哮喘的诊断及规范化治疗推荐.pptVIP

* * In addition to constriction (narrowing) of the airways, due to contraction of the smooth muscle in the airway wall, asthma is also associated with specific inflammatory changes. These inflammatory processes include exudation of mucus and plasma, oedema and shedding of the damaged epithelium Narrowing of the airways in asthma is produced by a combination of smooth muscle contraction, thickening of the airway wall, oedema and mucus in the airway lumen * In addition to constriction (narrowing) of the airways, due to contraction of the smooth muscle in the airway wall, asthma is also associated with specific inflammatory changes. These inflammatory processes include exudation of mucus and plasma, oedema and shedding of the damaged epithelium Narrowing of the airways in asthma is produced by a combination of smooth muscle contraction, thickening of the airway wall, oedema and mucus in the airway lumen * Inflammation 与 infection 的中文解释都是炎症，但病理学意义与治疗方面均迥然 不同。 * * 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 * Slide 16 ? When classifying asthma severity according to the GINA guidelines, it is important to realise that the ‘clinical’ setting can be very different from the situation in real life for many reasons * 我们知道，药物经气雾剂的定量阀门喷入口腔，80－90％咽下，经胃肠道吸收入血，被肝脏代谢，即‘‘首过效应’’失活,代谢产物进入全身循环，称其量为A。有10－20％的微小颗粒悬浮药物随吸入气流进到肺部小气道及细小支气管，真正发挥直接而强效的抗炎作用。其入血的代谢产物非常少，几可忽略称为B