2013哮喘防治指南(灰靳层版).pptVIP

支气管哮喘防治指南解读 俞万钧 哮喘防治指南(基层版) 支气管哮喘： 是一种慢性气道炎症性疾病 这种慢性炎症与气道高反应性的发生和发展有关 哮喘的发病是遗传和环境两方面因素共同作用的结果。 临床上表现为反复发作的喘息、气急、胸闷、咳嗽等症状，常在夜间和(或)清晨发作、加剧，大多数患者可经药物治疗得到控制。 哮喘的分期 根据临床表现哮喘可分为： 急性发作期（acute exacerbation） 慢性持续期（chronic persistent）：每周均有 临床缓解期（clinical remission）：临床控制并维持3个月以上。 治疗方案的确定和选择 药物的疗效 药物的安全性 患者状况：经济收入、文化水平、依从性等 当地的医疗资源 ACT（ASTHMA CONTROL TEST ）评分量表掌握哮喘控制程度 * * 哮喘控制 Global Initiative for Asthma. Global strategy for asthma management and prevention. Updated 2009. 哮喘临床控制* 无（或≤2次/周）日间症状 无日常活动和运动受限 无夜间症状或因哮喘夜间憋醒 无需（或≤2次/周）使用缓解药物治疗 肺功能正常或接近正常 * 在2009版GINA指南中已将“无急性发作”移至未来风险部分。 减少未来风险 急性发作 肺功能快速下降 药物的副作用 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd. 应根据以下原则选择治疗方案： 哮喘控制水平 当前的治疗 药物特性和各种哮喘治疗手段的可获得性 经济因素 治疗并达到哮喘控制 Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd. Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile . Copyright 2004-2011 Aspose Pty Ltd. * Asthma is a complex disease involving many different cells Current thinking on the pathophysiology of asthma regards it as a specific type of inflammatory condition, involving, in particular, mast cells, eosinophils and T lymphocytes, which release a wide range of inflammatory mediators These mediators act on cells in the airway, leading to contraction of smooth muscle, oedema due to plasma leakage and mucus plugging * 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 struc