雾化吸入普米克在小儿哮喘等疾病的应用.pptxVIP

雾化吸入普米克在小儿哮喘等疾病的应用第1页/共62页 2对于哮喘的认识*支气管因平滑肌痉挛而收缩水肿粘液分泌亢进炎性细胞浸润气道高反应 LTD4CysLT1CysLT1 = 半胱氨酰白三烯1型受体哮喘是一种气道的慢性炎症性疾病。慢性炎症形成后的气道,其反应性增高;当接触于各种危险因素时,气道出现阻塞和气流受限(由支气管收缩、粘液栓形成和炎症加重引起)。* GINA Pocket Guideline 2002第2页/共62页 3  制定规范的个体化长期治疗方案 ★定病情 ★定剂量 ★定途径 ★纠方法 ★避诱因 ★勤宣教第3页/共62页 4糖皮质激素在哮喘长期治疗中的应用1．糖皮质激素治疗哮喘的主要机制 （1）抑制气道炎症和降低气道高反应性 第4页/共62页 5 （2）有助于其他抗哮喘药物的疗效 ●增加糖皮质激素能促进细胞膜上?2受体的表达 ●增加气道?2受体的密度 ●提高气道平滑肌细胞?2受体的反应性等，因而 能增加?2受体的疗效。 （3）间接舒张支气管平滑肌作用糖皮质激素在哮喘长期治疗中的应用第5页/共62页 6PharmacotherapyReliever medications??Short-acting inhaled β2 agonists??Other bronchodilatorsController medications??ICS??LTRA??Long-acting β2 receptor agonists (LABAs) (only in combination with ICS)??Sustained-release theophylline??Anti-IgE antibodies??Cromolyn sodium??Oral steroids第6页/共62页 7ICS??A first-line treatment for persistent asthma.??Reduces the frequency and severity of exacerbations.??Should be introduced as initial maintenance treatment (200?μg BDP equivalent) when the patient has inadequate asthma control.??Atopy and poor lung function predict a favorable response to ICS .??If control is inadequate on a low dose after 1–2?months, reasons for poor control should be identified. If indicated, an increased ICS dose or additional therapy with LTRAs or LABAs should be considered.第7页/共62页 82006-- GINA★Inhaled therapy is the cornerstone of asthma treatment for children of all ages. ★Almost all children can be taught to effectively use inhaled therapy. ★Different age groups require different inhalers for effective therapy, so the choice of inhaler must be individualized. 第8页/共62页 9 Choosing an Inhaler Device forChildren with AsthmaAge Group Preferred Device Alternate DeviceYounger than Pressurized metered- Nebulizer with 4 years dose inhaler plus mask dedicated spacer with face mask4 – 6 years Pressurized metered-