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Astimin doğal seyri

jorrit gerritsen. Astimin doğal seyri. jorrit gerritsen. natural course of asthma. question. what is asthma ?. what is asthma ?. asthma is like love: everybody knows what it is, but nobody can define it. asthma is a clinical (doctor’s) diagnosis.

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Astimin doğal seyri

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  1. jorrit gerritsen Astimin doğal seyri

  2. jorrit gerritsen natural course of asthma

  3. question what is asthma ?

  4. what is asthma ? asthma is like love: everybody knows what it is, but nobody can define it.

  5. asthma is a clinical (doctor’s) diagnosis

  6. induced by infection (episodic / transient) allergic asthma (recurrent / chronic) wheezing late onset asthma phenotypes preschool wheezing 1m 1 2 3 4 5 6 years

  7. wheeze

  8. wheeze • < 1 year → 80% no wheeze age 3 • age 1 – 2 → 60% no wheeze age 3 • Age 2 – 3 → 30-40% no wheeze age 3

  9. prevalence current wheeze Illi S, et al. Lancet 2006;368:763

  10. questions is wheezing harmless ? & is wheezing asthma ?

  11. EPITHELIAL LOSS Turato G, et al. AJRCCM 2008;178:476-82

  12. BASEMENT MEMBRANE THICKENING Turato G, et al. AJRCCM 2008;178:476-82

  13. how to study natural course of asthma? • starts as early as possible (before birth) • regular follow-up (annual, at important ages) • basic design of the study crucial for the interpretation of the results • early lung function measurements • large cohorts • no much migration in the cohort • most favorable to have one main researcher

  14. what is known about childhood asthma? • 30% of children have asthma symptoms before age 1, and 70% before age 3 • severe asthma ~ 1% of children • 40 to 70 % of children have still symptoms and thereby asthma between the age 20 to 30 yrs • severe asthma adults ~ 5 % • no information on effects early treatment and outcome • relationship between asthma and adult COPD still unknown

  15. effect of early treatment and outcome Pedersen S, Respir Med

  16. Robertson CF. Med J Austr 2002;177:S42-4.

  17. Longitudinalchangeslungfunction Sears et al. NEJM 2003;349:1414-22

  18. lung function at birth – 22 yrs Martinez FD, Proc ATS 2009;6:272

  19. intra uterine growth retardation

  20. iugr and lung function Kotecha SJ, et al. ARJCCM 2010;181:969

  21. BHR and growth of FEV1 from childhood to young adulthood Xuan et al, AJRCCM 2000 N=557. Expected FEV1 = -12% at age 19, given same initial FEV1 and growth in height

  22. BHR and growth of from childhood to young adulthood N=557. Expected ratio = -9% at age 19, entering the plateau phase with suboptimal lung functions Xuan et al, AJRCCM 2000

  23. Recent severe exac predict future severe exac in severe asthma Haselkorn T, JACI 2009;124:921

  24. lung function young adults predicts airflow obstruction 20 yrs later Kalhan R, et al. Am J Med 2010;123-468

  25. outcome childhood asthma Van der Toorn et al. AJRCCM 2001;164:2107-13

  26. MBP-epithelium Van der Toorn et al. AJRCCM 2001;164:2107-13

  27. bronchial biopsies clinical remission controls Van der Toorn et al. AJRCCM 2001;164:2107-13

  28. longitudinal changes airway hyperresponsiveness Tantisira KG, ARJCCM 2008;178:325

  29. conclusions • Outcome of asthma and wheeze depends on: • early life events • initial airway obstruction • intra-uterine growth retardation • bronchial hyperreactivity • treatment ? • many unknown factors • the relationship between asthma and COPD not clear

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