logging in or signing up Органы дыхания и средства доставки Arkhipov Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 138 Category: Entertainment License: All Rights Reserved Like it (0) Dislike it (0) Added: June 15, 2009 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript ???????? ? ?????????? ??????? ??????? : ???????? ? ?????????? ??????? ??????? 15.06.2009 ???????? ? ?????????? ??????? ??????? : ???????? ? ?????????? ??????? ??????? ???????? ? ?????????? ?????? ?????? ?????????????? ?????? ??????? ???????? ?????????? ???????? ?????? : ???????? ?????? ????? ?????? ? 2 ???? ?????? ?????? ??????? ?????? : ????? ?????? ? 2 ???? ?????? ?????? ??????? ?????? ?????? 2 ????? 4 ????? 3 ????? ??????? ?????? ?????? ????????????? ???????? ???????????? ?????? : ???????????? ?????? ????? ?????? ???????????? 40 ?????? ?????? : ????? ?????? ???????????? 40 ?????? ?????? ????????? ???????? : ????????? ???????? ?????????????? ??????? : ?????????????? ??????? ???????? 1.5 ??. ? ??????. ?????? ????? ???? ????????? «???????» ?? ????????? ?? 6 ?????. ?????, ??????????? ??? ?????? ????????? ???? ???? ????????? ? ??????????? ??????????? ?????: ????????? – 6 ??? ??? – 5 ????? ? ????? ?????????? – 8 ????? ? ????? J Appl Physiol.1985; 58: 1157-1163 Högger and Rohdewald, Rev Contemp Pharm 1998 ????????????? ?????? ?????? : ????????????? ?????? ?????? ?????????? : ?????????? ?????????????? ?????????????? ???????? II ???? ??????? ?? ?????? ? ???????????? ??????? ????????????? ?????????: ??????? ?? ?????? - ??? ????? ??????? ??????? (???????????? ????????) ? ?????? ???????? ???????, ??? ? ??????? (???????????? ??????????? ??????? ? ??????? ????????) ??????????? ???????????-??????????? ???????? : ??????????? ???????????-??????????? ???????? ?????????????? ???????? : ?????????????? ???????? ????? ???????? ????? ?????????? ????? 1,6% ?? ?????? ?????? ????????????? ????. ????????????? ?????????????? ? ?????? ? 16-17 ??? ??????, ??? ?????????????? ???????? ? 2,5 ???? ?????? ????? ?????????? ?????? ? ??????? ?????? : ?????????? ?????? ? ??????? ?????? ????????? : ????????? ??????? ?????? r1 ????????? ??????? ?????? ????????? r2 ????????? – ???????????? ???? ?????????? ??? ?????????? ?? 130% ?? ?????? ????? ??????? ????????? ? ??????? : ??????? ????????? ? ??????? ???? ????????? ??????????? ?????????????? ??????? ???????????? ?????? : ???????????? ?????? ????? ?? ????????, % ??????? ????????????? ????? : ??????? ????????????? ????? ????? ??????? ????????????? ????? : ????? ??????? ????????????? ????? ?????????? ?????? ????????: : ?????????? ?????? ????????: ???? ?????????? ?? ????????? ?????????, ???????????? ? ??????? ?????????? 5-? ????????? ?????????? ????????????? ???? ??????? ????????? ??????? ??????????? ???? ???????? ?????????? ?????? ? ?????????? ???????? ??????? – ??????????? ????? ???? : ????? ???? ??? V- ???????? ????????, P – ???????? ????????, R – ????????????? ??? ? – ???????? ????, I – ?????? ??????, r - ?????? ????????????? ??????????? ????? : ????????????? ??????????? ????? ????????????? ? ??????? ? ??????????? ?? ????????? : ????????????? ? ??????? ? ??????????? ?? ????????? ????????????? ???????????? ?????? : ????????????? ???????????? ?????? ????????????? ?????????? ?????? : ????????????? ?????????? ?????? ????????? ?????? ??????? : ????????? ?????? ??????? ????????? ????????????????:(1) ??????????? : ????????? ????????????????:(1) ??????????? ????????? ????????????????:(2) ???? ????????????? ???? : ????????? ????????????????:(2) ???? ????????????? ???? ????????? ????????????????:(3) ???????? ??????? ? ??????????? ???????? : ????????? ????????????????:(3) ???????? ??????? ? ??????????? ???????? ??????????? ?????????? ?????? ??? ???????? ? ???? : ??????????? ?????????? ?????? ??? ???????? ? ???? ???????????? ?????????? ??????????? ????? : ???????????? ?????????? ??????????? ????? ??????????????? ????????? ? ??????? ???? : ??????????????? ????????? ? ??????? ???? ????? ???? ????? ???????????? ?????? ???? ????. ????????? ??????? ??????? ???? ??????? ????????? ?????? ???????????? ???????? ? ?????????? ??????? ??????? : ???????? ? ?????????? ??????? ??????? ???????? ? ?????????? ?????? ?????? ?????????????? ?????? ??????? ???????? ?????????? ???????????????? ????? ? 158 ??????????? ????????????? ?? : ???????????????? ????? ? 158 ??????????? ????????????? ?? ATS/ERS Task Force Asthma Control, 2005 ???????? ?????? : ???????? ?????? ?????????????????? : ?????????????????? ?????????????? : ?????????????? ?????? ????? - ????? : ?????? ????? - ????? ????????????? ????????????? ????? ? ??????? 25%-75% ?? ???? : ????????????? ????????????? ????? ? ??????? 25%-75% ?? ???? ????????????? : ????????????? 590,00 EUR ????????????? : ????????????? Reddel et al. Lancet 1999;353:364-369 ???? ?? ??????????? ???????????????? : ???? ?? ??????????? ???????????????? postFEV1 - preFEV1 preFEV1 ???????? ???????????: ?? FEV1: >12 % ? >200 ?? ?? PEF: > 60 ?/??? Quanjer et al. ERJ 1993;6(suppl.16):5-40 ?100% ???????????????????? ???? : ???????????????????? ???? % ??????? ???1 ???????????? ??????????, ??/?? ???????? PC20 ?? ???? ??????? ???? : ???????? PC20 ?? ???? ??????? ???? Booms et al., JACI 1997;99:330-337 ????????? ??????? ????????? PC20 ?????? 2.0 1.5 1.0 0.5 0.0 -0.5 ?????? ??????? -1 0 4 8 12 13 14 Medical Research Council Dyspnea Scale : Medical Research Council Dyspnea Scale Brooks 1982 Borg CR 10 Scale (Dyspnea Assessment) : Borg CR 10 Scale (Dyspnea Assessment) Borg,G., Med Sci Sports Exerc 1982; 14:377-81 ???????????? ?????? ?????, ????? ??????? ????? ??????? ??????? ????????? ????????? ?????? ????? ?????? ??? ????????? ACQ (?? ??????? ??????? ??????????? ?? 0 ?? 6-?? ??????) : ????????? ACQ (?? ??????? ??????? ??????????? ?? 0 ?? 6-?? ??????) ??? ????? ?? ??????????? ??-?? ???????????? ????? ????? ? ??????? ?? ????????? ??????? ????????? ? ??? ???? ???????? ???????? ???????????? ????? ????? ? ?????? ??????????, ? ??????? ?? ????????? ??????? ????????? ???? ?????????? ???? ???????????? ??-?? ???????????? ????? ? ????? ?? ????????? ??????? ????????? ??????? ?????? ?? ?????????? ??-?? ???????????? ????? ? ????? ?? ????????? ??????? ? ??????? ?????? ???????, ? ????? ?? ????????? ??????, ?? ?????????? ????????? ???????? ???????, ? ??????? ?? ????????? ??????, ????????? ?????? ?????? ?????????????????? ???????? ????????? ????????? ???????? ???1 ? % ?? ???????? ?? ?????? ?????????? ??????. Juniper EF, Svensson K, Mork AC, Stahl E. Respir Med 2005;99: 553–8. ????????? SMART vs ??????? : ????????? SMART vs ??????? COSMOS Trial ACQ5 ????? (0–6) 1.0 1.2 1.4 1.6 1.8 2.0 0 4 12 26 52 p=0.07 SMART ??????? ???. The St Georges respiratory questionnaire (SGRQ) : The St Georges respiratory questionnaire (SGRQ) ??? ?????? ?? 7 ????????? ??????????? ??????? ?????????????? ???????????? ??? ?????? ???????? ????? Jones PW, Quirk FH, Baveystock CM (1991) The St Georges respiratory questionnaire Respiratory Medicine 85 (supplement B) 25-31 ?????????, ??????? ? ?? ??????????: ??????? ?? ???????? ????? : ?????????, ??????? ? ?? ??????????: ??????? ?? ???????? ????? ???? ? 6-?? ???????? ??????? (6MWT) ? ????????? ?????????? ? ??????? ???? : ???? ? 6-?? ???????? ??????? (6MWT) ? ????????? ?????????? ? ??????? ???? V.M. Pinto-Plata et al. Eur Respir J 2004; 23: 28–33. ?=0,003 ??????????, % ?????? ????? ???? (BMI) : ?????? ????? ???? (BMI) ???: m — ????? ???? ? ??????????? h — ???? ? ?????? (? ?????????? ? ??/?2). Slide 55: FEV1 < 35% PT # 1 58 y FEV1: 28 % MRC: 2/4 PaO2: 70 mmHg 6MWD: 540 mt BMI: 30 BODE: 3 1 2 3 4 PT # 2 62 y FEV1: 33% MRC: 2/4 PaO2: 57 mmHg 6MWD: 400 m BMI: 21 BODE: 6 PT # 3 69 y FEV1: 35% MRC: 3/4 PaO2: 66 mmHg 6MWD: 230 m BMI: 34 BODE: 7 PT # 4 72 y FEV1: 34% MRC: 4/4 PaO2: 60 mmHg 6MWD: 154 m BMI: 24 BODE: 9 ?????? ????? ???? (BMI) ? ???????????? ??????? ???? : ?????? ????? ???? (BMI) ? ???????????? ??????? ???? Chailleux E et al. CHEST 2003; 123:1460–1466 ???? ???????????? ???????????? NO : NO NO : NO Ricciardolo et al. Thorax 2003 De Gouw et al. Eur Respir J 1998 ??????? ? ?????????? ???????? ???????? ?????? : ?????? ??????? IgE : ??????? IgE Burrows B, et al. N Engl J Med 1989 ??????? IgE ? ?????? (??/??)* n=2,657 0.32 1 3.2 10 32 100 320 1,000 3,200 1.0 2.5 5.0 10 20 40 ????? (??????? ?????????????) Log ???????????????? ????? : ???????????????? ????? ???????? ? ?????????? ??????? ??????? : ???????? ? ?????????? ??????? ??????? ???????? ? ?????????? ?????? ?????? ?????????????? ?????? ??????? ???????? ?????????? ??????????????? ????????????? ?????????? : ??????????????? ????????????? ?????????? ????????? ??????????? ???? ???????? ????????? ????????? ???????? ??? ?????? ??????????? ?????? ???????? : ??????????? ?????? ???????? ??????? ???????? ?????????? ???????? ??????? ???????????? ????????? : ??????? ???????????? ????????? ??????? ??????? ??????, ??? ??????? ???????????? ????????? ??????????? ?????. ?????? ?? ????. ?????? ?? ???????? ????????? ? ??????? ?????? ???????? : ????????? ? ??????? ?????? ???????? ??. ???????, ??????? ???? ???????? ?????????? ?????? ?????????????? ?? ??????????? ?? ???? ?????????, % ????????? ? ??????? ?????? ???????? : ????????? ? ??????? ?????? ???????? ????????? ? ???????? ????? : ????????? ? ???????? ????? ??????? ???? ????????? ???? ?????????? ??????????? ????????? ?????????? : ?????????? ??????????? ????????? ?????????? ???? ????? ???????? ???? ????????????? ???????????????? : ???????????????? Saari SM et al. Chest 1998; 113:1573-79 0 1 ??? 2 ???? 4 ???? 24 ???? ???????? ???????? : ???????? ???????? ?????????? ???????????? ???????? ??????? ?????????? ?????????? ????????????? ?????????? : ????????????? ?????????? OMRON (??????) PARI (????????) ????????????? ?????? : ????????????? ?????? ?????? ??? ????????? ?? ??????????? ?????? ????????? ????????. ?????? ??????????? ??????? 15-30 ??? ??????? 2-5 ??? ?????????? ?????????? : ?????????? ?????????? Omron NE-U14 ???????? ???????? : ???????? ???????? ?????????? ???????????? ???????? ??????? ?????????? ?????????? ?????????? ?????????? : ?????????? ?????????? ??????????? ????????? ???????? ??????? ???????? 30 ?/? ????????? ????????? ? ??????????? : ????????? ????????? ? ??????????? ??????????? ?????????? ???? : ??????????? ?????????? ???? ??????????, ???????????? ?????? : ??????????, ???????????? ?????? ?????????? ???????? : ?????????? ???????? ??????????? : ??????????? HFA – ??????????????? ??????? ?????? ???????? ?????? CFC – ??????????????? (?????) Slide 82: ??????????? HFA – ?????????????? ??. Ø 1,1 ??? CFC – ??????????????? (?????) ??. Ø 3,5 ??? ??????????? : ??????????? Slide 84: Leach CL et al. Eur Respir J 1998; 12(6): 1346-53 HFA – ?????????????? ??. Ø 1,1 ??? CFC – ??????????????? ??. Ø 3,5 ??? ???????? ?????????????? : ???????? ?????????????? Crim C et. al. Clin Ther 2001;23:1339–1354. Mackie AE et. al. Clin Pharmacokinet 2000;39:17–22. Mackie A et. al. Clin Pharmacokinet 2000;39:23–30. Daley-Yates P et. al. Br J Clin Pharmacol 2001;51:400–409. Thorsson L et. al. Rhinology 1993;31:7–10. Brutsche MH et. al. Lancet 2000;356:556–561. Rohatagi S et. al. J Clin Pharmacol 2003;43:1–11. ?????????? BDP : ?????????? BDP Br J Clin Pharmacol. 2001 May; 51(5): 400–409. RRA ????????????? = 100 BDP F=2% (?????? ??????) BMP ? 25 ??? ???????? BMP F=62% (???- 26% , ?????? – 36%) ???????????? F=33% (???- 13% , ?????? – 20%) ???????????? BDP ? ?????? ??? ????????????? ??????????? ?????? ????? : ???????????? BDP ? ?????? ??? ????????????? ??????????? ?????? ????? Chet Leach, www.fda.gov ?????? vs ????????? : ?????? vs ????????? Papi A et al. Eur Respir J 2007; 29:682-689 ???, ???. ?/??? ???. ?????? BDP/F 100/6 ??? * 2 ???? ????????? BUD/F 200/6 ??? * 2 ???? ? <0.001 ????????? ????? ? ??? ?? ???? (1200 ???): ???????????? ????????? ? ????? : ????????? ????? ? ??? ?? ???? (1200 ???): ???????????? ????????? ? ????? Thorax 2000;55:345 ????????? ?? ?????? HFC ?? ?????????? ????? : ????????? ?? ?????? HFC ?? ?????????? ????? ???????? ???????? : ???????? ???????? ?????????? ???????????? ???????? ??????? ?????????? ?????????? ?????? ????????? : ?????? ????????? ???????? ???? : ???????? ???? % ?? ??????????? ???? ? ???? ??????????? ??????? ??????? ? ??????????????? ????????? ???????? ???????? : ???????? ???????? ?????????? ???????????? ???????? ??????? ?????????? ?????????? ?????????? ??????? ???????? : ?????????? ??????? ???????? Aerolizer Novartis ?????????? ??????? ???????? : ?????????? ??????? ???????? Handihaler Boehringer Ingelheim ?????????? ??????? ???????? : ?????????? ??????? ???????? Diskus GSK ?????????? : ?????????? ????????? ??? ???????? ????????? (1) ??????????? ????? ?????????? ??????????? (2) ?????? ??? ?????? ????????? (3) ? ???? ??????????? ??????? ?? ???? ?????????? ??????? (4) ??????? ??? (5) ??????????? ???????????? ??????? ? ?????????? ??????? ???????? ????????? ?????????? : ??????????? ???????????? ??????? ? ?????????? ??????? ???????? ????????? ?????????? ???????????? : ???????????? ???????? ???????? ??????????? : ??????????? You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
Органы дыхания и средства доставки Arkhipov Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 138 Category: Entertainment License: All Rights Reserved Like it (0) Dislike it (0) Added: June 15, 2009 This Presentation is Public Favorites: 0 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript ???????? ? ?????????? ??????? ??????? : ???????? ? ?????????? ??????? ??????? 15.06.2009 ???????? ? ?????????? ??????? ??????? : ???????? ? ?????????? ??????? ??????? ???????? ? ?????????? ?????? ?????? ?????????????? ?????? ??????? ???????? ?????????? ???????? ?????? : ???????? ?????? ????? ?????? ? 2 ???? ?????? ?????? ??????? ?????? : ????? ?????? ? 2 ???? ?????? ?????? ??????? ?????? ?????? 2 ????? 4 ????? 3 ????? ??????? ?????? ?????? ????????????? ???????? ???????????? ?????? : ???????????? ?????? ????? ?????? ???????????? 40 ?????? ?????? : ????? ?????? ???????????? 40 ?????? ?????? ????????? ???????? : ????????? ???????? ?????????????? ??????? : ?????????????? ??????? ???????? 1.5 ??. ? ??????. ?????? ????? ???? ????????? «???????» ?? ????????? ?? 6 ?????. ?????, ??????????? ??? ?????? ????????? ???? ???? ????????? ? ??????????? ??????????? ?????: ????????? – 6 ??? ??? – 5 ????? ? ????? ?????????? – 8 ????? ? ????? J Appl Physiol.1985; 58: 1157-1163 Högger and Rohdewald, Rev Contemp Pharm 1998 ????????????? ?????? ?????? : ????????????? ?????? ?????? ?????????? : ?????????? ?????????????? ?????????????? ???????? II ???? ??????? ?? ?????? ? ???????????? ??????? ????????????? ?????????: ??????? ?? ?????? - ??? ????? ??????? ??????? (???????????? ????????) ? ?????? ???????? ???????, ??? ? ??????? (???????????? ??????????? ??????? ? ??????? ????????) ??????????? ???????????-??????????? ???????? : ??????????? ???????????-??????????? ???????? ?????????????? ???????? : ?????????????? ???????? ????? ???????? ????? ?????????? ????? 1,6% ?? ?????? ?????? ????????????? ????. ????????????? ?????????????? ? ?????? ? 16-17 ??? ??????, ??? ?????????????? ???????? ? 2,5 ???? ?????? ????? ?????????? ?????? ? ??????? ?????? : ?????????? ?????? ? ??????? ?????? ????????? : ????????? ??????? ?????? r1 ????????? ??????? ?????? ????????? r2 ????????? – ???????????? ???? ?????????? ??? ?????????? ?? 130% ?? ?????? ????? ??????? ????????? ? ??????? : ??????? ????????? ? ??????? ???? ????????? ??????????? ?????????????? ??????? ???????????? ?????? : ???????????? ?????? ????? ?? ????????, % ??????? ????????????? ????? : ??????? ????????????? ????? ????? ??????? ????????????? ????? : ????? ??????? ????????????? ????? ?????????? ?????? ????????: : ?????????? ?????? ????????: ???? ?????????? ?? ????????? ?????????, ???????????? ? ??????? ?????????? 5-? ????????? ?????????? ????????????? ???? ??????? ????????? ??????? ??????????? ???? ???????? ?????????? ?????? ? ?????????? ???????? ??????? – ??????????? ????? ???? : ????? ???? ??? V- ???????? ????????, P – ???????? ????????, R – ????????????? ??? ? – ???????? ????, I – ?????? ??????, r - ?????? ????????????? ??????????? ????? : ????????????? ??????????? ????? ????????????? ? ??????? ? ??????????? ?? ????????? : ????????????? ? ??????? ? ??????????? ?? ????????? ????????????? ???????????? ?????? : ????????????? ???????????? ?????? ????????????? ?????????? ?????? : ????????????? ?????????? ?????? ????????? ?????? ??????? : ????????? ?????? ??????? ????????? ????????????????:(1) ??????????? : ????????? ????????????????:(1) ??????????? ????????? ????????????????:(2) ???? ????????????? ???? : ????????? ????????????????:(2) ???? ????????????? ???? ????????? ????????????????:(3) ???????? ??????? ? ??????????? ???????? : ????????? ????????????????:(3) ???????? ??????? ? ??????????? ???????? ??????????? ?????????? ?????? ??? ???????? ? ???? : ??????????? ?????????? ?????? ??? ???????? ? ???? ???????????? ?????????? ??????????? ????? : ???????????? ?????????? ??????????? ????? ??????????????? ????????? ? ??????? ???? : ??????????????? ????????? ? ??????? ???? ????? ???? ????? ???????????? ?????? ???? ????. ????????? ??????? ??????? ???? ??????? ????????? ?????? ???????????? ???????? ? ?????????? ??????? ??????? : ???????? ? ?????????? ??????? ??????? ???????? ? ?????????? ?????? ?????? ?????????????? ?????? ??????? ???????? ?????????? ???????????????? ????? ? 158 ??????????? ????????????? ?? : ???????????????? ????? ? 158 ??????????? ????????????? ?? ATS/ERS Task Force Asthma Control, 2005 ???????? ?????? : ???????? ?????? ?????????????????? : ?????????????????? ?????????????? : ?????????????? ?????? ????? - ????? : ?????? ????? - ????? ????????????? ????????????? ????? ? ??????? 25%-75% ?? ???? : ????????????? ????????????? ????? ? ??????? 25%-75% ?? ???? ????????????? : ????????????? 590,00 EUR ????????????? : ????????????? Reddel et al. Lancet 1999;353:364-369 ???? ?? ??????????? ???????????????? : ???? ?? ??????????? ???????????????? postFEV1 - preFEV1 preFEV1 ???????? ???????????: ?? FEV1: >12 % ? >200 ?? ?? PEF: > 60 ?/??? Quanjer et al. ERJ 1993;6(suppl.16):5-40 ?100% ???????????????????? ???? : ???????????????????? ???? % ??????? ???1 ???????????? ??????????, ??/?? ???????? PC20 ?? ???? ??????? ???? : ???????? PC20 ?? ???? ??????? ???? Booms et al., JACI 1997;99:330-337 ????????? ??????? ????????? PC20 ?????? 2.0 1.5 1.0 0.5 0.0 -0.5 ?????? ??????? -1 0 4 8 12 13 14 Medical Research Council Dyspnea Scale : Medical Research Council Dyspnea Scale Brooks 1982 Borg CR 10 Scale (Dyspnea Assessment) : Borg CR 10 Scale (Dyspnea Assessment) Borg,G., Med Sci Sports Exerc 1982; 14:377-81 ???????????? ?????? ?????, ????? ??????? ????? ??????? ??????? ????????? ????????? ?????? ????? ?????? ??? ????????? ACQ (?? ??????? ??????? ??????????? ?? 0 ?? 6-?? ??????) : ????????? ACQ (?? ??????? ??????? ??????????? ?? 0 ?? 6-?? ??????) ??? ????? ?? ??????????? ??-?? ???????????? ????? ????? ? ??????? ?? ????????? ??????? ????????? ? ??? ???? ???????? ???????? ???????????? ????? ????? ? ?????? ??????????, ? ??????? ?? ????????? ??????? ????????? ???? ?????????? ???? ???????????? ??-?? ???????????? ????? ? ????? ?? ????????? ??????? ????????? ??????? ?????? ?? ?????????? ??-?? ???????????? ????? ? ????? ?? ????????? ??????? ? ??????? ?????? ???????, ? ????? ?? ????????? ??????, ?? ?????????? ????????? ???????? ???????, ? ??????? ?? ????????? ??????, ????????? ?????? ?????? ?????????????????? ???????? ????????? ????????? ???????? ???1 ? % ?? ???????? ?? ?????? ?????????? ??????. Juniper EF, Svensson K, Mork AC, Stahl E. Respir Med 2005;99: 553–8. ????????? SMART vs ??????? : ????????? SMART vs ??????? COSMOS Trial ACQ5 ????? (0–6) 1.0 1.2 1.4 1.6 1.8 2.0 0 4 12 26 52 p=0.07 SMART ??????? ???. The St Georges respiratory questionnaire (SGRQ) : The St Georges respiratory questionnaire (SGRQ) ??? ?????? ?? 7 ????????? ??????????? ??????? ?????????????? ???????????? ??? ?????? ???????? ????? Jones PW, Quirk FH, Baveystock CM (1991) The St Georges respiratory questionnaire Respiratory Medicine 85 (supplement B) 25-31 ?????????, ??????? ? ?? ??????????: ??????? ?? ???????? ????? : ?????????, ??????? ? ?? ??????????: ??????? ?? ???????? ????? ???? ? 6-?? ???????? ??????? (6MWT) ? ????????? ?????????? ? ??????? ???? : ???? ? 6-?? ???????? ??????? (6MWT) ? ????????? ?????????? ? ??????? ???? V.M. Pinto-Plata et al. Eur Respir J 2004; 23: 28–33. ?=0,003 ??????????, % ?????? ????? ???? (BMI) : ?????? ????? ???? (BMI) ???: m — ????? ???? ? ??????????? h — ???? ? ?????? (? ?????????? ? ??/?2). Slide 55: FEV1 < 35% PT # 1 58 y FEV1: 28 % MRC: 2/4 PaO2: 70 mmHg 6MWD: 540 mt BMI: 30 BODE: 3 1 2 3 4 PT # 2 62 y FEV1: 33% MRC: 2/4 PaO2: 57 mmHg 6MWD: 400 m BMI: 21 BODE: 6 PT # 3 69 y FEV1: 35% MRC: 3/4 PaO2: 66 mmHg 6MWD: 230 m BMI: 34 BODE: 7 PT # 4 72 y FEV1: 34% MRC: 4/4 PaO2: 60 mmHg 6MWD: 154 m BMI: 24 BODE: 9 ?????? ????? ???? (BMI) ? ???????????? ??????? ???? : ?????? ????? ???? (BMI) ? ???????????? ??????? ???? Chailleux E et al. CHEST 2003; 123:1460–1466 ???? ???????????? ???????????? NO : NO NO : NO Ricciardolo et al. Thorax 2003 De Gouw et al. Eur Respir J 1998 ??????? ? ?????????? ???????? ???????? ?????? : ?????? ??????? IgE : ??????? IgE Burrows B, et al. N Engl J Med 1989 ??????? IgE ? ?????? (??/??)* n=2,657 0.32 1 3.2 10 32 100 320 1,000 3,200 1.0 2.5 5.0 10 20 40 ????? (??????? ?????????????) Log ???????????????? ????? : ???????????????? ????? ???????? ? ?????????? ??????? ??????? : ???????? ? ?????????? ??????? ??????? ???????? ? ?????????? ?????? ?????? ?????????????? ?????? ??????? ???????? ?????????? ??????????????? ????????????? ?????????? : ??????????????? ????????????? ?????????? ????????? ??????????? ???? ???????? ????????? ????????? ???????? ??? ?????? ??????????? ?????? ???????? : ??????????? ?????? ???????? ??????? ???????? ?????????? ???????? ??????? ???????????? ????????? : ??????? ???????????? ????????? ??????? ??????? ??????, ??? ??????? ???????????? ????????? ??????????? ?????. ?????? ?? ????. ?????? ?? ???????? ????????? ? ??????? ?????? ???????? : ????????? ? ??????? ?????? ???????? ??. ???????, ??????? ???? ???????? ?????????? ?????? ?????????????? ?? ??????????? ?? ???? ?????????, % ????????? ? ??????? ?????? ???????? : ????????? ? ??????? ?????? ???????? ????????? ? ???????? ????? : ????????? ? ???????? ????? ??????? ???? ????????? ???? ?????????? ??????????? ????????? ?????????? : ?????????? ??????????? ????????? ?????????? ???? ????? ???????? ???? ????????????? ???????????????? : ???????????????? Saari SM et al. Chest 1998; 113:1573-79 0 1 ??? 2 ???? 4 ???? 24 ???? ???????? ???????? : ???????? ???????? ?????????? ???????????? ???????? ??????? ?????????? ?????????? ????????????? ?????????? : ????????????? ?????????? OMRON (??????) PARI (????????) ????????????? ?????? : ????????????? ?????? ?????? ??? ????????? ?? ??????????? ?????? ????????? ????????. ?????? ??????????? ??????? 15-30 ??? ??????? 2-5 ??? ?????????? ?????????? : ?????????? ?????????? Omron NE-U14 ???????? ???????? : ???????? ???????? ?????????? ???????????? ???????? ??????? ?????????? ?????????? ?????????? ?????????? : ?????????? ?????????? ??????????? ????????? ???????? ??????? ???????? 30 ?/? ????????? ????????? ? ??????????? : ????????? ????????? ? ??????????? ??????????? ?????????? ???? : ??????????? ?????????? ???? ??????????, ???????????? ?????? : ??????????, ???????????? ?????? ?????????? ???????? : ?????????? ???????? ??????????? : ??????????? HFA – ??????????????? ??????? ?????? ???????? ?????? CFC – ??????????????? (?????) Slide 82: ??????????? HFA – ?????????????? ??. Ø 1,1 ??? CFC – ??????????????? (?????) ??. Ø 3,5 ??? ??????????? : ??????????? Slide 84: Leach CL et al. Eur Respir J 1998; 12(6): 1346-53 HFA – ?????????????? ??. Ø 1,1 ??? CFC – ??????????????? ??. Ø 3,5 ??? ???????? ?????????????? : ???????? ?????????????? Crim C et. al. Clin Ther 2001;23:1339–1354. Mackie AE et. al. Clin Pharmacokinet 2000;39:17–22. Mackie A et. al. Clin Pharmacokinet 2000;39:23–30. Daley-Yates P et. al. Br J Clin Pharmacol 2001;51:400–409. Thorsson L et. al. Rhinology 1993;31:7–10. Brutsche MH et. al. Lancet 2000;356:556–561. Rohatagi S et. al. J Clin Pharmacol 2003;43:1–11. ?????????? BDP : ?????????? BDP Br J Clin Pharmacol. 2001 May; 51(5): 400–409. RRA ????????????? = 100 BDP F=2% (?????? ??????) BMP ? 25 ??? ???????? BMP F=62% (???- 26% , ?????? – 36%) ???????????? F=33% (???- 13% , ?????? – 20%) ???????????? BDP ? ?????? ??? ????????????? ??????????? ?????? ????? : ???????????? BDP ? ?????? ??? ????????????? ??????????? ?????? ????? Chet Leach, www.fda.gov ?????? vs ????????? : ?????? vs ????????? Papi A et al. Eur Respir J 2007; 29:682-689 ???, ???. ?/??? ???. ?????? BDP/F 100/6 ??? * 2 ???? ????????? BUD/F 200/6 ??? * 2 ???? ? <0.001 ????????? ????? ? ??? ?? ???? (1200 ???): ???????????? ????????? ? ????? : ????????? ????? ? ??? ?? ???? (1200 ???): ???????????? ????????? ? ????? Thorax 2000;55:345 ????????? ?? ?????? HFC ?? ?????????? ????? : ????????? ?? ?????? HFC ?? ?????????? ????? ???????? ???????? : ???????? ???????? ?????????? ???????????? ???????? ??????? ?????????? ?????????? ?????? ????????? : ?????? ????????? ???????? ???? : ???????? ???? % ?? ??????????? ???? ? ???? ??????????? ??????? ??????? ? ??????????????? ????????? ???????? ???????? : ???????? ???????? ?????????? ???????????? ???????? ??????? ?????????? ?????????? ?????????? ??????? ???????? : ?????????? ??????? ???????? Aerolizer Novartis ?????????? ??????? ???????? : ?????????? ??????? ???????? Handihaler Boehringer Ingelheim ?????????? ??????? ???????? : ?????????? ??????? ???????? Diskus GSK ?????????? : ?????????? ????????? ??? ???????? ????????? (1) ??????????? ????? ?????????? ??????????? (2) ?????? ??? ?????? ????????? (3) ? ???? ??????????? ??????? ?? ???? ?????????? ??????? (4) ??????? ??? (5) ??????????? ???????????? ??????? ? ?????????? ??????? ???????? ????????? ?????????? : ??????????? ???????????? ??????? ? ?????????? ??????? ???????? ????????? ?????????? ???????????? : ???????????? ???????? ???????? ??????????? : ???????????