(Asthma)

[Chronic inflammatory] cell mast

cell,eosinophils,T-lymphocyte,macrophage,neutrophil
[bronchial hyper-reactivity]

1. Acute bronchoconstriction [Airway muscle]

2. Air way edema

3. Chronic mucous plug formation
4. Air way remodeling

 [Airway muscle]
[Airway lining]

beta2-agonist

Spirometry
1.
2.

3.
4.
5.
6.

spray
Aspirin

gastroesophageal reflux disease

spirometry
FEV1 [force expiratory volume in one minute] peak flow meter PEF [peak expiratory
flow] PEF 1-2
20
Spirometry

FEV1 15% beta-agonist 15

FEV120% steroid 14
PEF PEF 20%
=(PEF-PEF)*100)(PEF-PEF)/2

FEV1 1

Animal Allergen

HEPA

HEPA

House-Dust Mite Allergen

55 C
50%

Cockraches Alergen



Food Allergies


Indoor Fungi

50%

Isocynates

 Outdoor Allergen

Moulds

HEPA

Pollutantants and Irritants

Sulfite Sensitivity
Infections
NSAID aspirin brufen diclofenac betablock propanolol atenolol metoprolol
Rhinitis/Sinusitis
Antihistamine/decongestant steroid
Gastresophageal Reflux
3 6-8

aspirin

sulfite

HEPA and Electroststic filter spore

Humidifier
Ozone

1. Mild Intermittent
2. Mild Persistent
3. Moderate Persistent
4. Severe Persistent




1 Mild Intermittent
1.

2-3
2

2.

PEF>80%
<20%

2 Mild Persistent
1.

2 1

2

2.

PEF>80%
20-30%

3 Moderate Persistent
1.

2.

PEF >60%-<80%
>30%

4 Severe Persistent
1.

2.

PEF <60%
>30%

Status Asthmaticus



2
1. Long-Term Control medications Controller

2

Corticosteroid inhaled
Cromolyn sodium and Nedocromil
Long-acting beta2-agonists inhaled steroid 12
Theophylline sustained-release inhaled steroid
Leukotriene modifiers inhaled steroid

2. Quick-relief medications Reliever

Short-acting Beta2-agonists30
Anticholinergics Short-acting Beta2-agonists
systemic corticosteroids

3. steroid Long-acting
beta2-agonists
Symbicort Seretide

Quick-relief medications

1. bronchodilator

2. Peak flow meter

3.


4.

beta2-agonist

1.
2.

[Long-Term Control] [Quick

Relief]

Long-Term Control Medications

Quick-Relief Medications

inhaled steroid cromolyn

Theophylline 12
leukotriene

inhaled steroid

inhaled steroid-
long -acting
inhaled beta2-agonist
sustained release theophylline
long -acting beta2-agonist
tablet

shorting-acting Inhaled beta2-agonist

short-acting Inhaled beta2-agonistg

2
2
shorting-acting Inhaled beta2-agonist

short-acting Inhaled beta2-agonist

3
1-6
1

shorting-acting Inhaled beta2-agonist

short-acting Inhaled beta2-agonist

3
1-6
2

inhaled steroid

long -acting inhaled beta2agonist sustained release

theophyllin long -acting
beta2-agonist tablet
steroid tablet

shorting-acting Inhaled beta2-agonist

short-acting Inhaled beta2-agonist

3
4
1-6
3

(PeakFlow)
. (Steroid )
.
.
1. PEF 80 - 100% ()
Wheeze ,

short-acting beta2-agonists 3 PEF80%

short-acting beta2-agonists 4 2
inhaled steroid 2
2
short-acting beta 2-agonist

2. PEF 50 - 80% , ,

Quick-relief medications 20 3
Quick-relief medications 2-4 puff space 13-4
4 PEF>70%4

inhaled steroid 2 PEF

steroid prenisolone[5mg] 23

3. PEF 50%

1. short-acting beta2-agonists 2-4 puff space 20 1

1
2. inhaled steroid 2 PEF >80%
3. steroid 5mg 23
4. short-acting beta2-agonists 2-4 puff space 42
steroid 2
5. 10short-acting beta2-agonists

PEF


1.
2.
3. 2

sprey

PEF

2
1. steroid steroid
32-3
3
2.


1. 1
1
2. 3 1

1.
2.
3.
4.
5.

PEF

PEF

short-acting beta2-agonists 20 31

Peak flow rate

3
1.
PEF =

PEF

PEF =

80% 100%
PEF

100/

short-acting beta2-agonists 3 PEF80%

short-acting beta2-agonists 4 2
inhaled steroid 2
2
short-acting beta 2-agonist

2.
PEF =

PEF

PEF =

60% 80%
PEF

100-120 /

Quick-relief medications 20 3
Quick-relief medications 2-4 puff space 13-4
4 PEF>70%4
inhaled steroid 2 PEF 80%
steroid prenisolone[5mg] 23

3.
PEF =

PEF

PEF =

50% PEF

120/

short-acting beta2-agonists 2-4 puff space 20

inhaled steroid 2 PEF >80%
steroid 5mg 23
short-acting beta2-agonists 2-4 puff space 42 steroid
2
10short-acting beta2-agonists

1. ______________
2. ______________
3. PEF
4.3
5.
6.
7.
8. [short-acting inhaled beta2-agonist]
9.[short-acting inhaled beta2-agonist]
10.______________________________________
11.

1.

30

120 160
PEF< 60%

2. 3
3. steroid 2-6
4.

3

PEF

1.
2.
3.
4.
5.
6.
7.

1-2
PEF<50%

1.
2.
3.
4.
5.
6.

steroid
2
ICU
3 1
beta2-agonist 2

3.
4.
5.
6.

1. steroid
2. 2
ICU
3 1
beta2-agonist 2

Nocturnal asthma Nocturnal

asthma
short acting beta-agonist
long acting beta-agonist

Exercise-induced asthma exercise-induced asthma

beta-agonist 15-30 45 long acting beta-agonist
30-60 12 Cromolyn 15 2-4
steroid

Asthma during pregnancy