1、感冒-不仅仅是上呼吸道感染,2,Definition,The common cold (acute viral rhinopharyngitis, , acute coryza, viral upper respiratory tract infection, or a cold) is a contagious, viral infectious disease of the upper respiratory system, primarily caused by rhinoviruses, (picornaviruses小核糖核酸病毒 ) or coronaviruses. It is
2、the most common infectious disease in humans；there is no known cure, but it is very rarely fatal.,3,Definition,Collectively, colds, influenza, and other infections with similar symptoms are included in the diagnosis of influenza-like illness.Often, influenza and the common cold are mistaken for each
3、 other, even by professional healthcare workers, but most of the recommended home treatments (drinking plenty of warm fluids, keeping warm, etc.) are similar if not the same.The symptoms of influenza often include a fever and are more severe than the cold.,4,SYMPTOM,cough, sore throat, runny nose, n
4、asal congestion, and sneezing; sometimes accompanied by pink eye, muscle aches, fatigue, malaise, headaches, muscle weakness, uncontrollable shivering, loss of appetite, and rarely extreme exhaustion. Fever is more commonly a symptom of influenza, another viral upper respiratory tract infection (URT
5、I) whose symptoms broadly overlap with the cold, but are more severe. Symptoms may be more severe in infants and young children (due to their immune system not being fully developed) as well as the elderly (due to their immune system often being weakened).,5,SYMPTOM,A sensation of chilliness even th
6、ough the cold is not generally accompanied by fever, and although chills are generally associated with fever, the sensation may not always be caused by actual fever. In one study, 60% of those suffering from a sore throat and upper respiratory tract infection reported headaches, often due to nasal c
7、ongestion. The symptoms of a cold usually resolve after about one week; however, it is not rare that symptoms last up to three weeks.,6,What is the Difference Between Influenza and the Common Cold?,7,complications,opportunistic coinfections or superinfections such as acute bronchitis, bronchiolitis,
8、 croup, pneumonia, sinusitis, otitis media, or strep throat.（脓毒性咽喉炎） People with chronic lung diseases such as asthma and COPD are especially vulnerable. Colds may cause acute exacerbations of asthma, emphysema or chronic bronchitis,8,Cause and susceptibility,one of the 99 known serotypes of rhinovi
9、rus, a type of picornavirus. Around 30-50% of colds are caused by rhinoviruses. Other viruses causing colds are coronavirus (causing 10-15%), human parainfluenza viruses, human respiratory syncytial virus, adenoviruses, enteroviruses, or metapneumovirus. 5-15% are caused by influenza viruses. In tot
10、al over 200 serologically different viral types cause colds. Coronaviruses are particularly implicated in adult colds. Due to the many different types of viruses and their tendency for continuous mutation, it is impossible to gain complete immunity to the common cold.,9,Cause and susceptibility,Slee
11、p Lack of sleep has been associated with the common cold. Those who sleep fewer than 7 hours per night were three times more likely to develop an infection when exposed to a rhinovirus when compared to those who sleep more than 8 hours per night.Vitamin D A 2009 study found that low blood serum leve
12、ls of vitamin D were associated with increased rates of the common cold. A randomized controlled trial found that 104 post-menopausal African American women living in New York given vitamin D were three times less likely to report cold and flu symptoms than 104 placebo controls. A low dose (800 IU/d
13、ay) not only reduced reported incidence, it abolished the seasonality of reported colds and flu. A higher dose (2000 IU/day), given during the last year of the trial, virtually eradicated all reports of colds or flu.,10,Cause and susceptibility,Exposure to cold weather prolonged exposure to cold wea
14、ther such as rain or winter conditions Cold No evidence that short-term exposure to cold weather or direct chilling increases susceptibility to infection, implying that the seasonal variation is instead due to a change in behaviors such as increased time spent indoors at close proximity to others te
15、st the hypothesis that acute cooling of the feet causes the onset of common cold symptoms. Constriction of blood vessels of the nasal passages which might lead to reduced immunity Decreased temperature may result in a drop in tissue permeability and, as a result, may lead to reduced plasma leakage.
16、-complement proteins,11,Pathophysiology,saliva or nasal secretions of an infected person; in aerosol form generated by coughing and sneezing; or from contaminated surfaces.,12,Pathophysiology,Major entry point for the virus is normally the nose, - back of the nose and the adenoid area. The virus the
17、n attaches to a receptor, ICAM-1, which is located on the surface of cells of the lining of the nasopharynx. The receptor fits into a docking port on the surface of the virus. Large amounts of virus receptor are present on cells of the adenoid.,13,Pathophysiology,Rhinovirus colds do not generally ca
18、use damage to the nasal epithelium.Macrophages trigger the production of cytokines, which in combination with mediators cause the symptoms.Cytokines cause the systemic effects. The mediator bradykinin(缓激肽） plays a major role in causing the local symptoms such as sore throat and nasal irritation,14,P
19、athophysiology,The common cold is self-limiting, and the hosts immune system effectively deals with the infection. Within a few days, the bodys humoral immune response begins producing specific antibodies that can prevent the virus from infecting cells. Additionally, as part of the cell-mediated imm
20、une response, leukocytes destroy the virus through phagocytosis and destroy infected cells to prevent further viral replication. In healthy, immunocompetent individuals, the common cold resolves in seven days on average,15,Incubation period and progression of disease,The upper respiratory viral repl
21、ication cycle begins 8 to 12 hours after initial infection. Symptoms usually begin 2 to 5 days after initial infection but occasionally occur in as little as 10 hours after. Symptoms peak 23 days after symptom onset, whereas influenza symptom onset is constant and immediate.The symptoms usually reso
22、lve spontaneously in 7 to 10 days but some can last for up to three weeks,16,Prevention,The best way to avoid a cold is to wash hands thoroughly and regularly; and to avoid touching the eyes, nose, mouth, and face. Anti-bacterial soaps have no extraordinary effect on the cold virus; it is the mechan
23、ical action of hand washing with the soap that removes the virus particles. Rhinoviruses can live up to 3 hours outside the body on the skin or objects.In 2002, the Centers for Disease Control and Prevention recommended alcohol-based hand gels as an effective method for reducing infectious viruses o
24、n the hands of health care workers. The common cold is caused by a large variety of viruses, which mutate quite frequently during reproduction, resulting in constantly changing virus strains. Thus, successful immunization is highly improbable.,17,Lung disease and Influenza,Get vaccinated for both se
25、asonal flu and H1N1 flu 接种疫苗，包括季节性流感和H1N1流感Cover your nose and mouth with your arm when you cough or sneeze 打喷嚏时用胳膊挡住口鼻Wash your hands frequently with soap and water勤洗手 Alcohol-based hand cleaners are also effective when washing isnt possible酒精消毒 Avoid touching your eyes, nose or mouth避免接触眼睛及口鼻 Try
26、to avoid close contact with sick people避免与患病者近距离接触 Avoid large crowds不去人群密集处Ask family and friends to be mindful of your higher risk and not expose you to their sickness if they are ill 避免和高危人群接触Stay home if you are sick: 患病后勿外出For 7 days after symptoms begin; or 症状出现后7天或症状消失后24消失内Until clear of sym
27、ptoms for 24 hours Watch for public health advisories, as these recommendations may change健康咨询 For those with asthma, please remember to refer to and maintain your Asthma Action Plan as necessary.哮喘患者必要时仍需行哮喘治疗,18,Treatment,Conservative managementThe National Institute of Allergy and Infectious Dise
28、ases suggests getting plenty of rest, drinking fluids to maintain hydration, gargling with warm salt water, using cough drops, throat sprays, or over-the-counter pain or cold medicines. Saline nasal drops may help alleviate congestion.Treatments that may help alleviate symptoms include analgesics, d
29、econgestants, and cough suppressants, first-generation antihistamines such as brompheniramine, chlorpheniramine, diphenhydramine and clemastine (which reduce mucus gland secretion and thus combat blocked/runny noses but also may make the user drowsy). Second-generation antihistamines do not have a u
30、seful effect on colds.,19,Treatment,Conservative managementVitamin C in normal or mega doses has not been shown to be beneficial in a normal population for the prevention or treatment of the common cold. It however might be beneficial in people exposed to periods of severe physical exercise or cold
31、environments.Various cold medicines exist however little evidence suggest they are any more effective than simple analgesics. They include antitussives, antihistamines and decongestants usually in combination with an analgesic. They are not recommended for use in children because evidence does not s
32、upport their effectiveness and there are concerns of harm.,20,Treatment,Antibiotics Antibiotics only target bacteria and thus do not have any beneficial effect against the common cold.Antivirals There are no approved antiviral drugs for the common cold.Nasal steroid still in trialAlternative treatme
33、nts alternative treatments which similarly lack solid scientific evidence include calendula, ginger, garlic and vitamin C supplements.,21,惠菲宁的主要成分及药理作用,马来酸氯苯那敏（扑尔敏）（A）：抑制腺体分泌，减少鼻液后流对咽喉部的刺激以及抗胆碱能活性盐酸伪麻黄碱（D）：选择性地收缩血管，减轻水肿、充血对呼吸道的影响氢溴酸右美沙芬：通过抑制咳嗽中枢，有效控制咳嗽,22,右美沙芬无成瘾性和呼吸抑制，临床应用更放心,中华医学会呼吸病学分会哮喘学组. 中华结核与
34、呼吸杂志, 2005,28(11):738-44.周敏, 等. 中国新药与临床杂志, 2005,24(9):693-6.,抑制呼吸中枢、成瘾性,无呼吸中枢抑制作用、无成瘾性,中枢性非依赖性镇咳药,中枢性依赖性镇咳药,右美沙芬,可待因,作用于N-甲基-D-天冬氨酸受体和Sigma受体，具有中枢和外周镇咳作用,作用于阿片受体，中枢镇咳作用,镇咳作用强,相当或略强,分类,作用机理,疗效,安全性,23,美敏伪麻溶液：不良反应少，临床应用更放心,长期使用甘草可出现水肿、高血压、低血钾等副作用,24,中医中药,感冒的发生主要由于体虚，抗病能力减弱，当气候剧变时，人体内外功能不能适应，邪气乘虚由皮毛、口鼻而
35、入，引起一系列肺卫症状。 中医将感冒分为风寒型感冒、风热型感冒、暑湿型感冒和时行感冒（流行性感冒）四种类型。根据辨证施治的原则，不同类型的感冒应选用不同的中成药治疗。中成药含有西药成分,25,感冒-不仅仅是上呼吸道感染,Common ColdInfluenza,Complications,Cold like symptomsFatal Diseases,26,Complications dealing ENT,Acute Otitis MediaAcute RhinosinusitisAcute TonsillitisAcute LaryngitisAcute Epiglottitis,27,
36、感冒治疗的几个误区,乱吃抗生素硬扛着不看医生随便乱输液,28,慎用抗生素,英国的著名的健康和临床医疗研究所(National Institute for Health nd Clinical Excellence)就向大众指出：消炎药在很多情况下都是没有必要的，有时它们不但不能有效控制感染，反而容易导致带有超强抗药性的金黄色葡萄球菌等超级病菌的蔓延。 英国还出台了相关的行医规定：英国医生不得向患有耳部感染、咽喉肿痛、扁桃腺炎、支气管炎、感冒、咳嗽等轻微病症患者开抗生素。因此，医生不得不打发他们回家休息，最多给他们服用一些止痛片。,29,与几种疾病的鉴别,感冒与过敏性鼻炎感冒与百日咳 (百日咳杆菌）感冒与猩红热（乙型溶血性链球菌）感冒与脊髓灰质炎 （脊髓灰质炎病毒）,30,H1N1甲型流感,31,Thanks for your Concern,
