復(fù)旦大學(xué)課件—難治性哮喘治療的研究進(jìn)展

1、2021/8/61難治性哮喘難治性哮喘的診斷和治療的診斷和治療復(fù)旦大學(xué)附屬華山醫(yī)院呼吸科復(fù)旦大學(xué)附屬華山醫(yī)院呼吸科陳小東陳小東2021/8/62哮喘的定義支氣管哮喘(bronchial asthma,哮喘)是由多種細(xì)胞（如嗜酸性粒細(xì)胞、肥大細(xì)胞、T淋巴細(xì)胞、中性粒細(xì)胞、氣道上皮細(xì)胞等）和細(xì)胞組份（cellular elements）參與的氣道慢性炎癥性疾患。這種慢性炎癥導(dǎo)致氣道高反應(yīng)性的增加，通常出現(xiàn)廣泛多變的可逆性氣流受限，并引起反復(fù)發(fā)作的喘息、氣急、胸悶或咳嗽等癥狀，常在夜間和（或）清晨發(fā)作、加劇，多數(shù)患者可自行緩解或經(jīng)治療緩解。 2021/8/632021/8/642021/8/6520

2、21/8/662021/8/672021/8/682021/8/692021/8/610Zainudin BMZ etal, Respirology 2005;10:5792021/8/6112021/8/6122021/8/613*in children 6yrs:moderate-dose ICSOral glucocorticosteroid (lowest dose)anti-IgE antibodiesas needed rapid-acting 2-agonist2021/8/6142021/8/6152021/8/6162021/8/6172021/8/6182021/8/619

3、2021/8/620Newman KB, AJRCCM 1995 152:13822021/8/621Figure 1: FOL view of inspiratory adduction of the vocal cordsFigure 2A: normal inspiratory curveFigure 2B: attenuated inspiratory curve2021/8/6222021/8/6232021/8/6242021/8/6252021/8/6262021/8/6272021/8/628Very mildMildModerateSevereStep 3Step 4Step

4、 5Poor Control ContinuesTrial of Add on TherapiesOCSLTRAMTXGoldPoor Control ContinuesDACand OmalizumabStep 6Step 1Confirm diagnosisOptimisation of Therapy and EducationPoor Control ContinuesDACongoingStep 2Triggers and aggravating factors Removed or Managed2021/8/6292021/8/6302021/8/6312021/8/6322021/8/6332021/8/634Simpson J etal Respirology2021/8/635PlaceboCAM 1000mgt=-4t=0t=8t=12RFollow UpScreeningV1V2V3V4V52021/8/636ACTIVEPLACEBO* p= 0.0046 versus visit 22021/8/637Macrolide TreatmentPlacebo* p=0.016 versus placebo*2021/8/6382021/8/6392021/8/640Oba Y J Allergy