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BronchialasthmaDepartmentofrespirationKongLingfeiAsthma：humankiller!BackgroundofasthmaPrevalence：intheworld:1.6hundredmillioninChina:1～3％inShenyang:1.24％（1999）GINA:GlobalInitiativeforAsthma（1994）WHO/HLBIBronchialasthmaticdiagnosisguideline(1997）ChineseMedicalAcademyDefinitionsofasthma•Chronicairwayinflammation•Broncho-hyperresponsiveness,BHR•AirflowlimitationMechanism:allergytheoryantigenantigen↓↓againatopy→IgEantibody→mastcells,basophils↓histamineinflammatorymediaLTs↓PAFECPimmediateasthmaticreaction,IAR↓bronchialsmoothmusclespasmairwaynarrowMechanism:never-receptordisordertheoryadrenergicandcholinergicneroussystems,ACnon-adrenergicandnon-cholinergicneroussystems,NANCAC:α1-receptor、M1-、M3-receptorsexcitementNANC：PS-receptor↓bronchialsmoothmusclecontractionAC:β-receptor、M2-receptorexcitementNANC:VIPreceptor↓bronchialsmoothmuscledilationasthmaticairway:a1、M1、M3、PS↑/β、M2、VIP↓Mechanism:airwayinflammationtheoryantigen↓allergicairwayinflammation,AAIECP↑MBPinflammatorycells→inflammatorymediaLTsEOS↓PAFneutrophilslateasthmaticreaction,LARTlymphocyte(Th1/Th2↓)↓Th2cytokineIL-3、4、5，GM-CSF→IgE↑acuteinflammationacuteinflammationchronicinflammationchronicinflammationairwayremodellingairwayremodellinginflammationcells↑epitheliuminjuryinflammationcells↑epitheliuminjurybronchialcontractionmucousedemaairwaysecretion↑bronchialcontractionmucousedemaairwaysecretion↑airwaynarrowairwaynarrowBHR↑BHR↑airwayreversibility↓airwayreversibility↓symptomssymptomsexacerbationcellproliferationexcellularbase↑cellproliferationexcellularbase↑DiffermechanismsinacuteandchronicasthmaDiffermechanismsinacuteandchronicasthmaOthermechanisms:inducedfactors•Allergen:pollen,acarus•infection:virusormycoplasmalinfection•climateandphysicalandchemicalfactors•drugs:aspirininducedasthma,AIAβ-receptorinhibitor•heredity•Gastroesophagealrefluxdisease,GERD•Psychological,incretionfactors,sportsDiagnosisstandardsofasthma•symptoms•signs•recoveredways•exceptothercardiacandpulmonarydiseases•lungfunctionexamination→untypicalasthmaUntypicalasthma•Coughvariantasthma,CAV•Asthmawithgastroesphgealreflux•Exerciseinducedasthma,EIA•Druginducedasthma,DIA•Occupationalasthma,OALungfunctionsdiagnosisofasthma•Obstructiveventilationinsufficiencyandreversibilityofairwayobstruction•Variancerateofpeakexpiredflow(PEF)in24hours≥20%•BronchialchallengeispositiveLungfunctionsdiagnosisofasthma(1)FEV1<80%pre,FEV1/FVC%<70%bronchialdilationtestispositivePostFEV1-PreFEV1FEV1improvedrate＝×100%PreFEV1determinantstandard:FEV1improvedrate≥15％(+)FEV1improvedrate≥200mlLungfunctionsdiagnosisofasthma(2)PEFmeterPEFpredictedvalueLungfunctionsdiagnosisofasthma(2)PEF<80％preandPEFvariancerate≥20％PEFmax–PEFminPEFvariancerate＝×100%1/2(PEFmax+PEFmin)Determinantstandard：PEFvariancerate(24h)≥20%(+)Lungfunctionsdiagnosisofasthma(3)Bronchialchallengeispositive•therapeuticproperties•forbidproperties•methodsdruginduce:methocholinerhistamineexerciseinduceThestepsofchronicpersistentasthma分级分度喘息发作夜间发作日常活动％FEV1PEF变异率或％PEF1间歇发作<1次/w≤2次/m不受限≥80%<20%•轻度持续≥1次/w>2次/m发作时受限>80%<20%<1次/d3中度持续每日有症状>1次/w发作时受限60～80%20～30%4重度持续症状持续频繁受限<60%>30%ThestepsofacuteexacerbationasthmaThestepsofacuteexacerbationasthma临床特点轻度中度重度...