新-哮喘合并cOPD.ppt

哮喘合并COPD的诊治进展;为何要重视哮喘合并COPD？;流行病学;流行病学;慢性支气管炎 肺气肿;正常人的肺泡排空;COPD 患者中, 由于肺泡弹性的丧失、支持组织的破坏和小气道狭窄等，气流发生受限。;正常人的呼吸;COPD患者的呼吸;;自然病史;危险因素;长期哮喘出现以下情况时高度提示COPD;如何诊断哮喘合并COPD？;哮喘合并COPD患者气道炎症和气道重塑的特点？;粘液分泌过多;;;哮喘合并COPD气道炎症的特征;哮喘气流受限的形式;炎症 ;COPD的病理生理特点及肺功能改变;哮喘合并COPD气道重塑的特点;如何对哮喘合并COPD的患者进行治疗？;第1级;抗胆碱能药在哮喘治疗中的价值;GOLD 推荐：以FEV1为金标准的COPD分级治疗;抗胆碱能药物影响COPD的临床进程;胆碱能M3受体兴奋是支气管收缩的主要可逆机制; 结合 Kd (nM) 噻托溴铵 异丙托溴铵 Hm1 0.04 0.18 Hm2 0.02 0.20 Hm3 0.01 0.20 ;基线 ;抗胆碱能药在COPD治疗中的价值;Saito Y et al. Intern Med 2008; 47: 585-591;思力华针对气体陷闭,改善患者肺功能;病 例; 1. Tiotropium bromide in asthma patients: an alternative to inhaled long-acting beta-agonists? Lane, M, The journal of the Royal College of Physicians of Edinburgh, 40 (4), p.321-322, Dec 2010  MEDLINE/PubMed Citation on? similar results 2. Tiotropium bromide step-up therapy for adults with uncontrolled asthma. Peters, Stephen P / Kunselman, Susan J / Icitovic, Nikolina / Moore, Wendy C / Pascual, Rodolfo / Ameredes, Bill T / Boushey, Homer A / (...) / National Heart, Lung, and Blood Institute Asthma Clinical Research Network, The New England journal of medicine, 363 (18), p.1715-1726, Oct 2010 BACKGROUND: Long-acting beta-agonist (LABA) therapy improves symptoms in patients whose asthma is poorly controlled by an inhaled glucocorticoid alone. Alternative treatments for adults with uncontrolled asthma are needed. METHODS: In a three-way, ... MEDLINE/PubMed Citation on? similar results 3. Effect of tiotropium bromide on airway inflammation and remodelling in a mouse model of asthma. Ohta, S / Oda, N / Yokoe, T / Tanaka, A / Yamamoto, Y / Watanabe, Y / Minoguchi, K / (...) / Adachi, M, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology, 40 (8), p.1266-1275, Aug 2010 BACKGROUND: Tiotropium bromide, a long acting muscarinic receptor inhibitor, is a potent agent for patients