青岛雾化激素专家共识解读—雾化吸入糖皮质激素在儿科应用.ppt

* 支气管梗阻对吸入气雾剂治疗哮喘肺内沉积率的影响 该试验分两组，每组8例，同时吸入带有免疫荧光物质药物，观察肺内药物的分布情况 肺功能正常：FEV1-83 % 肺内药物分布均匀，肺轮廓清晰，边缘清楚，小气道内可见药物沉积 肺功能不正常：FEV1-36 % 肺内药物分布不均匀，肺边缘不清楚，药物主要沉积在大气道 This study examined the relationship between the magnitude of baseline bronchial obstruction and aerosol deposition in the the lungs of patients with asthma. Individuals (n=8) with an established clinical history of asthma inhaled a saline aerosol radiolabeled with technetium-99m-labeled sulfur colloid followed by a gamma camera scan. Individuals were scanned for up to two hours in order to quantify initial aerosol deposition and subsequent clearance from the respiratory tract.15 The gamma camera scans show the initial deposition of the radiolabeled aerosol in a patient who was unobstructed as demonstrated by an FEV1 of 83% predicted, and a patient with severe bronchial obstruction (FEV1 36% predicted). In the unobstructed patient, the deposition had a uniform appearance with well-defined lung margins, indicating considerable peripheral deposition. In the patient with bronchial obstruction, the distribution of aerosol was uneven with a predominance of hot spots of radioactivity located in the large central airways.15 There was a significant negative correlation between baseline FEV1 and aerosol clearance (p0.05). This demonstrates that at low FEV1 values (greater obstruction), a greater proportion of the aerosol was deposited in the large ciliated airways than in the small peripheral airways, because a greater proportion of the aerosol was cleared over the time period than at higher FEV1 values.15 The findings of a study of 8 patients have implications for the delivery of inhaled anti-inflammatory therapy. If a patient has bronchial obstruction, the amount of medication reaching the small airways may be reduced. Ref 15 p 740A,B Ref 15 p 742A p 741A,B Ref 15 p 741C p 742B 吸入激素抗炎作用的机制。 * 以往的吸入性糖皮质激素在哮喘维持期的疗效已取得广泛肯定，为什么现在可以用于哮喘急性期治疗呢？经过临床医生和药理学专家长期探索，发现激素的非经典作用途径是它快速起效的机理。如图所示，糖皮质激素具有经典和非经典作用途径