-婴幼儿喘息PPT课件.ppt

1、2001 2001启动启动健康婴儿健康婴儿喘鸣喘鸣消退消退哮喘哮喘遗传性过敏遗传性过敏症症预防预防恶化恶化婴儿婴儿病毒感染病毒感染类型类型频率频率/严重程度严重程度年龄年龄TH1TH1变态反应变态反应 / 哮喘哮喘TH2 变态反应变态反应 / 哮喘哮喘患有哮喘的儿童患有哮喘的儿童或成人或成人鼻病毒鼻病毒哮喘的恶化哮喘的恶化急诊急诊住院住院RVRSVPIVMartinez F et al. ERJ 1998; 12: Suppl 27, 3s-8s. Sigurs N,et al.E et al. Am J Respir Crit Care Med 2005;171:13714140353025

2、20151050正常对照正常对照RSV感染患者感染患者5.437P0.001哮喘患者比例（）哮喘患者比例（）46名婴儿期曾因名婴儿期曾因RSV（呼吸道合胞病毒）导致毛细支气管炎的患者以及（呼吸道合胞病毒）导致毛细支气管炎的患者以及92例例正常对照组，随访至正常对照组，随访至13岁。岁。 ARI ARI中更多是由于鼻病毒引起中更多是由于鼻病毒引起, , 包括包括 wLRI wLRI Spiteri M,Nicod LP,Eur Respir 2002 18;1013Spiteri M,Nicod LP,Eur Respir 2002 18;1013鼻病毒和呼吸道合胞病毒都是鼻病毒和呼吸道合胞病毒

3、都是5岁发生哮喘或持续喘息的危险因素岁发生哮喘或持续喘息的危险因素Robert F. et al J Allergy Clin mmunol 2004; 114：1023鼻病毒和呼吸道合胞病毒都是鼻病毒和呼吸道合胞病毒都是5岁发生哮喘或持续喘息的危险因素岁发生哮喘或持续喘息的危险因素Robert F. et al J Allergy Clin mmunol 2004; 114：10238.06.04.02.0OddsRatiosforAsthmaNumber wLRI in first year 0 1 2无过敏无过敏 6岁时岁时有过敏有过敏 6岁时岁时每一表型的评估应严格每一表型的评估应严格

4、 各表型之间存在交叉各表型之间存在交叉 * *儿童也可能是特应质儿童也可能是特应质# # 不同的病源不同的病源, , 包括刺激物的暴露至今尚未证实有过敏原包括刺激物的暴露至今尚未证实有过敏原有无需要讨论的问题Wicken K etal.Clin.Exp.Allergy 1999,29(6)7662.患儿已经喘2次，又有湿疹，以及母亲年幼时喘过，应高度重视！ PRACTALL EAACI / AAAAI Consensus ReportPRACTALL=Practicing Allergology; EAACI=European Academy of Allergy and Clinical I

5、mmunology; AAAAI=American Academy of Allergy, Asthma, and Immunology. PRACTALL EAACI / AAAAI Consensus ReportAdapted from Bacharier LB, et al. Allergy. 2008;63(1):534. INSUFFICIENT CONTROLbICS(200 g BDP equivalent)LTRAa(Dose depends on age)INSUFFICIENT CONTROLcIncrease ICS dose (800 g BDP equivalent

6、)ORAdd LTRA to ICSORAdd LABAINSUFFICIENT CONTROLcStep Up Therapy to Gain ControlStep down if appropriateStep down if appropriateConsider other options Theophylline Oral corticosteroidsaLTRA may be particularly useful if the patient has concomitant rhinitis; bCheck compliance, allergy avoidance, and

7、reevaluate diagnosis;cCheck compliance and consider referring to specialist.ICS=inhaled corticosteroids; LTRA=leukotriene receptor antagonist; BDP=beclomethasone dipropionate; LABA=long-acting 2-agonist.Adapted from Bacharier LB, et al. Allergy. 2008;63(1):534.Increase ICS dose (400 g BDP equivalent

8、)ORAdd ICS to LTRAPRACTALL EAACI / AAAAI Consensus ReportOR每一表型的评估应严格每一表型的评估应严格 各表型之间存在交叉各表型之间存在交叉 * *儿童也可能是特应质儿童也可能是特应质# # 不同的病源不同的病源, , 包括刺激物的暴露至今尚未证实有过敏原包括刺激物的暴露至今尚未证实有过敏原*Grimfeld A, Holgate ST, Canonica GW, Prophylactic management of children at risk for recurrent upper respiratoryinfections: t

9、he Preventia I Study. Clin Exp Allergy, 2004, 34(11): 1665-7258*Grimfeld A, Holgate ST, Canonica GW, Prophylactic management of children at risk for recurrent upper respiratoryinfections: the Preventia I Study. Clin Exp Allergy, 2004, 34(11): 1665-7259P=0.001P=0.001开瑞坦显著减少幼儿的喘鸣次数*Grimfeld A, Holgate

10、 ST, Canonica GW, Prophylactic management of children at risk for recurrent upper respiratoryinfections: the Preventia I Study. Clin Exp Allergy, 2004, 34(11): 1665-7260*Grimfeld A, Holgate ST, Canonica GW, Prophylactic management of children at risk for recurrent upper respiratoryinfections: the Preventia I Study. Clin Exp Allergy, 2004, 34(11): 1665-7261Phase IPhase IIPhase IIILong termViralinfectionAcutephasePersistent wheezingWheezing and asthmaDaysWeeksMonths(Not to scale)25 岁间歇发作的哮喘病儿, 用孟鲁司特治疗12个月：