哮喘的炎症指标最新进展-节选.pptx

Airways Narrowing哮 喘 的 病 理Trigger factorMucus pluggingAirway wall oedemaSmooth muscle spasm第二页，共六十三页。NORMAL1 2 3 4 5 6 确定是否有气道阻塞: 用肺功能仪litresOBSTRUCTEDSensitivity = 35%FEV1secondsSmith et al. AJRCCM., 2004第三页，共六十三页。GINA 哮喘的定义… chronic inflammatory disorder of the airways … … increase in airway hyper-responsiveness … … recurrent episodes of respiratory symptoms …… variable airflow obstruction …… reversible spontaneously or with treatment.Global INitiative for Asthma 2007第四页，共六十三页。哮 喘 的 炎 症 亚 型BAA.NeutrophilicB.EosinophilicC.Mixed cellularityD.PaucigranularC D Simpson et al Respirology 2006; 11: 54-61第五页，共六十三页。Is airway inflammation related to …cigarette smoking ….. active or passive?infection ….. bronchiectasis?air pollution ….. e.g. diesel fumes?allergic (IgE-mediated) asthma? ….. e.g. ascaris lumbricoides?- Depending on the cause, the type of airway inflammation may be different. - This is important because it will influence the potential response to anti-inflammatory treatment 第六页，共六十三页。Only eosinophilic inflammation issteroid responsive第七页，共六十三页。Relationship between sputum eosinophils and response to ICS therapyN = 120“Unstable asthma〞Rx Trial of: FLU 500μg/day ORFLU 2000μg/day ORoral prednisolone 30mg/dayBaseline sputum eosinophils %Meijer et al. Clin. Exp. Allergy 2002; 32: 1096-1103第八页，共六十三页。Relationship between sputum neutrophils and response to ICS therapy in asthmaNeutros 65% Eos 2%, n=11All others n=38 PC20FEV1VASBUD 800 μg/day for 2 monthsGreen et al. Thorax 2002第九页，共六十三页。Eosinophilic inflammation issteroid responsive inflammationBrown, 1958第十页，共六十三页。Respiratory symptoms in patients with “asthma〞Co-existing pathology e.g. rhinitis with post-nasal dripOther pathology e.g. bronchiectasis, GE refluxPoor compliance, inadequate anti-inflammatory treatmentAnxiety leading to hyperventilation or vocal cord dysfunction“Asthma〞 symptoms第十一页，共六十三页。Respiratory symptoms in