雾化吸入普米克在小儿哮喘等疾病的应用.ppt
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1、1,儿童哮喘吸入治疗的新理念,哮喘的本质 吸入激素治疗的地位 把吸入治疗带回家的意义,2,对于哮喘的认识*,支气管因平滑 肌痉挛而收缩 水肿 粘液分泌亢进 炎性细胞浸润 气道高反应,LTD4,CysLT1,CysLT1 = 半胱氨酰白三烯1型受体,哮喘是一种气道的慢性炎症性疾病。慢性炎症形成后的气道,其反应性增高;当接触于各种危险因素时,气道出现阻塞和气流受限(由支气管收缩、粘液栓形成和炎症加重引起)。,* GINA Pocket Guideline 2002,3,制定规范的个体化长期治疗方案,定病情 定剂量 定途径 纠方法 避诱因 勤宣教,4,糖皮质激素在哮喘长期治疗中的应用,1糖皮质激素治
2、疗哮喘的主要机制 (1)抑制气道炎症和降低气道高反应性,5,(2)有助于其他抗哮喘药物的疗效 增加糖皮质激素能促进细胞膜上2受体的表达 增加气道2受体的密度 提高气道平滑肌细胞2受体的反应性等,因而 能增加2受体的疗效。 (3)间接舒张支气管平滑肌作用,糖皮质激素在哮喘长期治疗中的应用,6,Pharmacotherapy,Reliever medications Short-acting inhaled 2 agonists Other bronchodilators Controller medications ICS LTRA Long-acting 2 receptor agonists
3、 (LABAs) (only in combination with ICS) Sustained-release theophylline Anti-IgE antibodies Cromolyn sodium Oral steroids,7,ICS, A first-line treatment for persistent asthma. Reduces the frequency and severity of exacerbations. Should be introduced as initial maintenance treatment (200 g BDP equivale
4、nt) when the patient has inadequate asthma control. Atopy and poor lung function predict a favorable response to ICS . If control is inadequate on a low dose after 12 months, reasons for poor control should be identified. If indicated, an increased ICS dose or additional therapy with LTRAs or LABAs
5、should be considered.,8,2006- GINA,Inhaled therapy is the cornerstone of asthma treatment for children of all ages. Almost all children can be taught to effectively use inhaled therapy. Different age groups require different inhalers for effective therapy, so the choice of inhaler must be individual
6、ized.,9,Choosing an Inhaler Device for Children with Asthma,Age Group Preferred Device Alternate Device Younger than Pressurized metered- Nebulizer with 4 years dose inhaler plus mask dedicated spacer with face mask 4 6 years Pressurized metered- Nebulizer with dose inhaler plus mouthpiece dedicated
7、 spacer with mouthpiece Older than Dry powder inhaler, Nebulizer with 6 years or breath-actuated mouthpiece pressurized metered- dose inhaler, or pressurized metered- dose inhaler with spacer and mouthpiece,2006-GINA,10,Estimated Equipotent Daily Doses of Inhaled Glucocorticosteroids for Children,Dr
8、ug Low Daily Medium Daily High Daily Dose(g) Dose(g) Dose(g) BDP 100-200 200-400 400 Budesonide 100-200 200-400 400 Ciclesonide(环索奈德) 80-160 160-320 320 Flunisolide(氟尼缩松) 500-750 750-1250 1250 Fluticasone 100-200 200-500 500 Mometasome furoate 100-200 200-400 400 Triamcinolone acetonide 400-800 800-
9、1200 1200 (氟羟泼尼松龙),2006GINA,11,Children 5 years and younger,Treatment with inhaled glucocorticosteroids in children 5 years and younger with asthma generally produces similar clinical effects as in older children, but dose-response relationships have been less well studied. The clinical response may
10、 differ depending on the inhaler and the childs ability to use the inhaler correctly. With use of a spacer device, daily doses 400 g of budesonide or equivalent result in near-maximum benefits in the majority of patients. Use of inhaled glucocorticosteroids does not induce remission of asthma and it
11、 returns when treatment is stopped.,2006-GINA,12,Children 5 years and younger,Treatment with inhaled glucocorticosteroids in children 5 years and younger with asthma generally produces similar clinical effects as in older children, but dose-response relationships have been less well studied. The cli
12、nical response may differ depending on the inhaler and the childs ability to use the inhaler correctly. With use of a spacer device, daily doses 400 g of budesonide or equivalent result in near-maximum benefits in the majority of patients.,2006- GINA,13,普米克令舒在呼吸科及儿科应用广泛,美国FDA批准普米克令舒为5岁以下儿童唯一可雾化给药的吸入
13、型糖皮质激素 中国SFDA批准的唯一可雾化吸入的糖皮质激素,14,布地奈德 高气道选择性的吸入糖皮质激素 特点:局部抗炎作用强,全身副作用小 全身生物利用度低:11 半衰期短:2.8小时 肝脏首过代谢率高,药物在半小时内迅速灭活,15,布地奈德局部抗炎作用强,Miller-Larsson et al, 1997,布地奈德,布地奈德,细胞核,脂解作用,酯化作用,布地奈德 复合物 无活性,糖皮质激素受体,细胞膜,长链脂肪酸,16,100 80 60 40 20 0 -20,0 1 2 3 4 5 6 7 8,占原始水平的,BUD FP BDP Hydrocortisone,大鼠气管以同位素标记药物
14、表面灌流后滞留时间比较,灌流后时间(小时),(Miller-Larsson et al. 1994),布地奈德在气道实际滞留时间长,17,布地奈德,血浆 脂肪组织,250 200 150 100 50 0,0 12 24 36 48 60 72 84 96 108,布地奈德1mg, b.d.反复用药后血浆与组织内药量变化,首剂后时间(小时),(Thorsson et al. 1996, 1997),药物量(mg),布地奈德反复给药组织中无蓄积,18,普米克 令舒,雾化 吸入,细胞粘附因子,血管内皮细胞 裂隙减少,炎症区域 血管减少,收缩微血管,局部炎症、水肿减少,雾化吸入普米克令舒有效控制局部
15、气道炎症,炎症细胞滚动,渗出减少,19,2糖皮质激素的给药途径,鉴于哮喘是一种气道的慢性炎症,且该炎 症在相当长的时间内将持续存在, 因此选 择一种安全、适合长期用药的给药途径至 关重要。 糖皮质激素的吸入疗法是哮喘患儿预防性 (长期)治疗的首选给药途径。,20,雾化治疗(1)优缺点,21,雾化吸入糖皮质激素的优势,直接进入上、下呼吸道的病变部位,减少了全身药物的用量,使用安全可靠,雾化吸入糖皮质激素,迅速发挥作用,副作用小,无需特殊吸入技巧,德国百瑞 吸入疗法,22,普米克非卤素类吸入型糖皮质激素,普米克(布地奈德, budesonide),地塞米松(dexamethasone),HO,CH
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- 雾化 吸入 普米 小儿 哮喘 疾病 应用
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