英文班支气管哮喘-ILD.ppt

Atypical asthma Cough or chest tightness Cough-variant asthma: cough only often at night or early in the morning Triggered by exercise\cold air Relieved with bronchodilators\ICS 特殊类型哮喘 Exercise-induced asthma Aspirin asthma：asthma,nasal polyp and aspirin intolerance Asthma-COPD overlap syndrome IIP的临床病理相关 根据病情IIP分类 UIP的病理诊断 影像-病理-临床诊断 Therapy for acute exacerbation of IPF Steroid therapy methylpredisone 0.5-1.0g ivgtt x 3d，followed by 1-2mg/d Cyclosporin A Ig Antimicrobial therapy Oxygen therapy Supporative therapy 吡非尼酮治疗IPF有效 N Engl J Med 2014;370:2083-92. 尼达尼布(nintedanib) 尼达尼布(nintedanib)为三重酪氨酸激酶抑制剂,靶点包括血小板源生长因子(PDGF)、血管内皮生长因子(VEGF)和碱性纤维母细胞生长因子(bFGF),也可抑制MAPK和Akt激活 Nintedanib（尼达尼布）治疗IPF有效 N Engl J Med 2014;370:2071-82. 抗胃食道反流治疗IPF N-乙酰半胱氨酸（NAC）对IPF的作用 Demedts et al. NEJM 2005 N Engl J Med 2014;370:2093-101 NAC治疗IPF；对肺功能无影响 其它治疗 肺移植 氧疗与对症治疗 康复 中医中药 Nature History of IPF IPF小结 IPF是一种预后较差的疾病，病程各异 疾病恶化表现为呼吸道症状加重、肺功能下降、肺CT进行性肺纤维化、急性呼吸衰竭甚至死亡 临床表现为呼吸困难和肺部Velcro啰音 高分辨率肺CT（HRCT）是诊断重要手段 目前内科治疗有效的药物为： 吡非尼酮pirfenidone，尼达尼布Nintedanib Suggesting reading GINA REPORT, GLOBAL STRATEGY FOR ASTHMA MANAGEMENT AND PREVENTION. / An Official ATS/ERS/JRS/ALAT Clinical Practice Duideline: Treatment of Idiopathic Pulmonary Fibrosis. Am J Respir Crit Care Med Vol 192(2). pp e3-e19, 2015 An Official American Thoracic Society/European Respiratory Society Statement: Update of the International Multidisciplinary Classification of the Idiopathic Interstitial Pneumonias. Am J Respir Crit Care Med Vol 188, Iss. 6, pp 733–748, Sep 15, 2013 * 新近由GINA出版的“全球哮喘疾病负担”的报告中指出中国的哮喘患者死亡率极高，约每100,000位哮喘患者中有36.7位患者会因哮喘死亡，而加拿大仅为1.6位哮喘患者。另外，中国农村地区哮喘患者死亡率是城市的2倍。 * * * 首先我们介绍“白三烯受体拮抗剂用于哮喘起始治疗”。 * * * * Ground glass opacity(GGO) pulmonary alveolar proteinosis Bronchoalveolar Lavage肺泡灌洗 Normal：细胞总数5~10x106，巨噬细胞85~90%，L10~15%，N+E 1% Diagnosis: E25% eosinophilic pneumonia periodic acid–Schiff (PAS)+: alveolar proteinosis BAL lymphocytes ( 35%) sarcoidosis, HP,LIP,drug-induced I