哮喘联盟

   摘要
   背景：少数哮喘患者尽管已经接受了强化治疗，其哮喘病情仍未控制或部分控制。由于需要广泛的诊断性评估、缺乏关于个体化治疗的证据以及医疗资源的高消耗，这些患者存在特殊的挑战。
   方法：重度哮喘的定义、诊断和治疗，是基于选出的文献综述和作者的临床经验而提出的。
   结果：重度哮喘被定义为当给予高剂量吸入糖皮质激素和额外的控制药物（如长效吸入 β2 受体激动剂、孟鲁司特，和/或茶碱）治疗，或使用口服糖皮质激素（每年至少6个月）哮喘仍未充分控制；或减少药物治疗后哮喘无法充分控制。在任何进一步的治疗被评估前，应先进行鉴别诊断，治疗合并症、避免持续的接触触发物，并提高患者依从性。此外，为长期稳定哮喘病情和减少误工/误学推荐肺康复。也可使用其他药物包括噻托溴铵，奥马珠单抗（适用于IgE介导的哮喘），以及阿奇霉素（适用于非嗜酸细胞性哮喘）。白介素-5 或其受体抗体，将很快被批准用于治疗重度嗜酸细胞性哮喘。
   结论：重度哮喘的诊断和治疗是耗时的，并需要专业的经验。仍需要专业的治疗中心，继续医学教育以及重度哮喘患病率的研究。
 

（林江涛 审校）
Dtsch Arztebl Int. 2014 Dec 12;111(50):847-55. doi: 10.3238/arztebl.2014.0847.

 

Severe asthma: definition, diagnosis and treatment.
 

Lommatzsch M1, Virchow CJ.
 

Abstract
BACKGROUND: A minority of patients with asthma have uncontrolled or partially controlled asthma despite intensive treatment. These patients present a special challenge because of the extensive diagnostic evaluation that they need, insufficient evidence regarding personalized treatments, and their high consumption of health-care resources.
METHODS: The definition, diagnosis, and treatment of severe asthma are presented on the basis of a selective literature review and the authors' clinical experience.
RESULTS: Severe asthma is present, by definition, when adequate control of asthma cannot be achieved by high-dose treatment with inhaled cortico steroids and additional controllers (long-acting inhaled beta 2 agonists, montelukast, and/or theophylline) or by oral corticosteroid treatment (for at least six months per year), or is lost when the treatment is reduced. Before any further treatments are evaluated, differential diagnoses of asthma should be ruled out, comorbidities should be treated, persistent triggers should be eliminated, and patient adherence should be optimized. Moreover, pulmonary rehabilitation is recommended in order to stabilize asthma over the long term and reduce absences from school or work. The additional drugs that can be used include tiotropium, omalizumab (for IgE-mediated asthma), and azithromycin (for non-eosinophilic asthma). Antibodies against interleukin-5 or its receptor will probably be approved soon for the treatment of severe eosinophilic asthma.
CONCLUSION: The diagnosis and treatment of severe asthma is time consuming and requires special experience. There is a need for competent treatment centers, continuing medical education, and research on the prevalence of severe asthma.
 

Dtsch Arztebl Int. 2014 Dec 12;111(50):847-55. doi: 10.3238/arztebl.2014.0847.