinM.D.,PulmonaryMedicinezhujianghospital,southernmedicaluniversity,DefinitionofAsthma,AchronicinflammatorydisorderoftheairwaysManycellsandcellularelementsplayaroleChronicinflammationisassociatedwithairwayhyperresponsivenessthatleadstorecurrentepisodesofwheezing,breathlessness,chesttightness,andcoughingWidespread,variable,andoftenreversibleairflowlimitation,Source:
PeterJ.Barnes,MD,AsthmaInflammation:
CellsandMediators,Source:
PeterJ.Barnes,MD,Mechanisms:
AsthmaInflammation,Source:
PeterJ.Barnes,MD,AsthmaInflammation:
CellsandMediators,哮喘病理生理学,支气管高反应性平滑肌增生/体积增大炎症介质释放增多,炎症细胞数增加黏膜水肿支气管高反应气道分泌物增加上皮损伤,细胞增生(平滑肌细胞、黏液腺)基质蛋白沉积增加基底膜增厚血管新生,平滑肌功能障碍,气道炎症,气道重塑,BurdenofAsthma,Asthmaisoneofthemostcommonchronicdiseasesworldwidewithanestimated300millionaffectedindividualsPrevalenceincreasinginmanycountries,especiallyinchildrenAmajorcauseofschool/workabsence,BurdenofAsthma,HealthcareexpendituresveryhighDevelopedeconomiesmightexpecttospend1-2percentoftotalhealthcareexpendituresonasthma.DevelopingeconomieslikelytofaceincreaseddemandPoorlycontrolledasthmaisexpensive;investmentinpreventionmedicationlikelytoyieldcostsavingsinemergencycare,AsthmaPrevalenceandMortality,Source:
MasoliMetal.Allergy2004,中国是哮喘病死率最高的国家之一,534岁年龄组患者哮喘病死率(case-fatalityrates),36.7/10万(10.0/10万,处于高水平),在中国,每100,000位哮喘患者中有36.7位哮喘患者会因哮喘死亡。
GINA2004MasoliM(2004).TheglobalburdenofasthmaGINAreport.,RiskFactorsforAsthma,Hostfactors:
predisposeindividualsto,orprotectthemfrom,developingasthmaEnvironmentalfactors:
influencesusceptibilitytodevelopmentofasthmainpredisposedindividuals,precipitateasthmaexacerbations,and/orcausesymptomstopersist,FactorsthatExacerbateAsthma,AllergensRespiratoryinfectionsExerciseandhyperventilationWeatherchangesSulfurdioxideFood,additives,drugs,FactorsthatInfluenceAsthmaDevelopmentandExpression,HostFactorsGeneticAtopyAirwayhyperresponsivenessGenderObesity,EnvironmentalFactorsIndoorallergensOutdoorallergensOccupationalsensitizersTobaccosmokeAirPollutionRespiratoryInfectionsDiet,IsitAsthma?
RecurrentepisodesofwheezingTroublesomecoughatnightCoughorwheezeafterexerciseCough,wheezeorchesttightnessafterexposuretoairborneallergensorpollutantsColds“gotothechest”ortakemorethan10daystoclear,AsthmaDiagnosis,HistoryandpatternsofsymptomsMeasurementsoflungfunctionSpirometryPeakexpiratoryflowMeasurementofairwayresponsivenessMeasurementsofallergicstatustoidentifyriskfactorsExtrameasuresmayberequiredtodiagnoseasthmainchildren5yearsandyoungerandtheelderly,TypicalSpirometric(FEV1)Tracings,123,45,VolumeFEV1NormalSubjectAsthmatic(AfterBronchodilator)Asthmatic(BeforeBronchodilator),Time(sec)Note:
EachFEV1curverepresentsthehighestofthreerepeatmeasurements,MeasuringVariabilityofPeakExpiratoryFlow,MeasuringAirwayResponsiveness,ClinicalControlofAsthma,No(orminimal)*daytimesymptomsNolimitationsofactivityNonocturnalsymptomsNo(orminimal)needforrescuemedicationNormallungfunctionNoexacerbations*Minimal=twiceorlessperweek,LevelsofAsthmaControl,DevelopPatient/DoctorPartnershipIdentifyandReduceExposuretoRiskFactorsAssess,TreatandMonitorAsthmaManageAsthmaExacerbationsSpecialConsiderations,AsthmaManagementandPreventionProgram:
FiveComponents,Revised2006,AsthmaManagementandPreventionProgram:
FiveInterrelatedComponents,DevelopPatient/DoctorPartnershipIdentifyandReduceExposuretoRiskFactorsAssess,TreatandMonitorAsthmaManageAsthmaExacerbationsSpecialConsiderations,AsthmaManagementandPreventionProgram,GoalsofLong-termManagement,AchieveandmaintaincontrolofsymptomsMaintainnormalactivitylevels,includingexerciseMaintainpulmonaryfunctionasclosetonormallevelsaspossiblePreventasthmaexacerbationsAvoidadverseeffectsfromasthmamedicationsPreventasthmamortality,AsthmacanbeeffectivelycontrolledinmostpatientsbyinterveningtosuppressandreverseinflammationaswellastreatingbronchoconstrictionandrelatedsymptomsEarlyinterventiontostopexposuretotheriskfactorsthatsensitizedtheairwaymayhelpimprovethecontrolofasthmaandreducemedicationneeds.,AsthmaManagementandPreventionPro.gram,AsthmaManagementandPreventionProgram,Althoughthereisnocureforasthma,appropriatemanagementthatincludesapartnershipbetweenthephysicianandthepatient/familymostoftenresultsintheachievementofcontrol,GuidelinesonasthmamanagementshouldbeavailablebutadaptedandadoptedforlocalusebylocalasthmaplanningteamsClearcommunicationbetweenhealthcareprofessionalsandasthmapatientsiskeytoenhancingcompliance,AsthmaManagementandPreventionProgramComponent1:
DevelopPatient/DoctorPartnership,AsthmaManagementandPreventionProgramComponent1:
DevelopPatient/DoctorPartnership,Educateco
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