Children AsthmaMa LianChildrenAsthmChildrenAsthm没上的课件没上的课件definition Asthma is a disease of chronic inflammation and varying degrees of severity replacing that of it being a disease of reversible airway obstruction. ChildrenAsthmChildrenAsthm没上的课件没上的课件What ;WhoCharacteristic： Airway hyperresponsivenessChildrenAsthmChildrenAsthm没上的课件没上的课件ChildrenAsthmChildrenAsthm没上的课件没上的课件 The etilogy: Genetic basis of a disease：Genetic factors, predominantly atopy and a parental history of asthma。 Atopic dermatitis and asthmaChildrenAsthmChildrenAsthm没上的课件没上的课件The etilogy environmental factors： Maternal smoking and family (especially maternal) history of atopy appear to be risk factors for persistent sensitization and development of asthma. Indeed,exposure to tobacco smoke in utero significantly increases asthma risk and influences the timing of sensitizationChildrenAsthmChildrenAsthm没上的课件没上的课件The etilogy sensitization and exposure to：Allergen: cockroaches, house dust mites, mold Alternaria alternata, ChildrenAsthmChildrenAsthm没上的课件没上的课件The etilogy Other aeroallergens： weather: flower: ChildrenAsthmChildrenAsthm没上的课件没上的课件The etilogy Other aeroallergens： feather: paint: makeup ChildrenAsthmChildrenAsthm没上的课件没上的课件The etilogyInfection: mycoplasma chlamydozoom ChildrenAsthmChildrenAsthm没上的课件没上的课件The etilogy Viral respiratory infections respiratory syncytial virus: are a significant risk factor for the development of childhood wheezing in the first decade of life.ChildrenAsthmChildrenAsthm没上的课件没上的课件The epidemiology Age：year84.8% Boy:girl1.5:1 1988-1990 China national suivey：1.0% Tibet：0.11% FuJian：2.03% ShiChuan：1.95% GuangDong：0.9% Stantou：5.0%ChildrenAsthmChildrenAsthm没上的课件没上的课件The epidemiology 1999：second suivey：adults：0.7%-1.5%；children：3%-5%China Asthma：10million20millionWorld Asthma：150millionChildrenAsthmChildrenAsthm没上的课件没上的课件The pathogenesis Airway inflammation（airway allergic inflammation）：both chronic inflammation and airway remodeling are more than likely to be involved in the development and progression of asthma in this young population. Indeed, evidence suggests that airway restructuring occurs early.The implications for treatment in any differences of inflammation and remodeling between children and adults, then, are likely to be important ChildrenAsthmChildrenAsthm没上的课件没上的课件ChildrenAsthmChildrenAsthm没上的课件没上的课件The pathogenesis inflammation cells ：eosinophil cells、 mast cells；inflammation mediators；cytokines；neuropeptides； imbalance or dysregulation in T h1/TH1-type immunity ChildrenAsthmChildrenAsthm没上的课件没上的课件Diagnosis Infant asthma： Children asthma: Cough variant asthma：ChildrenAsthmChildrenAsthm没上的课件没上的课件 Therapy Antiinflammation therapy: corticosteroids are considered as first-line anti-inflammatory treatment, especially in chronic asthma. ChildrenAsthmChildrenAsthm没上的课件没上的课件 Therapy Inhalec therapyThe use of corticosteroids in syntomathic asthma in childhood.Prescribed oral corticosteroids and so been at a high risk of side-effects,there is good evidence that inhaled corticosteroids are prescribed not only to too many asthmatic children but also to children who do not have asthma or who have other wheezing disorders.Current asthma guidelines identify inhaled corticosteroids (ICS) as the preferred initial long-term control therapy even in young children.ChildrenAsthmChildrenAsthm没上的课件没上的课件Drug Deposition with Inhaled Corticosteroids Deposited in oropharynxDeposited in lungsExhaledCFC-BDP MDI Leach CL. Int J Clin Pract Suppl 1998; 96: 23-27.ChildrenAsthmChildrenAsthm没上的课件没上的课件 TherapyManagement of the acute exacerbation of asthma.Short-acting beta-agonists：Oxygen：corticosteroids anticholinergics theosine ChildrenAsthmChildrenAsthm没上的课件没上的课件 Therapy maintenace therapycromolyn, long-acting beta(2)-agonists,inhaled corticosteroids, leukotriene receptor antagonistsTheosine（longcting）：H1-receptor antagonist：ChildrenAsthmChildrenAsthm没上的课件没上的课件 TherapyCombination therapy: addition of other long-term-control medications to inhaled corticosteroids.Anti-leukotrienes as add-on therapy to inhaled glucocorticoids in patients with asthmaChildrenAsthmChildrenAsthm没上的课件没上的课件 Therapythe use of therapy with anticholinergics and beta(2)-agonists the data showed a similar increase in pulmonary function with an approximately 35% reduction in the hospital admission rate. ChildrenAsthmChildrenAsthm没上的课件没上的课件全球哮喘防治创议全球哮喘防治创议(GINA 2002(GINA 2002年年) )速效吸入型2受体激动剂短效口服短效口服 2受体激动剂受体激动剂抗胆碱能药物抗胆碱能药物甲基黄嘌呤甲基黄嘌呤全身性皮质激素全身性皮质激素吸入型糖皮质激素吸入型糖皮质激素吸入长效吸入长效 2受体激动剂受体激动剂口服长效2受体激动剂抗白三烯药物甲基黄嘌呤色甘酸钠/尼多克罗米全身激素减量疗法哮喘的药物治疗哮喘的药物治疗快速缓解用药快速缓解用药长期控制用药长期控制用药ChildrenAsthmChildrenAsthm没上的课件没上的课件l白天症状；夜间症状；肺功能只要有一项达到高一级即应将病人按高一级方案治疗l询问病人使用短效B2激动剂的次数可帮助医生正确分级l根据症状及体征的分级常低估了哮喘的严重程度，肺功能检测在哮喘分级中十分重要临床哮喘严重度分级的几个问题ChildrenAsthmChildrenAsthm没上的课件没上的课件哮喘严重度分级（治疗前）病人出现任何一个严重度的征象病人出现任何一个严重度的征象, ,就足够将病人归入该一级就足够将病人归入该一级内内ChildrenAsthmChildrenAsthm没上的课件没上的课件 Prevention and education Paediatric asthma management in developing countries.The use of the Global Initiative for Asthma (GINA) guidelines may improve the quality of asthma treatment. Some of the directions in the GINA guidelines may be difficult to apply in developing countries.ChildrenAsthmChildrenAsthm没上的课件没上的课件Prognosis The natural history of asthma and early intervention.Outcome measures in childhood asthma.Effects of early treatment on the progression of asthma.Childhood asthma: tools that help parents manage it.ChildrenAsthmChildrenAsthm没上的课件没上的课件PCT studySubjects enrolled in PCTs of asthma have been exposed to unnecessary risks and harms. Clinical asthma trials involving children and adults do not benefit children as a class because they rarely provide subset analysis of children subjects.Forty-five studies were designed as PCTs and did not require that all subjects with more than mild asthma receive antiinflammatory medications. Of 24,953 subjects, 4653 (19%) for whom data are available withdrew from research, and 1247 subjects (9.4%) withdrew from PCTs due to asthma exacerbations compared with 358 subjects (3.1%)ChildrenAsthmChildrenAsthm没上的课件没上的课件