中国医科大学附属第一医院：《内科学》课程教学资源（PPT课件讲稿，双语版）Background of asthma

Bronchial asthma Department of respiration Kong Lingfei

Bronchial asthma Department of respiration Kong Lingfei

Asthma human killer

Asthma：human killer!

Background of asthma Prevalence: in the world: 1.6 hundred million in China:1-3 2 in Shenyang: 1.24%(1999) GINA: Global Initiative for Asthma (1994) WHO/HLBI Bronchial asthmatic diagnosis guideline(1997) Chinese Medical academy

Background of asthma Prevalence ：in the world: 1.6 hundred million in China: 1～3 ％ in Shenyang: 1.24 ％（1999） GINA: Global Initiative for Asthma（1994） WHO/HLBI Bronchial asthmatic diagnosis guideline (1997） Chinese Medical Academy

Definitions of asthma Chronic airway inflammation Broncho-hyperresponsiveness, BHR · Airflow limitation

Definitions of asthma • Chronic airway inflammation • Broncho-hyperresponsiveness, BHR • Airflow limitation

Mechanism: allergy theory antigen antigen again atopy→ ige antibody→→ mast cells, basophils ↓ histamine inflammatory media LTs PAF ECP immediate asthmatic reaction AR bronchial smooth muscle spasm airway narrow

Mechanism: allergy theory antigen antigen ↓ ↓again atopy→IgE antibody→mast cells, basophils ↓ histamine inflammatory media LTs ↓ PAF ECP immediate asthmatic reaction, IAR ↓ bronchial smooth muscle spasm airway narrow

Mechanism: never-receptor disorder theory adrenergic and cholinergic nerous systems, AC non-adrenergic and non-cholinergic nerous systems, NANC AC: aI-receptor, MI, M3-receptors excitement NANC: PS-receptor bronchial smooth muscle contraction AC:β- receptor、 M2-receptor excitement NANC: VIP receptor bronchial smooth muscle dilation asthmatic airway:a1、M、M3、PS↑/β、M2、VP↓

Mechanism: never-receptor disorder theory adrenergic and cholinergic nerous systems, AC non-adrenergic and non-cholinergic nerous systems, NANC AC: α1-receptor、M1-、M3-receptors excitement NANC：PS-receptor ↓ bronchial smooth muscle contraction AC: β-receptor、M2-receptor excitement NANC: VIP receptor ↓ bronchial smooth muscle dilation asthmatic airway: a1、M1、M3、PS↑/ β 、M2、VIP↓

Mechanism: airway inflammation theory antigen allergic airway inflammation, AAl ECP MBP inflammatory cells -inflammatory media LTs EOS PAF neutrophils late asthmatic reaction LAR TlymphocyteThI/Th2)) Th2 cytokine l3、4、5, GM-CSF→lgE↑

Mechanism: airway inflammation theory antigen ↓ allergic airway inflammation, AAI ECP ↑ MBP inflammatory cells →inflammatory media LTs EOS ↓ PAF neutrophils late asthmatic reaction, LAR T lymphocyte(Th1/Th2↓) ↓ Th2 cytokine IL-3、4、5，GM-CSF →IgE↑

DIffer mechanisms in acute and chronic asthma acute chronIc aIrway inflammation inflammation remodelling bronchial contraction mucous edema inflammation cells↑ cell proliferation epithelium injury excellular base↑ aIrway secretion aIrway narrow BHR↑ airway reversibility」 symptoms exacerbation

acute inflammation chronic inflammation airway remodelling inflammation cells ↑ epithelium injury bronchial contraction mucous edema airway secretion↑ airway narrow BHR↑ airway reversibility↓ symptoms exacerbation cell proliferation excellular base↑ Differ mechanisms in acute and chronic asthma

Other mechanisms: induced factors Allergen: pollen, acarus Infection: virus or mycoplasmal infection climate and physical and chemical factors drugs: aspirin induced asthma. AIA β- receptor inhibitor heredity Gastroesophageal reflux disease, GErD Psychological, incretion factors sports

Other mechanisms: induced factors • Allergen: pollen, acarus • infection: virus or mycoplasmal infection • climate and physical and chemical factors • drugs: aspirin induced asthma, AIA β-receptor inhibitor • heredity • Gastroesophageal reflux disease, GERD • Psychological, incretion factors, sports

Diagnosis standards of asthma symptoms signs recovered ways except other cardiac and pulmonary diseases lung function examination - untypical asthma

Diagnosis standards of asthma • symptoms • signs • recovered ways • except other cardiac and pulmonary diseases • lung function examination→untypical asthma