门诊常见慢性咳嗽的诊治__培训课件.pptVIP

一药---上下气道都管 二效---既抗炎又解痉 b2-agonist Other Exercise Fog Antigen Other Virus? AHR Mast cell Airway constriction Macrophage Eosinophil T lymphocyte Corticosteroid 顺尔宁 顺尔宁 三防---运动诱发哮喘 Exercise Induce Asthma Cough Bronchospasm 孟鲁司特 4 mg 安慰剂 (%) 患儿急性加重次数 冬 春 夏 秋 月 (在北半球) 1 2 3 4 5 6 7 8 9 10 11 12 5 10 0 15 PREVIA study:2～5岁儿童鼻病毒感染后喘息的预防 Bisgaard H ATS 2004 四治---病毒诱发喘息 五对---轻中重喘均有效 六能---维持哮喘控制 治疗并达到哮喘控制 监测并维持哮喘控制 评估哮喘控制水平 春花鼻炎 夏季运动哮喘 秋季病毒诱发哮喘 冬寒哮喘 顺畅呼吸 自由成长 欢迎提出宝贵意见 Slide 12: Central Role of Cysteinyl Leukotrienes in Asthma First identified in the late 1970s, the CysLTs, including LTD4, are key mediators in asthma. Early evidence of the importance of LTs in asthma was provided by their recovery in the blood, bronchoalveolar lavage fluid, and urine of patients after spontaneous or induced bronchospasm. The ability of specific LT receptor antagonists to increase airflow and reduce symptoms further supports LT involvement in this disease.1 CysLTs, including LTD4, are generated by inflammatory cells such as mast cells and eosinophils. Through multiple mechanisms, CysLTs and LT receptor occupation have been correlated with1: Increased vascular permeability and edema formation Increased mucus production with decreased mucociliary transport Recruitment of inflammatory cells, such as eosinophils, from bloodstream to airway. Eosinophil influx is a component in the inflammatory process that underlies asthma Eosinophils in the airway releasing inflammatory mediators, including cationic proteins, that can damage the epithelium. Epithelial damage can then expose sensory fibers to allow stimulation of cough or other bronchial reflexes Continued… Slide 16: Expression of the CysLT1 Receptor Using a panel of peripheral blood cell markers, Figueroa et al found the CysLT1 receptor expressed in cells of particular relevance to asthma, namely the eosinophils, monocytes/macrophages, B lymphocytes, and CD34+ granulocytic precur