治疗哮喘英语作文

篇一：哮喘英语讲稿

Asthma

1 Definition

Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. The chronic inflammation is associated with airway hyperresponsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread, but variable, airflow obstruction within the lung that is often reversible either spontaneously or with treatment.

2 Do you know … (asthma facts)

? Asthma is one of the most common chronic diseases worldwide.

? An increasing prevalence of asthma and incorrect treatment increase the mortality of

asthma.

3 Etiology and Pathogenesis (what cause asthma?)

(1) Etiology

Host factors

?

? Genetic predisposition Obesity

? Sex

Environmental factors ( Factors that Exacerbate Asthma)

Environmental factors include allergens, respiratory infections, diet, drugs, and exercises.

(2) Pathogenesis

?

?

?

? 变态反应 allergic reaction 气道炎症airway inflammation 气道高反应性airway hyperresponsiveness AHR 神经-受体平衡失调neuroceptor dysequilibrium

4 Clinical findings

(1) Symptoms

The typical symptoms of asthma are recurrent episodes of cough, worse particularly at night; shortness of breath, chest tightness, wheezing (means there are high-pitched whistling sounds

when breathing out, especially in children), and sputum production. These symptoms occur or worsen at night or in the early morning, awakening the patient. That is often reversible either spontaneously (转载于:www.Zw2.cN 爱 作 文 网)or with treatment.

? cough-variant asthma 咳嗽变异性哮喘

? exercise-induced bronchoconstriction 运动性哮喘

(2) Physical examination

The most common physical finding in asthma is diffusing, expiratory wheezing, an increased respiratory rate and prolonged expiration.

寂静胸（silent chest）:occasionally, in severe asthma exacerbations, wheezing may be absent owing to severely reduced airflow and ventilation.

5 Laboratory examination

(1 )Measurement of lung function

PEF↓ FEV1↓

diumal variation in PEF >20%

bronchial provocation test :＞20% decrease in FEV1 15 minutes after inhalation of a specific agents or after 6 minutes of exercise.

bronchial relaxation test :＞15% increase in FEV1 15 minutes after inhalation of short acting β2 agonist .

(2 )Measurement of allergic status

Skin tests with allergens or measurement of specific IgE in serum: The presence of allergies increases the probability of a diagnosis of asthma, and can help to identify risk factors that cause asthma symptoms in individual patients.

(3) Other laboratory examinations

Arterial blood gas analysis

Sputum studies

Chest X-ray

6 Diagnosis

(1) Asthma diagnosis

? History and patterns of symptoms

? Physical examination

? Spirometry to demonstrate reversibility

? Exclude other causes of wheezing

(2) Asthma staging

? Acute Asthma Exacerbation 急性发作期

? Chronic asthma persistent 慢性持续期

? Asthma paracmasis 缓解期

7 并发症（ Complication ）

Complications of asthma include airway infection, exhaustion, cor pulmonale肺源性心脏病/呼吸衰竭respiratory failure、气胸pneumothorax等

8 Therapy

? allergen avoidance

? main curative

Medications to treat asthma can be divided into two categories: relievers and controllers. Inhaled glucocorticosteroids are the most effective controller medications currently

available.

（1） β2-agonist 通过对气道平滑肌表面的β 2 受体的兴奋，舒张气道平滑肌。控制哮喘急性发作的首选药物。

short-Acting β2 -Agonists：5－10分钟起效，维持 4－6小时。如沙丁胺醇

（salbutamol）、特布他林（terbutaline）

Long-Acting β2 -Agonists：可维持12小时。如福莫特罗（furmoterol）、沙美特罗（ salmaterol）、班布特罗（bambuterol）

（2） Theophylline 抑制磷酸二酯酶，提高平滑肌细胞内的 cAMP 浓度外；刺激肾上腺分泌肾上腺素，增加呼吸肌的收缩；增强气道纤毛清除功能和抗炎作用。aminophylline氨茶碱 sustained-release theophylline缓释茶碱（controller）

（3） Anticholinergics降低迷走神经的张力，解除支气管痉挛

溴化异丙托品（ ipratropium bromide ）噻托溴铵(tiotropium bromide)

（4 ）Glucocorticosteroids

controlling airway inflammation

? decreasing airway hyperresponsiveness ?

systemic glucocorticosteroids：甲基强的松龙methylprednisolone、地塞米松dexamethasone、氢化可的松hydrocortisone、泼尼松prednisone、强的松prednisone. inhaled gulcocorticosteroids(ICS)：倍氯米松（beclomethasone.BDP）、布地奈德budesonide、氟替卡松fluticasone.

（5） Sodium Cromoglycate

（6）Leukotriene Modifier

扎鲁司特（zafirlukast安可来）、孟鲁司特（montelukast顺尔宁）

? treatment of Asthma exacerbation

The aims of treatment are to relieve airflow obstruction and hypoxemia as quickly as

possible, and to plan the prevention of future relapses. Early intervention may lessen the severity and duration of an exacerbation. The primary therapies for exacerbations include, depending on severity, repetitive or continuous administration of an inhaled short-Acting β2 -Agonists, early introduction of systemic glucocorticosteroids to patients with moderate to severe asthma exacerbations , and oxygen supplementation.

? treatment of asthma paracmasis

Depending on the patients’ current level of asthma control and current treatment , each

patients is assigned to one of five “treatment steps”. For example, if asthma is not controlled on the current treatment regimen, treatment should be stepped up until control is achieved. If control has been maintained for at least three months, treatment can be stepped down. At each treatment step ,reliever medication should be provided for quick relief of symptoms as needed. At step 2 to 5, patients also require one or more regular controller medications, which keep symptoms and attacks from starting.

9 Nursing diagnosis

? impaired gas exchange

related to increased airway resistance, airway inflammation, and airway spasm

? ineffective airway clearance

related to bronchospasm, ineffective cough, excessive mucus production, tenacious

secretions, and fatigue

? knowledge deficit

related to knowledge deficits of MDIs

10 nursing implemention

?

?

?

?

?

?

?

?

? reduce exposure to risk factors avoid food allergies, lay off alcohol and somking provide comfortable position, such as orthopnea monitoring conditions, especially at night or in the early morning keeping airway clear, and oxygen is given by mask or nasal prongs teach clients effective coughing techniques teach client to breathe deeply through the nose and exhale 2-3 times through pursed lips decrease the clients’ anxiety and panic teach clients the correct administration of medications, especially how to use inhaler

devices and monitoring the side effects.

Medicine care

? glucocorticosteroids

Oral candidiasis ,hoarseness, irritated throat and dry cough are local adverse effects caused by inhalation of corticosteroids. These problems can be reduced or prevented by mouth washing; take oral medicine after meals to reduce stimulation of gastrointestinal. It should never be abruptly discontinued but tapered gradually over time to prevent adrenal insufficient.

? β2 agonists

? short-acting inhaledβ2 agonist should be used only on an as-needed basis at the lowest

dose and frequency required, not for long-term, regular, single, and large-dose use ? control the drip rate while using salbutamol, and monitor adverse systemic effects, such as tremor and tachycardia.

? methylxanthines

? the main problem with theophylline is the relatively high incidence of side effects, which

include gastrointestinal symptoms, cardiac arrhythmias, low blood pressure, and even death.

? Side effects can be reduced by careful dose selection and monitoring the serum

concentration of theophylline.

? pay attention to concentration and speed while iv.drip ，>10min

? theophylline administration requires monitoring of its serum concentrations for safe and

effective use.

? liver disease, congestive heart failure, and certain drugs including cimetidine, some

quinolones, and some macrolides increase the risk of toxicity.

11 Heath education

篇二：2014年重度哮喘国际诊治指南

2014年ERS/ATS重度哮喘国际诊治指南发布

目标人群

初级保健提供者、肺病、过敏症专科医师

指南背景与目的

大多数哮喘患者使用现有药物能够得到有效治疗，但5％~10％的患者为重度或难治性哮喘。本指南对重度哮喘的定义进行了更新，并讨论了重度哮喘的可能表型，为临床医生治疗儿童（年龄≥ 6岁）和成人重度哮喘患者提供了建议。

已证实为哮喘，且明确合并症的患者，如在前一年需要使用高剂量吸入糖皮质激素（ICS）加一种二线药物如长效β2-受体激动剂（LABA）支气管扩张剂或在前一年≥50％的时间需要口服糖皮质激素控制病情（或尽管接受上述治疗，哮喘仍未得到控制）时，则可定义为重度哮喘。

要点

1. 明确哮喘的诊断、评价与哮喘变现类似或者与哮喘相关的疾病（例如，支气管炎、囊性纤维化、充血性心力衰竭、过敏性支气管肺曲霉病）。对于表现不典型的患者，可进行高分辨电脑断层扫描。

2. 评估患者的合并症和诱发因素：如鼻窦炎、鼻息肉、心理因素、声带功能障碍、肥胖、吸烟、阻塞性睡眠呼吸暂停、过度换气综合征、激素的影响（经前、经期、绝经期）、甲状腺疾病、症状性胃食管反流疾病、药物（阿司匹林、非甾体抗炎药、β-受体阻滞剂、血管紧张素转化酶抑制剂）。

3. 确定哮喘表型（如过敏、嗜酸性粒细胞、肥胖、早发或晚发）的特点。可以进行痰嗜酸性粒细胞计数的医学中心应采用这项技术。

4. 对于ICS治疗无应答的激素耐药患者，除高剂量ICS或LABA， 可考虑小剂量茶碱或长效抗胆碱剂，如噻托溴铵（思力华）。痰嗜酸细胞计数可用于指导成人患者治疗，但不推荐测定呼出气一氧化氮。对于过敏性哮喘患者，可考 虑试用奥马珠单抗（索雷尔）。不推荐甲氨蝶呤和大环内酯类抗生素。抗真菌药物仅用于过敏性支气管肺曲霉病患者。支气管热整形术因治疗重度哮喘患者的现有证 据可信度“非常低”，仅应在临床试验或登记研究中使用

ERS/ATS工作组关于年龄≥6岁者重度哮喘的定义

在过去的1年需要指南建议的全球哮喘创议（GINA）4~5级哮喘药物治疗[大剂量吸入性糖皮质激素（ICS）联合长效β2受体激动剂（LABA）或白三烯调节剂/茶碱]或全身激素治疗≥50%的时间，以防止变成未控制哮喘，或即使在上述治疗下仍表现为未控制哮喘。

未控制哮喘须至少符合以下一条。①症状控制差：哮喘控制问卷（ACQ）评分持续＞1.5，哮喘控制测试（ACT）评分＜20(或GINA指南定义为“非良好控制”)；②频繁重度发作：在过去1年中2次或以上全身激素治疗（每次超过3天）；③严重发作：在过去1年中至少1次住院、入住重症监护室（ICU）或接受机械通气；④气流受

限：适当停用支气管扩张剂后，一秒钟用力呼气容积（FEV1）＜80%预计值[同时FEV1与用力肺活量（FVC）比值（FEV1/FVC）降至＜正常值下限]。得到控制的哮喘在上述大剂量ICS或全身激素（或联合生物制剂）减量时恶化。

重症哮喘的诊断过程

第1阶段：确定哮喘诊断并识别难治性哮喘

重度哮喘诊断中不可或缺的一步是除外那些表现为“难治性”哮喘、但对其中的混杂因素进行合理诊治后，病情可获极大改善的病例。因此指南推荐，表现为“难治性”哮喘的患者应首先由哮喘专家对其哮喘诊断予以证实并进行3个月以上的评估和管理

第2阶段：鉴别轻度与重度哮喘

当哮喘的诊断得到证实、合并症得到诊治后，重度哮喘的定义为“需要大剂量ICS另加一种控制药物[和（或）全身激素]以防止其变成未控制哮喘，或在该治疗下仍表现为未控制哮喘”。这一定义包括那些曾充分试用过上述治疗但因无反应而停药的病例。对于6岁以上患者，“金标准或国际指南推荐的治疗”是大剂量ICS联合LABA、白三烯调节剂、茶碱和（或）长期全身激素作为基本治疗。

第3阶段：确定重度哮喘是否得到控制

没有满足未控制哮喘诊断标准的患者，如果在激素减量时哮喘恶化，也符合重度哮喘的定义。符合这一定义，预示着患者具有高度的未来风险、来自疾病本身的风险（哮喘发作和肺功能丧失）以及药物不良反应的风险。

重症哮喘的评估

难控制性哮喘的评估是要点所在，内容包括：①确定“难治性”哮喘者哮喘诊断的必要评估；②对混杂因素和合并症的合理评估；③初步确定可能对优化治疗有用的表型。

第1步：明确哮喘诊断

对于哮喘的诊断，医生应持一定的怀疑态度。据文献报告，非哮喘性疾病被误诊为未控制哮喘的比例高达12%~30%。 评估应从细致的病史采集开始，重点是哮喘相关症状，包括呼吸困难（及其与运动的关系）、咳嗽、喘息、胸闷和夜间憋醒。此外，应了解疾病发作的触发因素以及相关环境或职业因素。

在成人，可能被误诊为哮喘或与哮喘相关的疾病包括功能失调性呼吸困难/声带功能异常、慢性阻塞性肺疾病（COPD）、过度通气伴惊恐发作、充血性心力衰竭、药物不良反应、支气管扩张/囊性纤维化等。

第2步：评估合并症和促成因素

鉴于文献报告治疗不依从率高达32%~56%，因此对所有难控制哮喘患者都应评估其治疗依从性。吸入装置使用不当亦属常见并应引起重视。此外，多数大规模流行病学研究显示，重度哮喘与变应性/变态反应的相关性比轻度哮喘弱。变态反应与哮喘严重程度的相关性在儿童中更为明显。对于所有患者，明确特异性免疫球蛋白（Ig）E、过敏原暴露与症状间有无关联，有助于识别促进哮喘症状和发作的因素。

与难控制性哮喘和重度哮喘相关的合并症和促成因素包括：鼻-鼻窦炎/（成人）鼻息肉、声带功能异常、吸烟/吸烟相关疾病、阻塞性睡眠呼吸暂停、高通气综合征、胃食管反流病（症状性）、肥胖、激素、心理因素、药物等。

除与哮喘相关的合并症外，对于长期重度或难控制性哮喘患者，应对其治疗所致合并症，尤其大剂量吸入和全身激素相关合并症进行评估。

第3步：识别哮喘表型

哮喘特别是重度哮喘已被逐渐认为是一种异质性疾病，并非对现行治疗都有相似的反应或具有相同的临床病程。虽然目前还没有被广泛接受的特异性哮喘表型定义，但识别特定表型的特征将有助于预测疾病自然史，且可能最终促成靶向治疗或其他更有效治疗。

嗜酸粒细胞炎症、变应性/辅助性T细胞（Th）2型免疫反应及肥胖，是在考虑哮喘治疗时可能有用的特征或表型。通过现有方法，可识别早发性变应性表型、晚发性肥胖表型、晚发性嗜酸粒细胞表型等多种哮喘表型。

前述特征中，除血嗜酸粒细胞外，生物标志物检测由于操作复杂因而临床应用受到限制，且其在识别有临床意义的、能够指导治疗选择的哮喘表型方面的用途仍须进一步证实。

来源 欧洲呼吸学会(ERS,European Respiratory Society) 美国胸科学会(ATS)

篇三：英语作文

Spring Festival

Spring Festival is the most importanted popular festival in China. Before Spring Festival ,the people usually clean and decorate their houses.And they go to the Flower Fairs to buy some flowers.During Spring

Festival ,the adults usually give lucky money to children.People often get together and have a big meal.Some people eat dumpling for dinner.

I love Spring Festival. Happy New Year

On New Year's Eve, our class had a party. The atmosphere was good. It was out of the ordinary from the very beginning. The boy student from one bedroom gave an unusual performance. We saw a boy named Li Xinmin turn off all the lights in a sudden snap. Then with three resounding crow of a cock echoing in the hall, the hall was again brightly lit in a snap.

My birthday

Hello, I am Erika. My birthday is in winter. It’s cold. But I am happy, because I can play with snow. I like skating and making a snowman. It’s a good time for winter sports. On my birthday, I can get lots of birthday presents and My parents often take me to the ice rink. We always have a good time. I am happy on my birthday.

I like music

Many people like music. It has many sorts: soft music is graceful, rock music fast, classical music GREat, light music relaxing, and children, music interesting.

You can pick and choose whatever you like. Now popular songs are in fashion. If you like music, you usually like singing, too. I am no exception.

My brother and I like pop songs, and my parents like to listen to soft music. We are a musical family. Do you like music? Is your family full of music, too? Music is really GREat! I like it very much.

Introduce myself

Hello!nMy name is Amy .I am nine years old .I have a big family ,my father ,my mother ,my sister and me .My good friends is Lan jie .We in Class Four Grande .I like playing basketball，reading book. And my good friend like drawing .This is me. would you like to make friends with me ?

My friend

Hello !My name is Mike/Amy .good fried is Han Meimei .She is ten years old .She has a small family .There are three people in her family .She like black and white .Her favourite food is eggs. She like playing basketball .We go to school together every day .This is my

fried .Do you like her?

My dog

I have a dog. My dog name is DuDu. It is a boy. It is very lovely. DuDu is 8 years old. DuDu is fat. It wears a white coat. DuDu has two big eyes and two small ears. It has one short mouth. It has four fat legs. it likes run. It runs very fast. It likes bone and meat. My dog is smart. I like my dog. Do you like it?

I like summer

In the summer, the days are longer and the nights are shouter.It's very hot. People like to go swimming. I like swimming very much.So I often go to the swimming poll in the summer .And I can swim very well.

In the summer the trees and leaves are green. Flowers are open too. People don't like to go outside.They want to stay at home.Because in the room. It's very cool.

In the summer. People like to eat ice-cream.So there are many kinds of ice-cream.

A letter

I like swimming and I like eat ice-cream.So I like summer too.

Hello, Allen! I've got your E-mail. Thank you for your rapid reply! You know what that was my first time to write an E-mail, and it was so fun! I even wrote the wrong address at the first time .How silly I am! About the E-mail you sent me, the flash game is so interesting，and I forward it to my classmate. Everybody says it's the best game they ever played. It's so nice of you to send me the game. Where did you find the game? By the way, would you like to see a movie with me this Saturday? I hear that there is a cool movie and I have two tickets. Please give me the answer before Friday, so that I can make the plan.

PS: Can you tell me how to beat the game or give me the work through? Thanks.Best regards,

Peter

My family

There are four people in my family, my father, my mother, my sister and me. My father likes reading. My mother likes cooking. They both work in Leliu. They always go to work by car. They work hard.

My sister and I are pupils. I study in the primary school affiliated with Shunde No.1 Middle School. My hobby is collecting coins. My sister studies in Xishan Primary School. She likes watching TV. We love our family very much.