哮喘的炎症指标最新进展-节选课件.pptxVIP

哮喘炎症的非创伤性检测 指标及临床意义 • 苏州大学附属儿童医院 郝创利 Airways Narrowing Airway wall oedema 哮 喘 的 病 理 Mucus plugging Smooth muscle spasm Trigger factor NORMAL seconds Smith et al. AJRCCM., 2004 确定是否有气道阻塞: 用肺功能仪 Sensitivity = 35% 1 2 3 4 5 6 litres FEV1 … 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 GINA 哮喘的定义 A.Neutrophilic B.Eosinophilic C.Mixed cellularity D.Paucigranular 哮 喘 的 炎 症 亚 型 Simpson et al Respirology 2006; 11: 54-61 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 Only eosinophilic inflammation is steroid responsive N = 120 “Unstable asthma” Rx Trial of: 1. FLU 500µg/day OR 2. FLU 2000µg/day OR 3. oral prednisolone 30mg/day Relationship between sputum eosinophils and response to ICS therapy Meijer et al. Clin. Exp. Allergy 2002; 32: 1096-1103 Baseline sputum eosinophils % Neutros 65% 2%, n=11 FEV1 Relationship between sputum neutrophils and response to ICS therapy in asthma BUD 800 µg/day for 2 months Green et al. Thorax 2002 All others n=38 PC20 VAS Eos Eosinophilic inflammation is steroid responsive inflammation Brown, 1958 Co-existing pathology e.g. Other pathology e.g. rhinitis with post-nasal bronchiectasis, GE drip reflux Respiratory symptoms in patients with “asthma” Anxiety leading to hyperventila