Asthma: an old disease, a new challenge of future 氣喘 : 風雲再起 Asthma: an old disease, a...
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Transcript of Asthma: an old disease, a new challenge of future 氣喘 : 風雲再起 Asthma: an old disease, a...
氣喘 : 風雲再起Asthma: an old disease, a new Asthma: an old disease, a new
challenge of futurechallenge of future王圳華 醫師
Chun-Hua Wang, MD
Schematic representation of a) pro-asthmatic epithelium with a close relationship between altered epithelial cell transcription factors, goblet cell metaplasia and T-helper cell (Th) type 2 inflammation. b) The altered
epithelium also interacts with the underlying mesenchyme in a chronic wound response to contribute towards airway wall remodelling and ongoing inflammation
Clinical phenotypes of asthmaClinical phenotypes of asthma
Haldar P et al, AJRCCM 2008
Adult Asthma
GINA Guideline
Well controlledWell controlled
Step down
SucceedSucceed
Self ManagementWith minimal medications
Self ManagementWith minimal medications
FailFail
Not Well controlledNot Well controlled
Compliance
Identify triggering factors
YesYes
Avoid / TreatAvoid / Treat
NONO
Severe AsthmaSevere Asthma
Low dose or high doseLow dose or high dose
Not Well Controll Asthma
Not Well Controll Asthma
Bad compliance
Bad compliance Good compliance
Compliance monitor
Compliance monitor
No identified causesGERD
RhinitisSinusitis
EmotionalOccupationalDrug induced
ExerciseMenstruation
GERDRhinitisSinusitis
EmotionalOccupationalDrug induced
ExerciseMenstruation
History Therapeutic trial
History Therapeutic trial
Severe Asthma
Eosi
noph
ilic
Eosi
noph
ilic
Neu
trop
hilic
Neu
trop
hilic
Alle
rgic
(IgE
)Al
lerg
ic (I
gE)
Airw
ay
rem
odel
ing
Airw
ay
rem
odel
ing
Induced SputumBlood
Breath condensate FeNO
Bronchial biopsy
Induced SputumBlood
Breath condensate FeNO
Bronchial biopsy
Severe Asthma
High collapsibility of airways
Lung hyperinflation
High airway hyper-responsiveness
Inflammation(steroid insensitive)
Structural Changes
Environmental FactorsEnvironmental Factors Host FactorsHost Factors
GenomicsGenomics
EpigeneticsEpigenetics
Allergen, virus, or oxidant stress induced injury
Allergen, virus, or oxidant stress induced injury
Epithelial sheddingSubmucosal inflammation
Epithelial sheddingSubmucosal inflammation
Recruit bone-marrow-derived fibrocytes
Recruit bone-marrow-derived fibrocytes
Recruit fibrocytes to submucosa, ASM
Recruit fibrocytes to submucosa, ASM
FibroblastproliferationFibroblastproliferation
Myofibroblast
EGF, TGF-CTGF
Chronic stimulation
Airway remodelingAirway remodeling ASMASM
?
Acute inflammationAcute inflammation
CXCR4CXCR4
FibroblastFibroblast
CXCL12
Higher level of IL-13, TGF-1Higher level of IL-13, TGF-1
CCL19
CCR7CCR7 EGFREGFR
MyofibroblastMyofibroblast Tissue repairing
Anti-IgE antibodies
(Omalizumab)Omalizumab)
Anti-IgE antibodies
(Omalizumab)Omalizumab)
NeutrophilNeutrophilNeutrophilNeutrophil EosinophilsEosinophilsEosinophilsEosinophils AirwayAirwayremodelingremodeling
AirwayAirwayremodelingremodeling
AllergyAllergyEnviromentaEnviromenta
ll
AllergyAllergyEnviromentaEnviromenta
ll
PDE4 PDE4 inhibitorsinhibitors
PDE4 PDE4 inhibitorsinhibitors
Anti-IL5 Anti-IL5 antibodiesantibodies
Anti-IL5 Anti-IL5 antibodiesantibodies
??Anti-elastaseAnti-elastaseThermoplastyThermoplasty
??Anti-elastaseAnti-elastaseThermoplastyThermoplasty
??Anti-IgE AbAnti-IgE Ab
??Anti-IgE AbAnti-IgE Ab
FibrocytesFibrocytesOxidative stressOxidative stressMast cellsMast cells
Progressive remodelingProgressive remodelingPoorly controlPoorly controlProgressive remodelingProgressive remodelingPoorly controlPoorly control