支气管哮喘——【内科学】
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Volume FEV1
Normal Subject Asthmatic (After Bronchodilator) Asthmatic (Before Bronchodilator)
1 23 45 Time (sec)
Note: Each FEV1 curve represents the highest of three repeat measurements
实验室检查--PEF变异率
呼气峰流速（PEF） PEF变异率= 高PEF – 低PEF/平均PEF×%
Measuring Variability of Peak Expiratory Flow
Contents
•General Information •PathogenesisLeabharlann Baidu•Symptoms •Diagnosis •Treatment
Is it Asthma?
Recurrent episodes of wheezing Troublesome cough at night Cough or wheeze after exercise Cough, wheeze or chest tightness after exposure to airborne allergens or pollutants Colds “go to the chest” or take more than 10 days to clear
Contents
•General Information •Pathogenesis •Symptoms •Diagnosis •Treatment
实验室检查--支气管舒张试验
哮喘发作期间--FEV1变化 沙丁胺醇 特布他林 异丙托溴铵
Typical Spirometric (FEV1) Tracings
经典哮喘发病过程
哮喘发病机制--免疫炎症/神经/AHR
Source: Peter J. Barnes, MD
Asthma Inflammation: Cells and Mediators
Source: Peter J. Barnes, MD
Asthma Inflammation
Asthma Inflammation
支气管哮喘--定义
• 哮喘是由多种细胞包括气道的炎性细胞和结构细胞（如嗜 酸粒细胞、肥大细胞、T淋巴细胞、中性粒细胞、平滑肌 细胞、气道上皮细胞等）和细胞组分参与的气道慢性炎症 性疾病
• 这种慢性炎症导致气道高反应性，通常出现广泛多变的可 逆性气流受限，并引起反复发作性的喘息、气急、胸闷或 咳嗽等症状，常在夜间和（或）清晨发作、加剧
• 多数患者可自行缓解或经治疗缓解
Burden of Asthma
Asthma is one of the most common chronic diseases worldwide with an estimated 300 million affected individuals
Prevalence increasing in many countries, especially in children A major cause of school/work absence
Host Factors Genetic
- Atopy - Airway hyper-
responsiveness Gender Obesity
Factors that Exacerbate Asthma
Allergens Respiratory infections Exercise and hyperventilation Weather changes Sulfur dioxide Food, additives, drugs
Burden Of Asthma
Burden Of Asthma
Contents
•General Information •Pathogenesis •Symptom •Diagnosis •Treatment
Risk Factors for Asthma
Host factors: predispose individuals to, or protect them from, developing asthma
Environmental factors: influence susceptibility to development of asthma in predisposed individuals, precipitate asthma exacerbations, and/or cause symptoms to persist
（气道高反应性） that leads to recurrent episodes of wheezing （喘息）, breathlessness, chest tightness, and coughing Widespread, variable, and often reversible airflow limitation（气流 受限）
Is it Asthma?
症状特点
• 发作前常有流涕、眼痒、喷嚏等前驱症状
• 发作性呼吸困难、胸闷、咳嗽，伴有哮鸣音
• 应用支气管舒张剂或自行缓解
• 夜间及凌晨明显
• 特殊类型哮喘 • 咳嗽变异型哮喘
发作性、周期性、季节性
• 运动性哮喘
• 阿司匹林哮喘
体征特点
• 发作期胸部呈过度充气状态 • 广泛哮鸣音和呼气延长 • 非发作期体检可无异常
Contents
•General Information •Pathogenesis •Symptoms •Diagnosis •Treatment
Definition of Asthma
A chronic inflammatory disorder（慢性炎症） of the airways Many cells and cellular elements play a role Chronic inflammation is associated with airway hyper-responsiveness
Normal Subject Asthmatic (After Bronchodilator) Asthmatic (Before Bronchodilator)
1 23 45 Time (sec)
Note: Each FEV1 curve represents the highest of three repeat measurements
实验室检查--PEF变异率
呼气峰流速（PEF） PEF变异率= 高PEF – 低PEF/平均PEF×%
Measuring Variability of Peak Expiratory Flow
Contents
•General Information •PathogenesisLeabharlann Baidu•Symptoms •Diagnosis •Treatment
Is it Asthma?
Recurrent episodes of wheezing Troublesome cough at night Cough or wheeze after exercise Cough, wheeze or chest tightness after exposure to airborne allergens or pollutants Colds “go to the chest” or take more than 10 days to clear
Contents
•General Information •Pathogenesis •Symptoms •Diagnosis •Treatment
实验室检查--支气管舒张试验
哮喘发作期间--FEV1变化 沙丁胺醇 特布他林 异丙托溴铵
Typical Spirometric (FEV1) Tracings
经典哮喘发病过程
哮喘发病机制--免疫炎症/神经/AHR
Source: Peter J. Barnes, MD
Asthma Inflammation: Cells and Mediators
Source: Peter J. Barnes, MD
Asthma Inflammation
Asthma Inflammation
支气管哮喘--定义
• 哮喘是由多种细胞包括气道的炎性细胞和结构细胞（如嗜 酸粒细胞、肥大细胞、T淋巴细胞、中性粒细胞、平滑肌 细胞、气道上皮细胞等）和细胞组分参与的气道慢性炎症 性疾病
• 这种慢性炎症导致气道高反应性，通常出现广泛多变的可 逆性气流受限，并引起反复发作性的喘息、气急、胸闷或 咳嗽等症状，常在夜间和（或）清晨发作、加剧
• 多数患者可自行缓解或经治疗缓解
Burden of Asthma
Asthma is one of the most common chronic diseases worldwide with an estimated 300 million affected individuals
Prevalence increasing in many countries, especially in children A major cause of school/work absence
Host Factors Genetic
- Atopy - Airway hyper-
responsiveness Gender Obesity
Factors that Exacerbate Asthma
Allergens Respiratory infections Exercise and hyperventilation Weather changes Sulfur dioxide Food, additives, drugs
Burden Of Asthma
Burden Of Asthma
Contents
•General Information •Pathogenesis •Symptom •Diagnosis •Treatment
Risk Factors for Asthma
Host factors: predispose individuals to, or protect them from, developing asthma
Environmental factors: influence susceptibility to development of asthma in predisposed individuals, precipitate asthma exacerbations, and/or cause symptoms to persist
（气道高反应性） that leads to recurrent episodes of wheezing （喘息）, breathlessness, chest tightness, and coughing Widespread, variable, and often reversible airflow limitation（气流 受限）
Is it Asthma?
症状特点
• 发作前常有流涕、眼痒、喷嚏等前驱症状
• 发作性呼吸困难、胸闷、咳嗽，伴有哮鸣音
• 应用支气管舒张剂或自行缓解
• 夜间及凌晨明显
• 特殊类型哮喘 • 咳嗽变异型哮喘
发作性、周期性、季节性
• 运动性哮喘
• 阿司匹林哮喘
体征特点
• 发作期胸部呈过度充气状态 • 广泛哮鸣音和呼气延长 • 非发作期体检可无异常
Contents
•General Information •Pathogenesis •Symptoms •Diagnosis •Treatment
Definition of Asthma
A chronic inflammatory disorder（慢性炎症） of the airways Many cells and cellular elements play a role Chronic inflammation is associated with airway hyper-responsiveness