文档介绍：哮喘的炎症指标进展_节选
哮喘的炎症指标进展_节选哮喘的炎症指标进展_节选
Airways Narrowing
哮 喘 的 病 理
Trigger factor
Mucus plugging
Airway wall oedema
Smooth muscle spasm
确定是否有气道阻塞: 用肺功能仪
Sensitivity = 35%
Smith et al. AJRCCM., 2004
litres
FEV1
seconds
1 2 3 4 5 6
NORMAL
OBSTRUCTED
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
A
B
C
D
Simpson et al Respirology 2006; 11: 54-61
哮 喘 的 炎 症 亚 型
cellularity
Is airway inflammation related to …
cigarette smoking ….. active or passive?
infection ….. bronchiectasis?
air pollution ….. . diesel fumes?
allergic (IgE-mediated) asthma? ….. . 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
Relationship between sputum eosinophils and response to ICS therapy
N = 120
“Unstable asthma”
Rx Trial of:
FLU 500µg/day OR
FLU 2000µg/day OR
oral prednisolone 30mg/day
Meijer et al. Clin. Exp. Allergy 2002; 32: 1096-1103
Baseline sputum eosinophils %
Relationship between sputum neutrophils and response to ICS therapy in asthma
Green et al. Thorax 2002
PC20 FEV1 VAS
All others n=38
Neutros >65% Eos <2%, n=11
BUD 800 µg/day for 2 months
Eosinophilic inflammation is
steroid responsive inflammation
Brown, 1958