支氣管哮喘的治療

Treatment

of

BronchialAsthma

支氣管哮喘的治療周德訓(xùn)北京大學(xué)人民醫(yī)院呼吸與危重癥醫(yī)學(xué)科，醫(yī)師北京大學(xué)第二臨床醫(yī)學(xué)院內(nèi)科學(xué)教研室，教師Outline前情提要：哮喘的本質(zhì)哮喘治療：前人的方法針對本質(zhì)：如何控制炎癥直達(dá)靶點：現(xiàn)代的控制方案Howdidpeopletreatasthmainancienttime?HistoryReviewTheonlypossiblewayofapplyingmedicinesdirectlytothelungisthroughthewindpipe.--PhilipStern,1764Sanders

M.PrimaryCareRespiratoryJournal.2007;16(2):71-81R.Dalbyetal.InternationalJournalofPharmaceutics283(2004)1-9直達(dá)靶點，快速起效減少劑量，減少不良反應(yīng)避免肝臟代謝的首關(guān)效應(yīng)HistoryReviewSanders

M.PrimaryCareRespiratoryJournal.2007;16(2):71-81HistoryReviewSanders

M.PrimaryCareRespiratoryJournal.2007;16(2):71-81165417781858What’sthemostpowerfuldrugtostopinflammation?GlucocorticoidHydrocortisoneCortisonePrednisonePrednisoloneMethylprednisoloneDexamethasoneBarnesPJ,AdcockIM.Annalsofinternalmedicine,2003,139(5_Part_1):359-370.EffectsofGC控制炎癥反應(yīng)降低血管通透性修復(fù)內(nèi)皮功能……內(nèi)分泌代謝紊亂心血管功能障礙免疫抑制骨質(zhì)疏松胃潰瘍肌病…………Howcanwedeliverthedrugsafely?InhaledTherapy國際哮喘聯(lián)盟指南（GINA）推薦直達(dá)靶點，快速起效減少劑量，減少不良反應(yīng)避免肝臟代謝的首關(guān)效應(yīng)InhalerpMDIDPI--AccuhalerDPI--TurbuhalerInhaledCorticosteroid(ICS)布地奈德、氟替卡松等等首關(guān)效應(yīng)顯著代謝產(chǎn)物活性低生物利用度低PJBarnes,N.Eng.J.Med.1995請欣賞視頻

SummaryInhaledCorticosteroid(ICS)isaneffectiveandsafemedicinetocontrolthechronicairwayinflammationinasthma.WhatsideeffectcouldhappenduringICStreatment?NextTimeonAsthmaReferenceFromtheGlobalStrategyforAsthmaManagementandPrevention,

GlobalInitiativeforAsthma(GINA)2014.Availablefrom:/.陸再英、鐘南山，內(nèi)科學(xué)，人民衛(wèi)生出版社，第7版。BarnesPJ,AdcockIM.Howdocorticosteroidsworkinasthma?[J].Annalsofinternalmedicine,2003,139(5_Part_1):359-370.BarnesPJ.Inhaledglucocorticoidsforasthma[J].TheNewEnglandjournalofmedicine,1995,332(13):868-875.SandersM.Inhalationtherapy:anhistoricalreview[J].