Teaching ward roundAsthma,Main Contents,Case report Chief physician make supplementary physician visits and main chest examination for the patient Correction of physician visits and examination in the existing problems Case discussion,Case report,王欽平 70 years old 379294主訴：反復(fù)發(fā)作性喘息14年，加重7天。肺功能：FEV1：31%，F(xiàn)EV1/FVC:96%,Correction of physician visits and examination in the existing problems,Case discussion,The Definition Of Asthma ?,The Definition Of Asthma,A chronic inflammatory disease of the respiratory tract .Many cells and cellular components. Chronic inflammation in airway of high reactive and recurrent wheezing cough, chest tightness, and shortness of breath. Extensive, different levels of, usually reversible airflow limitation .,Case discussion,What celebritys have asthma ?,At the age of 42 , for asthma , died in Thailand, Chiang mai, On May 8, in 1995 .,Case discussion,The Pathogenesis Of Asthma ?,Pathogenesis,Associated with many genetic, and at the same time by the dual effects of genetic factors and environmental factors .,The Pathogenesis Of Asthma,Genetic factors Environmental factors,Airway hyper responsiveness,Airflow obstruction,Risk factors (seizures),symptoms,Case discussion,Clinical Manifestations ?,Clinical Manifestations,symptoms,Signs,Wheezing sound Chest is too much air condition .severe asthma without wheezing sound silence .Serious HR Orthopnea端坐呼吸 and heart rate increase fast, pulsus paradoxus奇脈, cyanosis 紫紺,Clinical Manifestations, The typical bronchial asthma: Attacks: recurrent of the breath difficulty breathing, there is seasonal, associated with exogenous inhaled allergens, and light night heavy day. Diffuse: acute onset, dual pulmonary diffuse wheezing sound, give priority to with expiratory phase. Reversible: the signs and symptoms can alleviate by oneself, from allergens or application after bronchodilators.,典型支氣管哮喘:攻擊:復(fù)發(fā)性的呼吸呼吸困難,有季節(jié)性,與外生吸入過敏原有關(guān),輕夜重天。擴(kuò)散:急性發(fā)作,雙肺彌漫性喘息的聲音,以呼氣為主的階段。可逆:癥狀和體征可以自行緩解,從支氣管擴(kuò)張劑后過敏原或應(yīng)用程序。,Clinical Manifestations,Not the typical bronchial asthma: paroxysmal bosom frowsty or refractory cough .,咳嗽變異性哮喘,Clinical Manifestations, Critical asthma (fatal) : often referred to as status asthmaticus, characterized by difficulty breathing, violet purple, sweat, cold limbs, pulse fine velocity, both lungs with wheezing sound. Can be threatening the life of the patient. So severe asthma attacks is asthma is one of the most common emergency.,重要的哮喘(致命的):通常被稱為“積狀態(tài),表現(xiàn)為呼吸困難,紫紫,汗,冰冷的四肢,脈沖速度,兩肺與喘息的聲音。可以威脅病人的生命。嚴(yán)重哮喘是哮喘是最常見的一種緊急情況。,Case discussion,Diagnosis standards of asthma？,Diagnosis standards of asthma,symptomssignsrecovered waysexcept other cardiac and pulmonary diseaseslung function examinationuntypical asthma,Lung functions diagnosis of asthma,Obstructive ventilation insufficiency and reversibility of airway obstructionVariance rate of peak expired flow (PEF) in 24 hours 20%Bronchial challenge is positive,Lung functions diagnosis of asthma(1),FEV1 80 % pre, FEV1/FVC% 70 % bronchial dilation test is positive Post FEV1 - Pre FEV1FEV1improved rate 100% Pre FEV1determinant standard:FEV1 improved rate15(+) FEV1 improved rate200ml,Lung functions diagnosis of asthma(2),PEF 80pre and PEF variance rate 20 PEF max PEF minPEF variance rate 100% 1/2( PEF max + PEF min )Determinant standard：PEF variance rate(24h) 20% (+),Lung functions diagnosis of asthma(2),PEF meter PEF predicted value,Lung functions diagnosis of asthma(3),Bronchial challenge is positivetherapeutic propertiesforbid propertiesmethods drug induce: methocholiner histamine exercise induce,阻塞性通氣不足和氣道阻塞的可逆性方差過期峰值流速(PEF)24小時(shí)內(nèi)20%支氣管的挑戰(zhàn)是積極的,Case discussion,The Differential Diagnosis ?,The Differential Diagnosis,Cardiac asthma A high heart, induction, rheumatic history .Cough, pink foam sample phlegm, widely detect rales and wheezing sound . X-ray enlarged heart and pulmonary edema . Lung function: restrictive ventilation dysfunction (rather than the airflow limitation) Avoid using epinephrine腎上腺素 and morphine嗎啡. Lung cancer Blood phlegmy, sputum found in cancer cells、Fiber lens, computed tomography (CT) Allergic lung infiltrates .,心臟哮喘高心,感應(yīng),風(fēng)濕性歷史。咳嗽,粉紅色泡沫樣痰,廣泛濕羅音和喘息的聲音。x光放大心臟和肺水腫。肺功能:限制性通氣功能障礙(而非氣流限制)避免使用腎上腺素和嗎啡。肺癌血痰,痰中發(fā)現(xiàn)癌細(xì)胞,纖維透鏡、計(jì)算機(jī)斷層掃描(CT)過敏性肺部浸潤,Case discussion,What is the treatment of bronchial asthma ?,Drugs for treating asthma,Glucocorticosteroid anti-inflammation 2-agonisttheophylline bronchodilatorsanticholinergic drugnon-steroid anti-inflammations,Drug therapy of asthma 快速緩解藥物 長期預(yù)防藥物,短效吸入 2-激動(dòng)劑吸入抗膽堿藥短效口服 2-激動(dòng)劑全身性糖皮質(zhì)激素短效茶堿,吸入型糖皮質(zhì)激素長效吸入 2-激動(dòng)劑白三烯受體拮抗劑緩釋茶堿吸入色甘酸鈉尼多克羅米酮替酚,Steroids with vein injection,methylprednisonlone 40 4 11-hydroxide 40320Hydrocortison 100 20 11-ketone 1001000dexamethason 5 0.75 11-ketone 1030,steroid dose =dose character dose/d (mg) (mg) (mg),Control Drug - Long-Acting Bronchodilators,Anticholinergic medicines 2- agonists,Non-steroid anti-inflammation drugs,Anti-histamine ：inhaler：色甘酸鈉 5mg200 oral ： 酮替酚、曲尼斯特 息思敏、開瑞坦等LTs receptor inhibitor： 順爾寧 10mg5,Classification of 2-agonsts (Politiek),3類起效慢 作用時(shí)間短口服型特布他林口服型沙丁胺醇口服型福美特羅,2類起效緩慢 作用時(shí)間長吸入型沙美特羅口服型班布特羅,4類起效快 作用時(shí)間短吸入型特布他林吸入型沙丁胺醇,1類起效快 作用時(shí)間長吸入型福美特羅,起效時(shí)間,快,慢,短 長 作用維持時(shí)間,快速緩解,維持治療,哮喘藥物各種吸入劑型,The Prognosis Of Asthma,Rational drug use, can reduce attack or heal. About half of the children, or to adulthood can complete remission after treatment. Unable to remove the factors such as induced asthma, asthma attacks and increase again and again.Status asthmaticus, such as concurrent e