Master72的部落格

不講番茄炒蛋蛋炒番茄的GINA guideline

Bronchial thermoplasty:

1. 美FDA approve for adult

2. 燒掉smooth muscle & goblet cell: 不會掐死也不會淹死, 降低severe attack機率

3. radiofrequency

4. used in segmental bronchus (>3mm)

5. long term side effect不大

Relationship between infection and wheezing or asthma:

1. 六個月內主要RSV, 六個月到五歲主要RV

2. asthma odds ratio: RSV 2.6, RV 9.8 --> 六個月內wheezing的長大不一定asthma, 六個月以後virus infection造成wheezing的asthma機率就很大

3. RV: 先致敏再造成wheezing; airway remodeling

4. pneumococcus colonization也提高asthma risk

5. 母奶TGF-beta強化Treg，降低allergy

6. 水解奶粉內含tolerogenic peptide，經M cell活化Treg降低allergy; 加probiotics效果提高

Airway clearance technique for children:

1. CPT易被誤為PT領域，現在稱bronchial hygiene therapy

2. Active cycle breathing technique: 深呼吸三次配huff

3. 拍痰背心, intrapulmonary vibrator, PEP valve

4. Postural drainage: 可用球讓小孩趴著玩，大小孩可用倒過來椅子鋪棉被

5. Blowing therapy: for PEEP; 吹風車、泡泡、樂器

6. 跳彈簧床

7. suction: 2010年起建議淺為主

8. for asthma: ACT無證據顯示有益

Asthma endotype:

1. early-onset allergic asthma

2. late-onset persistent eosinophilic asthma--> steroid, antifungal

3. obesity-related asthma: not related to Th2, try weight loss

4. Neutrophilic asthma: poor response to steroid, try macrolide, anti IL-17

5. 未來：個人化治療（因為多種endotype，是一種syndrome）；Treg清除戰場

6. 台灣人發明Anti-IgE, side effect不多，0.2% anaphylaxis

7. IgE上升造成IFN-gamma下降：可解釋為何過敏兒抵抗力差

Immunotherapy

1. 減敏療法anaphylaxis不多，mortality更少

2. 台灣越來越少人做