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

Bronchial asthma Yang,Dong(杨冬) yang dong@zs-hospital sh cn Department of Pulmonary medicine Zhongshan Hospital, Fudan Universtiy

Bronchial Asthma Yang，Dong (杨冬) yang.dong@zs-hospital.sh.cn Department of Pulmonary Medicine, Zhongshan Hospital, Fudan Universtiy

Objectives o Definition Pathogenesis and risk factors/stimuli e Clinical features Diagnosis and severity assessment e Medications for asthma Treatment of acute episodes Long-term management/ Chronic therapy

Objectives • Definition • Pathogenesis and risk factors/stimuli • Clinical features • Diagnosis and severity assessment • Medications for asthma • Treatment of acute episodes • Long-term management/Chronic therapy

What is asthma? Chronic disease of the airways that may cause Wheezing dyspnea Chest tightness Nighttime or early morning coughing Episodes are usually associated with widespread, but variable, airflow obstruction within the lung that is often reversible either spontaneously or with treatment

What is Asthma? • Chronic disease of the airways that may cause • Wheezing • dyspnea • Chest tightness • Nighttime or early morning coughing • Episodes are usually associated with widespread, but variable, airflow obstruction within the lung that is often reversible either spontaneously or with treatment

INITIA Global IN intiative for ASTHMA Asthma

G IN A lobal itiative for sthma

What is Epidemiology? Asthma is a highly prevalent disease that affects the quality of life of many people. o The prevalence is rising China:0.5-1.0%, about 20 million

What is Epidemiology? • Asthma is a highly prevalent disease that affects the quality of life of many people. • The prevalence is rising. • China: 0.5- 1.0%, about 20 million

Mechanisms Underlying the Definition of asthma Risk Factors (for development of asthma) INFLAMWATJON Airway Hyperresponsiveness Airflow obstruction Risk Factors Symptoms (for exacerbations)

Mechanisms Underlying the Definition of Asthma Risk Factors (for development of asthma) INFLAMMATION Airway Hyperresponsiveness Airflow Obstruction Risk Factors (for exacerbations) Symptoms

Pathogenesis of asthma Inhaled allergens Epithelial cells CCLTT SCF Mast cell TSLP histamine cysteinyl leukotrienes and CCLT and Dendritic L-9 CCL22 prostaglandin D, CCR4 Inno Smooth-muscle cell 」Tcel? Bronchoconstriction Antibody production CCR3 Eosinophil B cell Eosinophilic inflammation

Pathogenesis of asthma

Risk Factors that lead to Asthma development Host factors Environmental factors Genetic predisposition Indoor allergens Atopy Outdoor allergens Airway hyper- Occupational sensitizers a Tobacco smoke responsiveness Air pollution Gender Respiratory Infections Race/Ethnicity Parasitic infections a Socioeconomic factors Family size Diet and drugs a Obesity

Risk Factors that Lead to Asthma Development Host Factors  Genetic predisposition  Atopy  Airway hyper- responsiveness  Gender  Race/Ethnicity Environmental Factors  Indoor allergens  Outdoor allergens  Occupational sensitizers  Tobacco smoke  Air Pollution  Respiratory Infections  Parasitic infections  Socioeconomic factors  Family size  Diet and drugs  Obesity

Risk Factors for Developing Asthma Genetic Characteristics Atopy The body's predisposition to develop an antibody called immunoglobulin E(gE)in response to exposure to environmental allergens Can be measured in the blood Includes allergic rhinitis asthma, hay fever and eczema

Risk Factors for Developing Asthma: Genetic Characteristics Atopy – The body’s predisposition to develop an antibody called immunoglobulin E (IgE) in response to exposure to environmental allergens – Can be measured in the blood – Includes allergic rhinitis, asthma, hay fever, and eczema

Clearing the Air Indoor Air Exposures Asthma Development Biological Agents Chemical Agents Sufficient evidence of causal Sufficient evidence of causal relationship relationship House dust mite None found Sufficient evidence of association Sufficient evidence of association Environmental tobacco smoke None found (among pre-school aged children) Limited or suggestive evidence of Limited or suggestive evidence of association association Cockroach(among pre-school None found aged children) Respiratory syncytial virus(RSv)

Clearing the Air: Indoor Air Exposures & Asthma Development Biological Agents • Sufficient evidence of causal relationship – House dust mite • Sufficient evidence of association – None found • Limited or suggestive evidence of association – Cockroach (among pre-school aged children) – Respiratory syncytial virus (RSV) Chemical Agents • Sufficient evidence of causal relationship – None found • Sufficient evidence of association – Environmental Tobacco Smoke (among pre-school aged children) • Limited or suggestive evidence of association – None found