支管哮喘的诊断与治疗进展精品.pptVIP

吸入激素使用剂量换算表(成人) 药物 二丙酸倍氯米松 布地奈德 丙酸氟替卡松 低剂量 中剂量 200–500 μg 200–400 μg 100–250μg 高剂量 500–1000μg 400–800 μg 250–500 μg 1000 μg 800 μg 500 μg *应根据病人对治疗的反应来决定给予药物的剂量，这是最重要的。 Global Initiative for Asthma 2002 GINA方案中、重度哮喘病人的治疗 ICS+LABA 重度持续 中度持续 轻度持续 轻度间歇 按需使用短效?2激动剂 吸入激素 Global Initiative for Asthma 2002 五、有关哮喘治疗的疗程 缓解期哮喘采用皮质激素治疗，何时才能停药而不致近期复发，至今尚无明确答案，需参考一些客观指标： 1、PEF监测 对轻、中度哮喘病人，治疗目标应使日间最佳的PEF达到正常值，并持续7-l0天后才可减药。一般来说当PEF较本人最高值降低30％或以上方可出现症状。对重症病人，应使PEF达到本人稳定的最大值7-l0天后方可减药。但总的来说，PEF恢复至正常水平并非是停药的指征。 五、有关哮喘治疗的疗程 2、气道反应性测定 在症状消失后若患者的气道反应性(使用组胺或蒸馏水激发)恢复到正常水平(需停止口服皮质激素二周以上，停表面激素4天以上，停解痉药24小时以上测定) 停止用药而不致近期复发的把握较大。 3、气道炎症程度的测定 如痰液中嗜酸性细胞计数，血清中ECP测定等可作参考，但其价值有待探讨。 * 11 8 Inhaled antigen reaches and binds to antigen presenting cells (e.g. B cells) and T cells at or near the airway surface. The B cells secrete specific IgE under the control of a specific T lymphocyte cell type developed after exposure to a specific allergen presented by accessory cells. Once sensitised to a specific allergen, reexposure of the tissue to the same allergen augments the production of specific IgE that binds to specific receptors on the membrane of mast cells and also of basophils, eosinophils, macrophages and platelets. Allergens cross-linking specific IgE on the cell surface lead to activation with the release of both preformed and newly generated mediators that are believed to orchestrate the inflammatory cascade. * 2 The goals of asthma management are: Minimal, but ideally, no chronic symptoms both during the day and at night Minimal, or at least infrequent, exacerbations No emergency visits Minimal need for prn Beta2-agonists No limitations on activities, including exercise Near normal PEFR values variability 20% Minimal, but ideally, no adverse effects from the medicines used * 14 Long acting bronchodilators are used as controllers but they do not reverse airway inflammation and/or bronchial hyperresponsiveness. Long term treatment with anti-inflammatory drug