천식치료의 특징 김 영 삼 연세대학교 의과대학 내과학교실 호흡기내과

Presentation on theme: "천식치료의 특징 김 영 삼 연세대학교 의과대학 내과학교실 호흡기내과"— Presentation transcript:

1 천식치료의 특징 김 영 삼 연세대학교 의과대학 내과학교실 호흡기내과
People with asthma are highly sensitive to their environment. Children with asthma are particularly vulnerable to harmful environmental factors. Fortunately, interventions exist that can prevent and control asthma symptoms. The interventions include, but are not limited to, improving indoor and outdoor environments in which children with asthma live. 김 영 삼

2 천식은 완치되는 병인가요? 천식은 완치되는 병은 아니지만, 천식을 조절할 수 있습니다. 천식을 잘 조절하면 정상인과 같이 생활할 수 있습니다. 즉 직장생활을 하고 학교에도 갈 수 있으며, 밤에도 편하게 잠을 잘 수 있습니다. Asthma is a chronic disorder of the airways that causes recurrent and distressing episodes of wheezing, breathlessness, chest tightness, and nighttime or early morning coughing. Asthma can be difficult to diagnose and differentiate from other respiratory illnesses.

3 어떻게 하면 천식발작이 오지 않게 할 수 있습니까?
어떻게 하면 천식발작이 오지 않게 할 수 있습니까? 천식을 일으키게 하는 물질에 노출되지 않도록 해야 합니다. 그리고 의사가 지시하는 때에 천식약을 복용해야 하고 전혀 증상이 없고 숨이 차지 않더라도 1년에 최소한 2 - 3번 정도는 의사와 치료에 대해 상담을 해야 합니다. Risk factors are characteristics of individuals that increase the probability that they will experience a specific disease or condition associated with a disease. Risk factors include genetic predisposition and environmental exposures that can either lead a person to develop asthma or lead a person with asthma to have an attack. Just because a person is at risk for an illness does not mean that he or she will develop the illness. Being aware of the illnesses for which they are at risk may help people take precautions to avoid acquiring those illnesses.

4 천식을 생기게 하는 환경적인 요인 실내 실외 작업장의 물질 아스피린 집먼지진드기 바퀴벌레 동물의 털 곰팡이 꽃가루 곰팡이
Numerous environmental exposures can lead to the actual onset of asthma. These risk factors, which sensitize the airway and induce asthma, include indoor and outdoor inhaled allergens. Some of the most common indoor allergens are household dust mites, cockroaches, dander from furred or feathered animals, fungi, and pollens. The fraction of asthma cases related to indoor allergens appears to have increased since people have begun to spend more time indoors where homes have been carpeted, heated, cooled, and humidified. Other exposures that can lead to the development of asthma include aspirin and numerous exposures in occupational settings. Exposure to any of these factors increases the likelihood that a person will become sensitized to them.

5 집먼지진드기 Household dust mites produce one of the most common indoor allergens, and exposure to dust mites is a major risk factor for asthma worldwide. There are different types of household dust mites in different geographic areas, but all most commonly reside in carpets, pillows, mattresses, and soft furnishings.

6 바퀴벌레 Cockroach allergy is common in many parts of the country. Extremely high levels of exposure to cockroach allergen in inner cities may help explain the increased rates of asthma hospitalization and death among some urban children.

7 곰팡이 Molds and other fungi are other common indoor allergens. The optimal environment for indoor fungi to grow and cause fungi sensitivity is in dark, damp, and poorly ventilated places such as basements.

8 애완동물 Furry animals are a common source of allergens. They shed fur and feathers; they leave saliva, urine, and feces. Cats and rodents are potent asthma sensitizers, whereas dogs cause less allergic sensitivity than other mammals. People can become sensitized to urinary proteins from rodents, be they pets or pests.

9 꽃가루(화분) Outdoor allergens include pollens and fungi, both of which are almost unavoidable. Pollens that cause asthma usually come from trees, grass, and weeds. Outdoor fungi are usually molds and yeast that tend to be seasonal. Depending on where you live, the most active fungi season may be during either the hot days of summer or the rainy nights of fall.

10 천식의 병리 Airways are the passages that carry air to the lungs. As the airways progress through the lungs, they become smaller and smaller, like branches of a tree. It is currently thought that asthma produces its effects by leading to airway inflammation and airflow limitation. This inflammation may even be present when a person’s asthma is asymptomatic (that is, when the person is not experiencing any symptoms). When asthma is under control, as in the diagram on the left, the airways are clear, and air flows easily in and out. When asthma is not under control, the sides of the airways in the lungs become inflamed and swollen as in the diagram on the right. During an attack, muscles around the airways constrict and less air passes in and out of the lungs. The attack is also called an episode or exacerbation and can include coughing, chest tightness, wheezing, and difficulty breathing. It can be difficult to diagnose asthma in infants, young children, the elderly, smokers, workers exposed to chemical inhalants, people with seasonal asthma, and people with recurrent acute respiratory infections. Regular physical exams that include measurements of lung function and evaluations of a patient’s allergic status can help ensure a proper diagnosis. 정상 상태 기관지 수축 상태

11 가슴이 답답해오며 기침이 나고, 쌕쌕 소리가 난다.
천식발작의 증상에는 어떤 것이 있습니까? There are many things a person can do to lessen an asthma attack if properly instructed on how to do so. While experiencing an attack, a person with asthma will go through periods of worsening chest tightness, wheezing, coughing, waking at night, and/or shortness of breath. Any one or more of these symptoms along with a decrease in the lung function as measured by a peak expiratory flow (PEF) rate can indicate an attack. Since acute attacks can be life threatening, it is important that people suffering from an exacerbation recognize their symptoms and properly assess the severity of those symptoms. 가슴이 답답해오며 기침이 나고, 쌕쌕 소리가 난다.

12 천식발작을 일으키는 환경적인 요인 Exposures that exacerbate asthma are also known as triggers. In fact, by paying attention to circumstances preceding their attacks, people can learn to identify the specific allergens or irritants that are causing them. Some people may be affected by their asthma only at certain times of the year, while others are affected every day. Specific triggers of a person’s asthma can also change over time. Once a person is sensitized to either indoor or outdoor airborne allergens, contact with them can trigger significant changes in proper lung functioning. Air pollutants such as tobacco smoke, wood smoke, aerosol sprays, cooking oils, and polishes can also cause exacerbation. Respiratory infections can trigger attacks in people of any age. Exercise and hyperventilation can also lead to attacks. Adverse weather conditions like freezing temperatures, high humidity, thunderstorms, and excessive pollution have also triggered attacks, as have sulfur dioxide, some foods, food additives, and drugs such as aspirin. Strong emotional states such as elation, sadness, anger, and fear can all lead to hyperventilation and an attack. With proper management, however, many attacks can be avoided.

13 천식발작을 줄이기 위해서는? Dust mites thrive in soft furnishings like pillows, mattresses, and drapes. These microscopic organisms give off particles that cause allergic reactions when inhaled. Decreasing the number of dust mites to which people with asthma are exposed may help control their asthma. Some ways of doing this in the bedroom are by using bedding encasements, avoiding soft furnishings and cloth window coverings, washing bed linens weekly in hot water, and keeping the bedroom clean and dust free. The covers for pillows, mattresses, and box springs provide a barrier between the dust mites and the person with asthma. The bedding encasements, which are available commercially, may be plastic or vinyl, and are covered with cotton, nylon or knit fabric. A sheet and pillow cases are usually placed over the encasement for increased comfort. Any linens placed over the encasements should be washed weekly in hot water. Down-filled pillows, quilts, or comforters should not be used. Down filling consists of tiny feathers that contain large numbers of dust mites. Also, stuffed animals should be removed from the bedroom. If a child with asthma wants to play or sleep with a stuffed toy, wash the toy frequently in hot water.

14 천식발작을 줄이기 위해서는? Air pollution results from an accumulation of particles in the air and can become serious enough to cause injury or illness to plants and animals. Sources of outdoor pollution include industrial emissions, vehicle exhaust, tobacco smoke, pollen, and allergens from animals and insects. Ground-level ozone, or smog, is a major irritant. Indoor air pollution includes vapors from household cleaners and from gas stoves that are not properly vented, mold and mildew, animal dander, and environmental tobacco smoke. Each of these pollutants can lead to an asthma attack. Indoor air pollution may have increased since the advent of energy-efficient homes and buildings, thereby increasing the potential for human exposure to allergens and irritants.

15 천식환자들은 방안을(실내에서) 어떻게 해야 하나요?
A physician may ask questions such as these when examining someone with a possible diagnosis of asthma. Do you have a troublesome cough, particularly at night? Are you awakened by coughing or difficult breathing? Do you cough or wheeze after physical activity? Do you have breathing problems during a particular season? Do you cough, wheeze, or develop chest tightness after exposure to allergens? Do colds “go to your chest” or last more than ten days? Do you use any medications? How often? Are your symptoms relieved after you take medication?

16 증상완화제 속효성 beta2-agonist: 기관지확장제 경구약 보다는 흡입제의 효과가 더 크다.
The quick-relief medications immediately relieve the discomfort of chest tightness, coughing, and wheezing. They do this by relaxing the muscles around the airways. Quick relief medicines include the short-acting bronchodilators, which may be all that is necessary to treat people with mild, intermittent asthma.

17 대부분의 경우 최선의 방법은 흡입제를 복용하는 것입니다.
증상완화제 대부분의 경우 최선의 방법은 흡입제를 복용하는 것입니다. 1. 약물이 필요한 곳에 도달하여 직접 작용하고 2. 작용을 발휘하는데 소량만이 필요하며 3. 부작용이 더 적기 때문입니다. The quick-relief medications immediately relieve the discomfort of chest tightness, coughing, and wheezing. They do this by relaxing the muscles around the airways. Quick relief medicines include the short-acting bronchodilators, which may be all that is necessary to treat people with mild, intermittent asthma.

18 염증치료제(발작을 억제하는 약물) 스테로이드 제제 장기지속형 beta2-agonists
The long-term preventive medications most commonly prescribed are Corticosteroids (which are anti-inflammatory) and long-acting beta2-agonists. These medications can help prevent attacks for patients with persistent asthma and prevent symptoms on a long-term basis. The anti-inflammatory agents, particularly inhaled corticosteroids, are the most effective long-term preventive medication.

19 흡입기를 사용하는 법 Most of the medications prescribed to a person with asthma are taken by an inhaler. Other forms of medication prescribed are liquids, capsules, and tablets. The types of medications prescribed depend on the individual’s needs. The inhalers are also called metered-dose inhalers, meaning that the medications are measured by the inhaler apparatus. The metered-dose inhalers may contain either an anti-inflammatory drug or a bronchodilator, two different types of medications to treat asthma. Inhalers are usually the press-and-breathe type. Many people, however, especially young children, have a hard time coordinating the pressing and the breathing. This means that they may not get the full dosage of their medication. If a person’s inhalant is not having much effect, it could mean that the person is not using the inhaler properly or it is blocked or empty. It is a good idea to have a health care provider evaluate the technique of patients using inhalers. 뚜껑을 열고 흔든다.

20 흡입기를 사용하는 법 Most of the medications prescribed to a person with asthma are taken by an inhaler. Other forms of medication prescribed are liquids, capsules, and tablets. The types of medications prescribed depend on the individual’s needs. The inhalers are also called metered-dose inhalers, meaning that the medications are measured by the inhaler apparatus. The metered-dose inhalers may contain either an anti-inflammatory drug or a bronchodilator, two different types of medications to treat asthma. Inhalers are usually the press-and-breathe type. Many people, however, especially young children, have a hard time coordinating the pressing and the breathing. This means that they may not get the full dosage of their medication. If a person’s inhalant is not having much effect, it could mean that the person is not using the inhaler properly or it is blocked or empty. It is a good idea to have a health care provider evaluate the technique of patients using inhalers. 우선 숨을 내쉰다.

21 흡입기를 사용하는 법 흡입기를 입안에 넣고 새지않게 문 다음 숨을 들이쉬면서 흡입기를 누른다.
Most of the medications prescribed to a person with asthma are taken by an inhaler. Other forms of medication prescribed are liquids, capsules, and tablets. The types of medications prescribed depend on the individual’s needs. The inhalers are also called metered-dose inhalers, meaning that the medications are measured by the inhaler apparatus. The metered-dose inhalers may contain either an anti-inflammatory drug or a bronchodilator, two different types of medications to treat asthma. Inhalers are usually the press-and-breathe type. Many people, however, especially young children, have a hard time coordinating the pressing and the breathing. This means that they may not get the full dosage of their medication. If a person’s inhalant is not having much effect, it could mean that the person is not using the inhaler properly or it is blocked or empty. It is a good idea to have a health care provider evaluate the technique of patients using inhalers. 흡입기를 입안에 넣고 새지않게 문 다음 숨을 들이쉬면서 흡입기를 누른다.

22 흡입기를 사용하는 법 Most of the medications prescribed to a person with asthma are taken by an inhaler. Other forms of medication prescribed are liquids, capsules, and tablets. The types of medications prescribed depend on the individual’s needs. The inhalers are also called metered-dose inhalers, meaning that the medications are measured by the inhaler apparatus. The metered-dose inhalers may contain either an anti-inflammatory drug or a bronchodilator, two different types of medications to treat asthma. Inhalers are usually the press-and-breathe type. Many people, however, especially young children, have a hard time coordinating the pressing and the breathing. This means that they may not get the full dosage of their medication. If a person’s inhalant is not having much effect, it could mean that the person is not using the inhaler properly or it is blocked or empty. It is a good idea to have a health care provider evaluate the technique of patients using inhalers. 속으로 10을 센 후 입을 연다.

23 천식 발작이 오면 어떻게 해야 하나요? 천식 발작이 오면 가슴이 답답하며 기침이 나고 가슴에서 쌕쌕 소리가 납니다. 자는 도중에 잠에서 깨기도 합니다. 이런 경우에는 천식 발작을 일으키는 물체에서 멀리 떨어진 곳으로 가서, 효과가 빠른 기관지확장제를 흡입한 후 숨쉬기가 편해질 때까지 1시간 동안 편안하게 휴식을 취해야 합니다. Signs that may help patients or parents recognize the onset of an attack include : Itchy, watery, or glassy eyes Itchy, sore throat Sneezing Congestion Restlessness Runny nose Dark circles under the eyes An individual’s asthma management plan should define the appropriate response when any of these symptoms develop.

24 언제 응급실로 가야하나요? 효과가 빠른 기관지확장제를 흡입한 후에도 효과가 오래 가지 않거나 약물을 흡입해도 전혀 효과가 없어 숨을 자주 쉬고 몰아 쉬는 경우. 숨이 차서 말하기가 힘든 경우. 입술이나 손가락 끝이 시퍼렇게 변하는 경우. 숨을 쉬면 코가 옆으로 벌어지거나, 갈비뼈 혹은 목 주위의 피부가 들어가는 경우. 맥박이 빠르고, 걷기가 힘든 경우. The worsening of an attack can occur over minutes, hours, or even days. Recognition and proper treatment of an attack can prevent discomfort, and in some cases, emergency care and hospitalization. In case of an attack, symptoms should be listed and the peak flow rate (PFR) determined. If a person’s PFR is below his or her green zone despite increased medication, this may indicate the worsening of an attack. The attack may also be worsening if the individual needs more quick-relief medication or feels that the medication is not helping as much as it normally does. A mild attack can normally be treated at home with quick-relief bronchodilator medication. The patient’s individual management plan should provide the physician and the person with asthma with a guideline to follow, including prescription medication that may require consistent use for several days to improve the symptoms of the attack. A moderate attack may require a physician visit or hospital care. Patients who do not respond promptly to the medication and do not do well for at least three hours should be considered in need of emergency care.

25 효과가 빠른 기관지확장제는 어느 정도 사용할 수 있나요?
효과가 빠른 기관지확장제는 어느 정도 사용할 수 있나요? 효과가 빠른 기관지확장제를 흡입하면 한 동안 편하게 지낼 수 있습니다. 흡입제를 천식발작을 없애기 위해 매일 사용해야 하면 천식을 예방하는 약물도 같이 복용해야 합니다. 천식발작을 위해 하루 4번 이상 효과가 빠른 기관지확장제를 흡입해야 할 정도라면 치료에 대해 담당 주치의사와 상의를 해야합니다. Although asthma cannot be cured, it can be effectively controlled in most patients with the proper treatment. Two types of medication are usually used to control asthma: quick-relief and long-term preventive medication. Quick-relief medications provide prompt control of symptom’s while the long-term medications help prevent attacks and control chronic symptoms.

26 스테로이드 제제의 부작용