1、支气管哮喘的研究治疗进展支气管哮喘的研究治疗进展23Global Initiative for Asthma 20034Global Initiative for Asthma 20035Global Initiative for Asthma 200367哮喘免疫组织病理学改变哮喘免疫组织病理学改变8嗜酸性粒细胞嗜酸性粒细胞910哮喘的变态反应性炎症哮喘的变态反应性炎症11.12141516关于细胞因子的平衡（关于细胞因子的平衡（TH1/TH2）171819202122AsthmaCOPDAirflowlimitationSmoothMuscledysfunctionAirwayinflam
2、ationAirwayRemodellingMuco-cilliarydysfunctionStructuralchangeAirway inflamationSystemiccomponent23 急性炎症慢性炎症气道重塑 Asthma 24粘液分泌过多嗜酸性细胞肥大细胞 抗原Th2 细胞血管扩张新血管形成血浆渗出水肿形成中性粒细胞粘粘 液液 栓栓巨噬细胞/树突状细胞平滑肌收缩肥大/增生胆碱能反射上皮脱落上皮纤维化感觉神经激活神经激活Barnes PJ2526272829303132333435 0 2 4 6 24（M）100无夜间症状无夜间症状FEV1mPEF不用不用SABA气道高反应性
3、气道高反应性Woolcock AJ,et.al.Academic Press 20013637Douwes J,et.al.Thorax 2002383940414243慢慢 性性 炎炎 症症结结 构构 改改 变变急性炎症急性炎症发作发作激素疗效激素疗效反应反应时间时间Barnes PJ短效B2激动剂激素吸入型激素吸入激素长效B2激动剂44Reliever:Rapid-acting inhaled 2-agonist prnController:Daily inhaledcorticosteroid Controller:Daily inhaled corticosteroid Daily l
4、ong-acting inhaled b2-agonistController:Daily inhaled corticosteroid Daily long acting inhaled b2-agonistplus(if needed)When asthma is controlled,reduce therapyMonitorSTEP 1:IntermittentSTEP 2:Mild PersistentOutcome:Asthma ControlOutcome:Best Possible ResultsController:None -Theophylline-SR -Leukotr
5、iene -Long-acting inhaled b2-agonist -Oral corticosteroidStepwise Approach to Asthma Therapy454647PDE4抑制抑制cAMP代谢代谢48PDE4通过增加通过增加CAMP浓度，抑制嗜酸细胞炎症浓度，抑制嗜酸细胞炎症4950ED Bateman,et.al.Oralpresentation 157.ERS 200351M Aubier Oral presentation 157 ERS 20035253Tiotropium化学合成过程化学合成过程54Tiotropium vs Ipratropium5556575859 Boulet LP et.al AJRCCM 1997 Milgrom H et.al NEJM 199960胞降低;IgE细胞染色阳性细胞降低；T细胞亚群降低；B细胞降低；IL-4染色阳性细胞降低。Lousi R,et.al.AJRCCM 2000Green RH,et.al.Lancet 200261 Ayres JG,et.Al.JACI 2003 Holgates S,et.al.Cuur MRO 2001626364J.Karpel,et.al.p336 ERS200365P.Houle,et.al.p341 ERS 2003个人观点供参考，欢迎讨论！
