Bronchial asthma Yang,Dong(杨冬) yang dong@zs-hospital sh cn Department of Pulmonary medicine Zhongshan Hospital, Fudan Universtiy
Bronchial Asthma Yang，Dong (杨冬) yang.dong@zs-hospital.sh.cn Department of Pulmonary Medicine, Zhongshan Hospital, Fudan Universtiy
Objectives o Definition Pathogenesis and risk factors/stimuli e Clinical features Diagnosis and severity assessment e Medications for asthma Treatment of acute episodes Long-term management/ Chronic therapy
Objectives • Definition • Pathogenesis and risk factors/stimuli • Clinical features • Diagnosis and severity assessment • Medications for asthma • Treatment of acute episodes • Long-term management/Chronic therapy
What is asthma? Chronic disease of the airways that may cause Wheezing dyspnea Chest tightness Nighttime or early morning coughing Episodes are usually associated with widespread, but variable, airflow obstruction within the lung that is often reversible either spontaneously or with treatment
What is Asthma? • Chronic disease of the airways that may cause • Wheezing • dyspnea • Chest tightness • Nighttime or early morning coughing • Episodes are usually associated with widespread, but variable, airflow obstruction within the lung that is often reversible either spontaneously or with treatment
INITIA Global IN intiative for ASTHMA Asthma
G IN A lobal itiative for sthma
What is Epidemiology? Asthma is a highly prevalent disease that affects the quality of life of many people. o The prevalence is rising China:0.5-1.0%, about 20 million
What is Epidemiology? • Asthma is a highly prevalent disease that affects the quality of life of many people. • The prevalence is rising. • China: 0.5- 1.0%, about 20 million
Mechanisms Underlying the Definition of asthma Risk Factors (for development of asthma) INFLAMWATJON Airway Hyperresponsiveness Airflow obstruction Risk Factors Symptoms (for exacerbations)
Mechanisms Underlying the Definition of Asthma Risk Factors (for development of asthma) INFLAMMATION Airway Hyperresponsiveness Airflow Obstruction Risk Factors (for exacerbations) Symptoms
Pathogenesis of asthma Inhaled allergens Epithelial cells CCLTT SCF Mast cell TSLP histamine cysteinyl leukotrienes and CCLT and Dendritic L-9 CCL22 prostaglandin D, CCR4 Inno Smooth-muscle cell 」Tcel? Bronchoconstriction Antibody production CCR3 Eosinophil B cell Eosinophilic inflammation
Pathogenesis of asthma
Risk Factors that lead to Asthma development Host factors Environmental factors Genetic predisposition Indoor allergens Atopy Outdoor allergens Airway hyper- Occupational sensitizers a Tobacco smoke responsiveness Air pollution Gender Respiratory Infections Race/Ethnicity Parasitic infections a Socioeconomic factors Family size Diet and drugs a Obesity
Risk Factors that Lead to Asthma Development Host Factors Genetic predisposition Atopy Airway hyper- responsiveness Gender Race/Ethnicity Environmental Factors Indoor allergens Outdoor allergens Occupational sensitizers Tobacco smoke Air Pollution Respiratory Infections Parasitic infections Socioeconomic factors Family size Diet and drugs Obesity
Risk Factors for Developing Asthma Genetic Characteristics Atopy The body's predisposition to develop an antibody called immunoglobulin E(gE)in response to exposure to environmental allergens Can be measured in the blood Includes allergic rhinitis asthma, hay fever and eczema
Risk Factors for Developing Asthma: Genetic Characteristics Atopy – The body’s predisposition to develop an antibody called immunoglobulin E (IgE) in response to exposure to environmental allergens – Can be measured in the blood – Includes allergic rhinitis, asthma, hay fever, and eczema
Clearing the Air Indoor Air Exposures Asthma Development Biological Agents Chemical Agents Sufficient evidence of causal Sufficient evidence of causal relationship relationship House dust mite None found Sufficient evidence of association Sufficient evidence of association Environmental tobacco smoke None found (among pre-school aged children) Limited or suggestive evidence of Limited or suggestive evidence of association association Cockroach(among pre-school None found aged children) Respiratory syncytial virus(RSv)
Clearing the Air: Indoor Air Exposures & Asthma Development Biological Agents • Sufficient evidence of causal relationship – House dust mite • Sufficient evidence of association – None found • Limited or suggestive evidence of association – Cockroach (among pre-school aged children) – Respiratory syncytial virus (RSV) Chemical Agents • Sufficient evidence of causal relationship – None found • Sufficient evidence of association – Environmental Tobacco Smoke (among pre-school aged children) • Limited or suggestive evidence of association – None found