Lung functions diagnosis of asthma(2)
PEF meter
PEF predicted value
Lung functions diagnosis of asthma(2)
PEF < 80％pre and PEF variance rate ≥20％
PEF max – PEF min
4 重度持续 症状持续 频繁 受限 <60% >30%
The steps of acute exacerbation asthma
临床特点 轻度 中度 重度 危重度 气短 步行,上楼时 稍活动 休息时 体位 可平卧 喜坐位 前弓位 谈话方式 连续成句 字段 单词 不能讲话 精神状态 尚安静 时焦虑烦躁 常焦虑烦躁 嗜睡,意识障碍 出汗 无 有 大汗淋漓 呼吸频率 轻度增加 增加 >30次/分 三凹征 常无 可有 常有 胸腹矛盾运动 喘鸣音 呼吸末期散在 响亮弥漫 响亮弥漫 减弱或无 脉率 <100次/分 100～200次/分 >120次/分 <120次/次,不规则 奇脉 无,<10mmHg 有,10-25mmHg 常有,>25mmHg 无,呼衰 用β2后％PEF >70% 50～70% <50%或<100L/min PaO2 正常 60～80mmHg <60mmHg PaCO2 <40mmHg ≤45mmHg >45mmHg SaO2 >95% 91～95% ≤90% pH 降低
• • • • Allergen: pollen, acarus infection: virus or mycoplasmal infection climate and physical and chemical factors drugs: aspirin induced asthma, AIA β-receptor inhibitor • heredity • Gastroesophageal reflux disease, GERD • Psychological, incretion factors, sports
inflammation cells ↑ epithelium injury
cell proliferation excellular base↑
airway narrow
symptoms
BHR↑
airway reversibility↓
exacerbation
Other mechanisms: induced factors
The steps of chronic persistent asthma
分级 分度 喘息发作 夜间发作 日常活动 ％FEV1 PEF变异率 或％PEF ≥80% <20%
1 间歇发作 2
<1次/w
≤2次/m
不受限
轻度持续 ≥1次/w <1次/d
>2次/m 发作时受限
>80%
<20%
3 中度持续 每日有症状 >1次/w 发作时受限 60～80% 20～30%
Untypical asthma
• • • • • Cough variant asthma, CAV Asthma with gastroesphgeal reflux Exercise induced asthma, EIA Drug induced asthma, DIA Occupational asthma, OA
• • • • • Terbutaline Procaterol Formoterol Salbutemol Bambuterol 博利康尼 2.5mg 美喘清 50ug 安通克 40ug 全特宁 8mg 帮备 4mg
Definitions of asthma
• Chronic airway inflammation • Broncho-hyperresponsiveness, BHR • Airflow limitation
Mechanism: allergy theory
antigen antigen ↓ ↓again atopy→IgE antibody→mast cells, basophils ↓ histamine inflammatory media LTs ↓ PAF ECP immediate asthmatic reaction, IAR ↓ bronchial smooth muscle spasm airway narrow
Diagnosis standards of asthma
• • • • • symptoms signs recovered ways except other cardiac and pulmonary diseases lung function examination→untypical asthma
Distinguishing diagnosis of asthma
• • • • Cardiac asthma COPD Upper airway obstruction (lung cancer) Pulmonary eosiniphil infiltration
Correlation between asthma and COPD
Mechanism: never-receptor disorder theory
adrenergic and cholinergic nerous systems, AC non-adrenergic and non-cholinergic nerous systems, NANC AC: α1-receptor、M1-、M3-receptors excitement NANC：PS-receptor ↓ bronchial smooth muscle contraction AC: β-receptor、M2-receptor excitement NANC: VIP receptor ↓ bronchial smooth muscle dilation asthmatic airway: a1、M1、M3、PS↑/ β 、M2、VIP↓
PEF variance rate＝ 1/2( PEF max + PEF min ) Determinant standard：PEF variance rate(24h) ≥20% (+) ×100%
Lung functions diagnosis of asthma(3)
Bronchial challenge is positive • therapeutic properties • forbid properties • methods drug induce: methocholiner histamine exercise induce
Steroids with vein injection
steroid dose =dose character dose/d (mg) (mg) (mg)
4 20 0.75 11-hydroxide 40～320 11-ketone 11-ketone 100～1000 10～30
methylprednisonlone 40 Hydrocortison dexamethason 100 5
Mechanism: airway inflammation theory
antigen ↓ allergic airway inflammation, AAI ECP ↑ MBP inflammatory cells →inflammatory media LTs EOS ↓ PAF neutrophils late asthmatic reaction, LAR T lymphocyte(Th1/Th2↓) ↓ Th2 cytokine IL-3、4、5，GM-CSF →IgE↑
Discrimination between asthma and COPD
Asthma 症状 喘息 呼吸困难(休息或运动) 胸闷 咳嗽 经常出现夜间症状 部分病人 可逆性好 阳性 支气管收缩 COPD 咳嗽＋痰 呼吸困难(伴随运动) 喘息 胸闷 很少夜间症状 大多数病人 可逆性差 经常阴性 无支气管收缩
吸烟史 肺功能 激发试验 运动后
Drugs for treating asthma
• • • • • Glucocorticosteroid －anti-inflammation β 2-agonist theophylline bronchodilators anticholinergic drug non-steroid anti-inflammations
Bronchial asthma
Department of respiration Kong Lingfei
Asthma：human killer!
Background of asthma
Prevalence ：in the world: 1.6 hundred million in China: 1～3 ％ in Shenyang: 1.24 ％（1999） GINA: Global Initiative for Asthma（1994） WHO/HLBI Bronchial asthmatic diagnosis guideline (1997） Chinese Medical Academy
Inhaled steroids
• Baclomethason dipropionate 必可酮(BDP) • Budesonide 普米克(BUD) 普米克 都保 普米克令舒 • Fluticasone propionate 辅舒酮(FP) • Fluticasone + Salmeterol 舒利迭 50ug×200 100ug ×100 1mg/2ml 125ug ×100 100/50ug×60 250/50ug×60