哮喘
2018/01/05
摘要
哮喘，作为儿童和成人最常见的慢性非传染性疾病，表现为呼吸道症状及气流受限的变异性。哮喘是基因-环境相互作用的综合结果，临床表现、气道炎症类型和强度以及气道重塑具有异质性。哮喘的治疗目标在于获得哮喘良好控制：例如最大程度减轻症状和降低急性加重风险。抗炎和支气管扩张剂治疗是哮喘基础治疗，逐阶应用。根据症状控制、危险因素，合并症以及药物副作用以及患者主观评价共同决定药物治疗策略。重症哮喘定义为需要高强度治疗可以或依然无法达到哮喘控制的目标。针对重症哮喘的新型药物联合生物标志物为表型特异性治疗和个体化治疗的实施提供了可能性。在本文中，作者提供了哮喘相关的临床聚焦，包括流行病学、病理生理学、临床诊断，哮喘表型，重症哮喘，急性加重和承认以及大于5岁儿童的治疗措施。新生的治疗，争论以及治疗不确定性也有所讨论。
Asthma.
Lancet.2017Dec19.pii:S0140-6736(17)33311-1.doi:.1016/S0140-6736(17)33311-1. [Epub ahead of print]
Papi A, Brightling C, Pedersen SE, Reddel HK.
Abstract
Asthma-one of the most common chronic, non-communicable diseases in children and adults-is characterised by variable respiratory symptoms and variable airflow limitation. Asthma is a consequence of complex gene-environment interactions, with heterogeneity in clinical presentation and the type and intensity of airway inflammation and remodelling. The goal of asthma treatment is to achieve good asthma control-ie, to minimise symptom burden and risk of exacerbations. Anti-inflammatory and bronchodilator treatments are the mainstay of asthma therapy and are used in a stepwise approach. Pharmacological treatment is based on a cycle of assessment and re-evaluation of symptom control, risk factors, comorbidities, side-effects, and patient satisfaction by means of shared decisions. Asthma is classed as severe when requiring high-intensity treatment to keep it under control, or if it remains uncontrolled despite treatment. New biological therapies for treatment of severe asthma, together with developments in biomarkers, present opportunities for phenotype-specific interventions and realisation of more personalised treatment. In this Seminar, we provide a clinically focused overview of asthma, including epidemiology, pathophysiology, clinical diagnosis, asthma phenotypes, severe asthma, acute exacerbations, and clinical management of disease in adults and children older than 5 years. Emerging therapies, controversies, and uncertainties in asthma management are also discussed.
哮喘，作为儿童和成人最常见的慢性非传染性疾病，表现为呼吸道症状及气流受限的变异性。哮喘是基因-环境相互作用的综合结果，临床表现、气道炎症类型和强度以及气道重塑具有异质性。哮喘的治疗目标在于获得哮喘良好控制：例如最大程度减轻症状和降低急性加重风险。抗炎和支气管扩张剂治疗是哮喘基础治疗，逐阶应用。根据症状控制、危险因素，合并症以及药物副作用以及患者主观评价共同决定药物治疗策略。重症哮喘定义为需要高强度治疗可以或依然无法达到哮喘控制的目标。针对重症哮喘的新型药物联合生物标志物为表型特异性治疗和个体化治疗的实施提供了可能性。在本文中，作者提供了哮喘相关的临床聚焦，包括流行病学、病理生理学、临床诊断，哮喘表型，重症哮喘，急性加重和承认以及大于5岁儿童的治疗措施。新生的治疗，争论以及治疗不确定性也有所讨论。
（上海交通大学医学院附属瑞金医院呼吸与危重症医学科 周剑平 万欢英 摘译）
（Lancet.2017Dec19.pii:S0140-6736(17)33311-1.doi:.1016/S0140-6736(17)33311-1. [Epub ahead of print]）
（Lancet.2017Dec19.pii:S0140-6736(17)33311-1.doi:.1016/S0140-6736(17)33311-1. [Epub ahead of print]）
Asthma.
Lancet.2017Dec19.pii:S0140-6736(17)33311-1.doi:.1016/S0140-6736(17)33311-1. [Epub ahead of print]
Papi A, Brightling C, Pedersen SE, Reddel HK.
Abstract
Asthma-one of the most common chronic, non-communicable diseases in children and adults-is characterised by variable respiratory symptoms and variable airflow limitation. Asthma is a consequence of complex gene-environment interactions, with heterogeneity in clinical presentation and the type and intensity of airway inflammation and remodelling. The goal of asthma treatment is to achieve good asthma control-ie, to minimise symptom burden and risk of exacerbations. Anti-inflammatory and bronchodilator treatments are the mainstay of asthma therapy and are used in a stepwise approach. Pharmacological treatment is based on a cycle of assessment and re-evaluation of symptom control, risk factors, comorbidities, side-effects, and patient satisfaction by means of shared decisions. Asthma is classed as severe when requiring high-intensity treatment to keep it under control, or if it remains uncontrolled despite treatment. New biological therapies for treatment of severe asthma, together with developments in biomarkers, present opportunities for phenotype-specific interventions and realisation of more personalised treatment. In this Seminar, we provide a clinically focused overview of asthma, including epidemiology, pathophysiology, clinical diagnosis, asthma phenotypes, severe asthma, acute exacerbations, and clinical management of disease in adults and children older than 5 years. Emerging therapies, controversies, and uncertainties in asthma management are also discussed.
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成人重度难治性哮喘
