哮喘(英文和中文)

1BronchialAsthma(Asthma)支气管哮喘（哮喘）2I.Epidemiology流行病学Averycommondisease哮喘为常见病USA5%美国5％China0.5%-1.0%中国0.5%-1.0%Prevalenceisincreasingworldwide全球范围内该病的患病率在上升3II.Definition定义Asthmaisachronicinflammatorydisorderoftheairwaysinwhichmanycellsandcellularelementsplayarole.Thechronicinflammationcausesanassociatedairwayhyperresponsivenessthatleadstorecurrentepisodesofwheezing,breathlessness,chesttightness,andcoughing,particularlyatnightorintheearlymorning.Theseepisodesareusuallyassociatedwithwidespreadbutvariableairflowobstructionthatisoftenreversibleeitherspontaneouslyorwithtreatment.4KeyPointsChronicairwayinflammation气道慢性炎症Airwayhyperresponsiveness气道高反应性Reversibleairflowobstruction可逆性气道狭窄Symptoms:症状Wheezing喘鸣Breathlessness气短Chesttightness胸闷Coughing咳嗽Typicallyatnightorintheearlymorning典型者于深夜或凌晨发作5III.Etiology病因Unknown不明Geneticfactors?遗传因素？Environmentfactors?环境因素？Thecombinationofthesetwo?遗传与环境因素共同作用？6IV.RiskFactors易患因素1.HostFactors患者的因素Geneticpredisposition遗传易患性Atopy过敏体质Airwayhyperresponsiveness气道高反应性Gender性别Children:boysgirls儿童：男女Adults:malefemale成人：女男Race/ethnicity种族72.EnvironmentalFactors环境的因素Allergens(domesticmites,animalallergens,fungi,etc.)过敏原（屋尘螨，动物过敏原，真菌，等等）Respiratoryinfections(especiallyviralinfections)呼吸道感染（尤其是病毒感染）Exerciseandhyperventilation运动和高通气Weather气候变化Sulfurdioxide二氧化硫Food食品Additives食品添加剂Drugs药品8V.Pathogenesis发病机制Envir.factors+Geneticfactors环境＋遗传因素ChronicAirwayInflamation慢性气道炎症Acutebronchoconstriction急性支气管收缩Hyperresponsiveness气道高反应性Swellingoftheairwaywall气道壁肿胀Chronicmucusplugformation慢性粘液栓形成Airwaywallremodeling气道壁构型重建Airflowobstruction气流阻塞Symptoms各种症状9NetworkofInflammatoryProcess炎症反应网络GeneticFactors遗传因素------Envir.Factors环境因素Triggers诱因Bronchoconstriction,etc.支气管收缩等Symptoms症状10Relevantcells有关的细胞Mastcells肥大细胞Eosinophils嗜酸细胞Tlymphocytes(Th1/Th2)T细胞(Th1/Th2）Basocytes嗜碱细胞Neutrophils中性粒细胞Alveolarmacrophages肺泡巨噬细胞Epithelium上皮细胞others其他11Relevantmolecules有关的生物分子InflammatoryMediators炎症介质Histamine组织胺Acetylcholine乙酰胆碱Kinins激肽Adenosine腺苷Leukotrients(LTC4,LTD4,LTE4)白三烯Prostaglandins前列腺素Platelet-activatingfactor血小板活化因子etc.其他12Pro-inflammatorycytokines促炎症性细胞因子Interleukin-4(IL-4)白介素-4IL-5白介素-5Tumornecrosingfactor-a(TNF-a)肿瘤坏死因子-aetc.其他Anti-inflammatorycytokines抗炎症性细胞因子IL-18白介素-18IL-10白介素-10etc.其他13141516VI.Pathology病理学1.Attheearlystage早期Chronicairwayinflammation慢性气道炎症2.Later后期Chronicairwayinflammation慢性气道炎症Airwayremodeling气道构型重建ASMCproliferationASMC增生Mucusglandsenlargement黏液腺肥大Subepithelialfibrosis上皮下纤维化Others其他171819VII.Clinicalmanifestations临床表现Symptoms症状Episodicbreathlessnessandwheezing,worseparticularlyatnightandintheearlyhoursofthemorning.阵发性气短、喘鸣，深夜和凌晨尤其明显20Physicalsigns体征Betweenacuteepisodes：发作间歇期：Canbenoabnormalities可无明显异常21Duringacuteattack:急性发作期Wheezing----notalwaysparallelsthesymptoms哮鸣音－－其强度并不总是与症状平行Signsofhyperinflation----hypersonance肺过度充气症－－叩诊过度反响Signsofcomplication并发症的体征Infection感染Pneumothorax气胸Respiratoryfailure呼衰Heartfailure心衰etc.其他22Atypicalasthma不典型哮喘Symptom症状Cough咳嗽Tightchest胸闷Breathlessness气短Signs体征Withoutwheezing没有哮鸣音23VIII.Laboratory实验室检查1.Pulmonaryfunctiontests肺功能检查FEV1第一秒用力肺活量下降FEV1/FVCFEV1/用力肺活量比值下降24Foratypicalpatients非典型患者应该进行以下检查1.Bronchoprovocatingtests气道激发试验Histamine(组织胺）PD20-FEV17.8mol/LMchPD20-FEV112.8mol/L2.brobchodilatingtests支气管舒张试验FEV115%and200ml3.PEFvariation峰值流速变异率Inaday20%2526272.Bloodgasesanalysis血气分析PaO2,PaCO2PaCO2onlyinseverecasesPaCO2仅见于严重病例3.X-rayfilmX线胸片Hyperinflation过度充气征SignsofComplications并发症表现4.Skintestsforspecificantigens过敏原皮试5.Others其他Bloodroutine血常规Sputumculture痰培养etc.28Hyperinflation过度充气征29IX.Diagnosis诊断Typicalcases典型病例Symptoms+signs症状＋体征Atypicalcases不典型病例Symptoms+signs+lab.TestsBronchoprovocatingtests气道激发试验Brobchodilatingtests支气管舒张试验PEFvariation峰值流速变异率30Stagingofdiseaseseverity病情严重程度分级1.Longtermevaluation(Tab.2-4-1)长期病情评价Step1:Intermittent第一级：间歇发作Attack1/week,Nightattack2/monthPEF,FEV180%Pr.PEForFEV1-variation20%31Step2:Mildpersistent第二级：轻度持续发作1/weekattack1/dayNightattack2/monthPEF,FEV180%Pr.PEForFEV1-variation20-30%32Step3:Moderatepersistent第三级：中度持续发作AttackeverydayNightattack1/weekNeeddailyuseofinhaledshort-actingb2-agonistPEF,FEV160,80%Pr.PEForFEV1-variation30%33Step4:Severepersistent第四级：重度持续发作AttackfrequentlyNightattackfrequentlyLimitationofphysicalactivityPEF,FEV160%Pr.PEForFEV1variation30%342.Duringacuteexacerbation(Tab.2-4-3)急性发作期病情严重程度评价（见表2-4-3）35X.Differentialdiagnosis鉴别诊断(Table2-4-4)Leftventricularfailure左心衰Chronicasthmaticbronchitis慢喘支Acutebronchitis(esp.ininfants)急性支气管炎Lungcancer肺癌Benignairwaynarrowing良性气道狭窄Allergicpulmonaryinfiltration过敏性肺浸润……36XI.Drugsusedinasthma哮喘治疗药物1.Corticosteroids糖皮质激素Inhaler,oral,iv.,ivdrip剂型包括吸入、口服、静注、静滴Bestdrugtocontrolchronicairwayinflammation是控制慢性气道炎症最有效的药物Slow-acting(2w.forinhaler,6hforiv.)起效较慢（吸入制剂需两周，静脉注射需6小时）Sideeffects:commonwhenusedsystemically,butveryfewwithinhalers副作用：全身用药副作用较多，吸入用药副作用极少372.b2-agonistb2-受体激动剂Inhaler,oral有吸入和口服制剂Controlsymptomsquickly可以迅速控制症状Short-actingagentsareineffectiveforinflammation,butlong-termagentsare.短效制剂对于气道炎症无效，而长效制剂有效383.TheophyllinesOral,iv.,ivdrip