小气道病变在哮喘中的地位PPT课件.pptVIP

The diagram on the left shows the subsequent branching of the airways between the trachea at the start to the alveoli at the end. Small airways are defined as those less than 2 mm in internal diameter, which are located from the 4th to the 12th generation of airway branching in the lung. Small airways represent a difficult area of the lung to study. Despite this, there is now increasing recognition of their role in the pathogenesis of both asthma and COPD. In the slide, the main differences between large and small airways are summarized: INTERNAL DIAMETER: small airway diameter is 2mm whereas large airway internal diameter is 2 up to 18mm SURFACE AREA: surface area of small airways is indeed large and contrasts to the small surface area of large airways RECEPTOR DENSITY: while there is a high density of corticosteroid receptors in both the small and large airways, a high density of beta-adrenoreceptors appears to be present in the small airways compared to a lower density in the large airways. This is quite a busy and complex diagram showing pathways that contribute to inflammation in asthmatics airways. I would like you to specifically focus on the three circled areas in the centre of the diagram. Inhaled allergens activate sensitized mast cells by crosslinking surface-bound IgE molecules to release several bronchoconstrictor mediators, including cysteinyl leukotrienes and prostaglandin D2. Allergens are also processed by myeloid dendritic cells, which are conditioned by thymic stromal lymphopoietin (TSLP) secreted by epithelial cells and mast cells to release the chemokines CC-chemokine ligand 17 (CCL17) and CCL22, which act on CC-chemokine receptor 4 (CCR4) to attract T helper 2 (TH2) cells. TH2 cells have a central role in orchestrating the inflammatory response in allergy through the release of interleukin-4 (IL-4) and IL-13 (which stimulate B cells to synthesize IgE), IL-9 (which stimulates mast-cell proliferation) and IL-5 (which is necessary for eos