哮喘的炎症指标最新进展_节选教学幻灯片.pptVIP

* I am very grateful indeed to the organisers for this kind invitation to speak at this conference. The links between New Zealand and China are increasingly strong Even although New Zealand is a very small country with only 4 million inhabitants, our governments recently signed China’s first free trade agreement with any other sovereign country and I am sure that it will have a significant impact on the relationship between our two countries * This slide provides a reminder of the classical view of asthma A trigger e.g. a viral infection or an allergen results in increased airway inflammation. In turn this causes increased mucus production, oedema of the airway wall, and smooth muscle spasm. Because all of these contribute to airflow obstruction, we have relied on functional, physiological measurements of airflow obstruction to help us make a diagnosis. In particular, for the last 50 years we have used spirometry …… * But spirometry is not a sensitive test. Our data showed that the sensitivity of a low FEV1 FVC ratio was only 35%! i .e. spirometry is abnormal in less than half of all patients with asthma! * This is the internationally accepted definition of asthma from GINA. I have highlighted only the key phrases Asthma is an INFLAMMATORY DISORDER characterised by INCREASED AIRWAY HYPER-RESPONSIVENESS resulting in VARIABLE AIRFLOW OBSTRUCTION which causes RESPIRATORY SYMPTOMS * This slide shows the four types of airway inflammation in asthma These are: neutrophilic, eosinophilic, mixed cellularity and paucigranulocytic i.e. having few inflammatory cells at all. * There is another important consideration It is to determine the TYPE of airway inflammation Why? Well, FIRSTLY this will depend on the cause For example cigarette smoking and infection will cause neutrophilic airway inflammation Acute exposure to air pollution may do the same, but there is evidence that exposure to diesel fumes will enhance the patients susceptibility to allergic a