? ? ? ? ? (Asthma )

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? ? ? ? ?(Asthma )

• ?????????????
• ???? ???

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• A chronic inflammatory disorder of the
  airways

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• Characterized by
• 1?episodic airway narrowing
• 2? increased reactivity
• 3? pharmacologic and
• spontanoud reversibility

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• The classic triad of symptoms
• 1?Episodic expiratory dyspnea
• 2?persistent wheeze
• 3?Chronic cough
• Other associated symptoms
• 1?chest pain or tightness
• 2?sputum production

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• ??????
• ????

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????????(GINA)

• Global Initiative for Asthma

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????(Epidemiology)

• Incidence1-13
• 14 in China
• 510 in USA

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???????(Aetiology and Pathogenesis)

• NOT VERY CLEAR
• Genetic factors
• Environmental factors

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Precipitating factors
Virus Atmos drugs Others
House dust mite parainfluenza Cigarette smoking B-blockers Cold air
Flour,pollen VirusRes ozone aspirin emotion
Snimal danders Syncytial rhinovirus Sulphur dioxide Fumes
grain particulates exercise
mycetes Occupation
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Pathogenesis

• 1??????(Immuno- reaction)
• 2?????(Airway inflammation)
• 3??????(AHRairway high reaction)
• 4?????(Nerve machanism)

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Pathology
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????(Clinical features)

• Symptoms
• Signs
• wheezing sound
• prolonged expiratory sound
• tachycardia
• paradoxical pulsse
• cyanosis
• note---silent chest

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????????(Investigations)

• 1???(Lung function)
• (1)???? ?????????
• decraed FEV1,FEV1/FVC MMER,
• decreased PEF
• increased RV

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• (2)????
• (bronchial provocation test)
• ?????????
• ??? FEV1gt70
• ???? FEV1??gt20
• ????PD20-FEV1, PC20-FEV1

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• (3)????
• (bronchial dilation test)
• ?????????
• ?? ?
• ??FEV1??gt15,
• ??????gt200ml

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• (4)PEF????
• ??????????
• ??
• ????gt 20

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• 2???????
• (Gas blood analysis)
• PH A-aDO2 PaO2 PaCO2 A-aDO2
• (1)resp.alkalosis
• decresed PaO2,PaCO2,PH rised
• (2)resp.acidosis
• decresed PaO2,rised PaCO2
• (3)metablic acidosis

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• 3???X???(Chest X-ray)
• 4?????
• 5?????????
• ??
• ?? ??
• ??

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? ?
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Diagnosis Standard

• 1. Symptoms
• 2. Signs
• 3. Pharmacologic and
• spontanoud reversibility
• other disease
• 4. Atypical asthma
• special tests

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• ?????
• ???

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• Stages acute attacking stage
• remission stage

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• ?????????
• ??
• ??
• ??
• ??

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• ?????????
• ??? ??
• ??? ????
• ??? ????
• ??? ????

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????(Iffential diagnosis)

• Cardiac asthma
• Chronic asthmatic bronchitis
• Lung cancer
• Allergic lung diseases
• eosinophilic lung disease

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???(Complicatins)

1. Pneumothorax
2. Atelectasis
3. Mediastinal emphysema
4. Lung infections
5. Emphsema
6. Bronchiectasis
7. Interstitial pneumonia
8. Pulmonary fibrosis
9. Pulmonary heart disease

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??(Treatment)

• Let the patients with asthma working and
  living like the health persons?
• From GINA

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• ???????
• (Identify and avoid extrinsic factors)
• ?.????
• (Drug treatment)

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Drugs

• 1.??????---Bronchodilators
• (1) ß2?????????
• (agitator of b2 adrenergic receptor)
• short acting4-6h , salbutamol
• 
  terbutaline
• long acting10-12h,salmaterol
• 
  formoterol

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• Methodsinhalation
• oral medication
• intravenous injection

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• ????ß2??,----??????? ?,CAMP??,???????,???????
• ???
• ??,
• ?????
• ß2??????,???????

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• (2)????
• ??????????, ????
• ?????,??????
• ?ß2????????????
• ????
• ??? ?? ?????
• ??? ??,??,???

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• (3)???(theophyline)
• ?? ???????
• ??????
• ????????
• ???????
• ??????
• ??
• ????????

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• ??????
• ?? ?? ???
• ??
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• ????

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• ??? ???
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• ??????
• ????lt1?

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• (?)??????----???
• 1. ????? ?????
• ????????? ????????
  ????????
• ???????ß2??????
• ?? ?? ????
• ????
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• ???? ??

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• ???
• ??????

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• 2. ????????
• ????
• 
  ????

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• 3.????
• ????????????
• 4.?? ???
• ????
• ????

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?.????????(The treatment of acute attacking
stage)
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• ??????200-500??BDP
• ?? ???
• ?? ??????,
• ???????

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• ??500-1000??BDP
• ????????? ???
• ??LT???
• ????
• ??????

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• ??????
• ?????? ß2 ???
• ???????????
• ??????
• ??????
• ??????
• ????

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• ?.????
• ???????
• ????
• ????

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• ?.????
• ??? ( ???? )
• ( ???? )
• ????

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?????(Education and Management)

• ? ? ? ?
• ( The home of patients with asthma )
• PEFrecord in diary
• treatment plan

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??(Prognosis)