教学查房哮喘英文

药物：阿斯匹林与多基因 遗传有关，同时受遗传 因素和环境因素的双重
影响
等 气候变化、运动
The Pathogenesis Of Asthma
Genetic factors Environmental factors
气道炎症
Airway hyper responsiveness
Airflow
Risk factors (seizures)
Pathogenesis
Associated with many genetic, and at the same time by the dual effects of genetic factors and environmental factors .
吸入物：尘螨、花粉等 感染：病毒、细菌等 食物：鱼、虾、蛋、牛奶等
u Rational drug use, can reduce attack or heal.
u About half of the children, or to adulthood can complete remission after treatment.
u Unable to remove the factors such as induced asthma, asthma attacks and increase agaiDefinition Of Asthma ?
The Definition Of Asthma
A chronic inflammatory disease of the respiratory tract .
Many cells and cellular components. Chronic inflammation in airway of high
Hydrocortison
100 20 11-ketone 100～1000
dexamethason
5 0.75 11-ketone
10～30
Control Drug - Long-Acting Bronchodilators
Anticholinergic medicines β2- agonists
methocholiner histamine exercise induce
Case discussion
The Differential Diagnosis ?
The Differential Diagnosis
Cardiac asthma A high heart, induction, rheumatic history . Cough, pink foam sample phlegm, widely detect
Pre FEV1
determinant standard:FEV1 improved rate≥15％(+)
FEV1 improved rate≥200ml
Lung functions diagnosis of asthma(2)
PEF < 80％pre and PEF variance rate ≥20％
Obstructive ventilation insufficiency and reversibility of airway obstruction
Variance rate of peak expired flow (PEF) in 24 hours ≥20%
Bronchial challenge is positive
Case discussion
What celebritys have asthma ?
At the age of 42 , for asthma , died in
Thailand, Chiang mai, On May 8, in 1995 .
Case discussion
The Pathogenesis Of Asthma ?
重要的哮喘(致命的):通常被称为“积状态, 表现为呼吸困难,紫紫,汗,冰冷的四肢,脉冲 速度,两肺与喘息的声音。可以威胁病人的 生命。严重哮喘是哮喘是最常见的一种紧急 情况。
Case discussion
Diagnosis standards of asthma？
Diagnosis standards of asthma
PEF meter
PEF predicted value
Lung functions diagnosis of asthma(3)
Bronchial challenge is positive therapeutic properties forbid properties methods drug induce:
PEF max – PEF min
PEF variance rate＝
×100%
1/2( PEF max + PEF min )
Determinant standard：PEF variance rate(24h) ≥20% (+)
Lung functions diagnosis of asthma(2)
obstruction symptoms
Case discussion
Clinical Manifestations ?
Clinical Manifestations
symptoms
喘息 Wheezing 呼吸困难Dyspnea 咳嗽 Cough 胸闷 Chest distress
Signs
Wheezing sound Chest is too much air condition . severe asthma without wheezing sound silence . Serious HR Orthopnea端坐呼吸 and heart rate increase fast, pulsus paradoxus奇脉, cyanosis 紫绀
Lung functions diagnosis of asthma(1)
FEV1 < 80 % pre, FEV1/FVC% < 70 %
bronchial dilation test is positive
Post FEV1 - Pre FEV1
FEV1improved rate ＝
×100%
rales and wheezing sound . X-ray enlarged heart and pulmonary edema . Lung function: restrictive ventilation dysfunction (rather than the airflow limitation) Avoid using epinephrine肾上腺素 and morphine吗啡. Lung cancer Blood phlegmy, sputum found in cancer cells、 Fiber lens, computed tomography (CT) Allergic lung infiltrates .
Clinical Manifestations
Not the typical bronchial asthma: paroxysmal bosom frowsty or refractory cough .
咳嗽变异性哮喘
Clinical Manifestations
Critical asthma (fatal) : often referred to as "status asthmaticus," characterized by difficulty breathing, violet purple, sweat, cold limbs, pulse fine velocity, both lungs with wheezing sound. Can be threatening the life of the patient. So severe asthma attacks is asthma is one of the most common emergency.
起效时间
快速缓解
快 慢
4类
起效快 作用时间短 吸入型特布他林 吸入型沙丁胺醇
3类
起效慢 作用时间短 口服型特布他林 口服型沙丁胺醇 口服型福美特罗
短
1类
起效快 作用时间长
吸入型福美特罗
维
持
2类
起效缓慢 作用时间长
治 疗
吸入型沙美特罗
口服型班布特罗
长
作用维持时
哮喘药物各种吸入剂型
The Prognosis Of Asthma
symptoms signs recovered ways except other cardiac and
pulmonary diseases lung function
examination→untypical asthma
Lung functions diagnosis of asthma
Case discussion
What is the treatment of bronchial asthma ?
Drugs for treating asthma
Glucocorticosteroid －antiinflammation
β 2-agonist theophylline
Case report
王钦平 70 years old
379294
主诉：反复发作性喘息14年，加重7天。 肺功能：FEV1：31%，FEV1/FVC:96%
Correction of physician visits and examination in the existing problems