从炎论治,慢阻肺的抗炎治疗 PPT课件.pptVIP

001-GOLD 2014 * 布地奈德吸入后在气道中沉积，一部分被粘液的纤毛转运，一部分溶解在黏液中。布地奈德有适当的水溶性，能够溶解于黏液，快速持久与细胞膜密切接触，发挥抗炎作用。 下面的图显示的是不同激素从低到高剂量引起的支气管血管收缩效应的比较。横坐标是药物剂量，纵坐标是支气管血管内的血流指数。可以看到布地奈德引起的血管收缩效应显著强于其它两种药物，且这种效应可以看到随着剂量的增加而增强。 图：Dose/response relationship between inhaled fluticasone , beclomethasone and budesonide dose and airway blood flow (Qaw) in asthmatics (n=10). Data are presented as mean+-SD. *: pv0.05 versus baseline value. A total of 10 subjects with mild asthma and 10 normal volunteers, without any history of asthma or other respiratory disease, were recruited for this study. The subjects inhaled either BDP (1,680 mg), FP (880 mg) or BUD (1,000 mg) from commercially available metered-dose inhalers (MDIs) with a spacer in random order on three different days. Airway blood flow A previously validated and applied, soluble, inert gasuptake was used to measure Qaw [7, 13]. The subjects first inhaled room air and then exhaled 500 mL from the total lung capacity position. Subsequently, the subjects rapidly inhaled the same volume of gas from a gas mixture contained in a Teflon bag, consisting of 10% dimethylether (DME), 5% helium and a balance of oxygen. After a predetermined breath-hold time, the subject then exhaled into a spirometer, through a critical flow orifice, to standardise the expiratory flow. During exhalation, the instantaneous concentrations of DME, nitrogen and helium were measured at the airway opening using a mass spectrometer (Perkin-Elmer, Pomona, CA, USA) along with the expired gas volume. The manoeuvre was performed with two breath-hold times each of 5, 10, 15 and 20 s in random order. The Qaw was calculated by multiplying the helium-corrected DME concentration slope by the expired anatomic dead space volume (minus the proximal 50 mL) to obtain DME uptake, which was then divided by the mean DME concentration and the solubility coefficient for DME in blood (Fick9s principle). The anatomic dead space was derived from the nitrogen washout curve inscribed after the 10-