复旦大学：《内科学 Internal Medicine MBBS》课程教学资源（课件讲稿）呼吸系统_Introduction of respiratory system

思 旦大学附属中山医院 gshan Hospital, Fudan University [ Introduction Respiratory System Chunxue Bai MD Institute of Respiratory Diseases Fudan University www.zshospital.com

Chunxue Bai MD Institute of Respiratory Diseases Fudan University Introduction Respiratory System

Epidemiology In 2001, respiratory diseases was No 1 reason for mortality in china Urban Area No, 4(13.36%) Rural Area No. 1(22.46%) The morbidity of COPD, ALl, lung cancer, tuberculosis keeps increasing The burden of chronic respiratory diseases remains in high level New contagious respiratory diseases(SARS, bird flu) 复旦大学附属中山医院 呼吸科暨呼吸病研究所 上海市重点学

• In 2001, respiratory diseases was No 1 reason for mortality in China Urban Area No.4（13.36%） Rural Area No.1（22.46%） • The morbidity of COPD，ALI，lung cancer, tuberculosis keeps increasing • The burden of chronic respiratory diseases remains in high level • New contagious respiratory diseases (SARS, bird flu) Epidemiology

Risk Factors · Air pollution: Is the risk factor for chronic bronchitis COPD lung cancer 复旦大学附属中山医院 呼吸科暨呼吸病研究所 上海市重点学

Risk Factors • Air Pollution： Is the risk factor for – chronic bronchitis – COPD – lung cancer

Risk Factors Smoking: the main pollution in small area the main risk factor for chronic respiratory diseases and lung cancer in China 鹤舞自沙我心飞阳 L海巾字刺

Risk Factors • Smoking： the main pollution in small area the main risk factor for chronic respiratory diseases and lung cancer in China

China has big three for smoking JAMA Smoking in China: Findings of the 1996 National Prevalence Survey Gonghuan Yang; Lixin Fan, Jian Tan, et al Online article and related content current as of september 24 2009 JAMA.1999282(13)1247-1253do10.1001/ama282.13.1247) S THE WORLDS LARGEST PRO ducer and consumer of to bacco. China bears a substan- tial proportion of the global burden of smoking-related disease. Of Chinas population of 1.2 billion, more than 300 million men and 20 million women are smokers, making China the world's largest actual and potential na tional market for cigarettes. In 1994 SINGA 6net山医院 上海市重点学

China has big three for smoking

Risk Factors Inhaled Antigens: the morbidity of asthma is increasing icture by

Risk Factors • Inhaled Antigens： the morbidity of asthma is increasing

Risk Factors New Pathogens and antimicrobial resistance ESBL, MRSA, antimicrobial resistant bacterial Virus non-specITIc pathogens Influenza virus ESB Influenza enters rough the nose and settles in the respiratory tract. Lungs Influenza virus 医院 上海市重点学

Risk Factors • New Pathogens and antimicrobial resistance – ESBL, MRSA, antimicrobial resistant bacterial – Virus – non-specific pathogens ESBL

Physiology Defense Double circulation: pulmonary circulation interposed between the right and left ventricles blood gas exchange production and release humoral mediators a barrier to maintain lung fluid balance bronchial circulation from systemic circulation mostly perfuse the upper airways Pulmonary Arteries and veins provide nutritive flow 中山医院 病研究所 点学剽

• Double Circulation： – pulmonary circulation: interposed between the right and left ventricles blood gas exchange production and release humoral mediators a barrier to maintain lung fluid balance – bronchial circulation: from systemic circulation mostly perfuse the upper airways provide nutritive flow Physiology & Defense

Physiology Defense Defense Mechanisms and Immunology physical barrier: against airbone pathogens and irritants(cough clearance, mucus cytoplasmic cilia) SIZE (diameter) HOST DEFENSES Turbinates AMBIENT AIR 10 ANATOMIC BARRIE ANGULATION OR AIR MICRO-ORGANISMS MUCO-CILIARY Turbulent flow COUGH Airway angulation AIR EXCHANGE SURFACE 05-3p SURFACTANT SONINS-IgG. FIBRONECTIN COMPLEMENT alternate pathway) ALVEOLAR MACROPHAGES 0.5 (stays in gaseous PLASMA COMPONENTS VASO-ACTIVE MEDIATORS大学附属中山医院 科暨呼吸病研究所 上海市重点学

• Defense Mechanisms and Immunology – physical barrier: against airbone pathogens and irritants (cough clearance, mucus￾cytoplasmic cilia) Physiology & Defense

Physiology Defense Defense Mechanisms and Immunology alveolar clearance(alveolar macrophages PMN, T cell) lmmunology(lgA、lgM、gG) Too strong stimuli and weak defense results in lesion and injury of the lung Asthma COPD ALI infection 复旦大学附属中山医院 呼吸科暨呼吸病研究所 上海市重点学

• Defense Mechanisms and Immunology – alveolar clearance (alveolar macrophages, PMN, T cell) – Immunology (IgA、IgM、IgG) Too strong stimuli and weak defense results in lesion and injury of the lung – Asthma – COPD – ALI – infection Physiology & Defense