哮喘-病房讲课.pptVIP

初始治疗方案制定： 对于未经治疗的持续性哮喘患者，应从第2级别（即低剂量ICS或白三烯调节剂）开始； 若哮喘未控制，则治疗级别应从第3级别开始： 低剂量ICS＋LABA联合治疗 中高剂量ICS 低剂量ICS＋白三烯调节剂 低剂量ICS＋缓释茶碱 哮喘治疗的目标是：达到并维持哮喘临床控制： 无（或≤2次/周）白天症状 无日常活动（包括运动）受限 无夜间症状或因哮喘憋醒 无（或≤2次/周）需接受缓解药物治疗 肺功能正常或接近正常 无哮喘急性加重 * 非特异性气道激发试验,从低-高浓度,平静吸入经雾化期产生的雾化爷,吸入组织胺累积剂量7.8mmol或乙酰甲胆碱浓度8mg/ml以内，肺通气功能（FEV1）下降20％者为气道高反应性 These tests are sensitive for a diagnosis of asthma, but have limited specificity25. This means that a negative test can be useful to exclude a diagnosis of persistent asthma in a patient who is not taking inhaled glucocorticosteroid treatment, but a positive test does not always mean that a patient has asthma26. This is because airway hyperresponsiveness has been described in patients with allergic rhinitis27 and in those with airflow limitation caused by conditions other than asthma, such as cystic fibrosis28, bronchiectasis, and chronic obstructive pulmonary disease (COPD)29. * * 抗原抗体作用,过敏性抗体IgE对皮肤和黏膜下组织的肥大细胞有强的亲和力. In treatment-na?ve patients with persistent asthma, treatment should be start at Step 2, or, if very symptomatic (uncontrolled), at step 3. All patients with persistent asthma require one or more regular controller medications (Steps 2 through 5). Step 2 is the initial treatment for most treatment-na?ve patients with persistent asthma symptoms. If symptoms at the initial consultation suggest that asthma is poorly controlled, initial treatment may be commenced at step 3. The scheme presented in Figure is based upon these principles, but the range and sequence of medications used in each clinical setting will vary depending on local availability (for cost or other reasons), acceptability and preference. To include GINA 2006 update guide for step-up and step-down dosing as part to maintain asthma control a continuous cycle of : Assessing Asthma Control Treating to Achieve Control Monitoring to Maintain Control 哮喘教育和环境因素控制 按需使用速效β2 激动剂 按需使用速效β2激动剂 控制 治疗方案 选择1种 选择1种 增加1种 或1种以上 增加1种 或1种以上 低剂量ICS 低剂量ICS＋ 长效β2激动剂 中高剂量ICS＋ 长效β2激动剂 口服糖皮质激