【医院科室培训】_1.哮喘讲课-北京协和医院学习.pptVIP

美国胸科医师学会 controlling your asthma patient guide * Asthma is a chronic inflammatory disease with episodic attacks, involving acute inflammation on top of chronically persistent inflammation Acute inflammation in asthma is associated with bronchoconstriction, plasma exudation / oedema, vasodilatation and mucus hypersecretion Chronic inflammation in asthma is associated with subepithelial fibrosis, smooth muscle hyperplasia / hypertrophy, mucus gland hyperplasia and new vessel formation If asthma remains uncontrolled or poorly controlled, the underlying persistent inflammation in the airways leads to structural changes (remodelling) that reduce the extent of FEV1 response to short courses of steroids Definition of Asthma (GINA, updated 2005) Key Point: Clinically, asthma is a continuously changing combination of these 4 basic elements. The patients that we see not only present differently from each other, but also vary themselves over time in the way that these four features manifest themselves. As noted here, a key factor in defining asthma is that it changes continuously. SOURCES: Asthma in America: A Landmark survey. National Survey Data. Available at: /cities/national.html; Updated from the NHLBI/WHO Workshop Report: Global Strategy for Asthma Management and Prevention, issued January, 1995, and revised 2002. NIH Publication No. 02-3659. 哮喘是多种炎症细胞和炎症因子参与的慢性炎症反应。慢性炎症反应被认为是哮喘关键的病理生理过程，炎细胞可以释放出许多炎症介质和细胞因子，最终发挥生物学效应。 其中白三烯是重要的炎症介质，在各种炎症细胞中都有其受体的表达，其是惟一通过抑制其作用可同时改善肺功能和哮喘症状的炎症介质 * 11 8 Inhaled antigen reaches and binds to antigen presenting cells (e.g. B cells) and T cells at or near the airway surface. The B cells secrete specific IgE under the control of a specific T lymphocyte cell type developed after exposure to a specific allergen presented by accessory cells. Once sensitised to a specific allergen, reexposure of the tissue to the same allergen augments the production of specific IgE that binds to specific receptors on the membrane of mast cells and al