哮喘联盟

   摘要
   目的：儿童哮喘急性发作最常见的原因是呼吸道的季节性感染。然而，其管理并没有考虑到潜在的感染或其它突发的异常。
   最新发现：环境触发因素、气道微生物与非特异性免疫反应的相互作用是哮喘急性发作的关键因素。固有细胞因子IL-33和IL-25的增加和干扰素通路中异常的分子反应与鼻病毒的感染相关。真菌过敏原引起的急性发作也可以诱导IL-33，强调了IL-33是一个具有吸引力的治疗靶点。细菌感染和病毒感染在急性发作中的作用相等，尤其是在学龄前儿童中更为显著，但是一些生物体具有防护的作用。需要对感染相关急性发作的机制进行研究，尤其是在学龄前儿童中。急性发作所导致的肺功能的进行性丧失在6-11岁的儿童中最显著，低FEV1现在被认为是慢性阻塞性肺疾病和过早死亡的一个关键预测指标。尽管预防急性发作很重要，但是次优的患者教育、维持治疗的处方和依从性及缺乏预测性生物标志仍是儿童哮喘急性发作的关键的未解决的问题。
   总结：需要综合考虑急性发作的促进因素和预测因子以及患儿的年龄和临床表型，来实现个体化的管理，而非目前的所有患者采用相同的方法。
 

（苏欣 审校）
 Curr Opin Pulm Med. 2016 Jan;22(1):25-31. doi: 10.1097/MCP.0000000000000223.

 

Pathogenesis and prevention strategies of severe asthma exacerbations in children.
 

Cook J1, Saglani S.
 

Abstract
PURPOSE OF REVIEW:Exacerbations of asthma in children are most frequently precipitated by respiratory infections with a seasonal pattern. However, management takes little account of the underlying infective or other precipitant abnormality.
RECENT FINDINGS:Interactions between environmental triggers, the airway microbiome and innate immune responses are key determinants of exacerbations. Elevated innate cytokines interleukin (IL)-33 and IL-25, and abnormal molecular responses in the interferon pathway are associated with rhinoviral infections. Exacerbations caused by fungal allergens also induce IL-33, highlighting this as an attractive therapeutic target. An equal contribution of bacterial and viral infection during exacerbations, particularly in preschool children, has become increasingly apparent, but some organisms may be protective. Investigation of mechanisms underlying infection-related exacerbations especially in preschool children is needed. Progressive loss of lung function from exacerbations is most pronounced in children aged 6-11 years, and low FEV1 is now recognized as a key predictor for the development of chronic obstructive pulmonary disease and premature death. Although prevention of exacerbations is critical, suboptimal patient education, prescription and adherence to maintenance therapy, and a lack of predictive biomarkers, remain key unaddressed issues in children.
SUMMARY:Precipitants and predictors of exacerbations, together with the child's age and clinical phenotype, need to be used to achieve individualized management in preference to the current uniform approach for all.
 

Curr Opin Pulm Med. 2016 Jan;22(1):25-31. doi: 10.1097/MCP.0000000000000223.