长期口服糖皮质激素(OCS)治疗成人重症哮喘的作用及其相关副作用
2018/11/13
摘要
本文综述了长期口服糖皮质激素(OCS)治疗成人重症哮喘的作用及其相关副作用。通过MEDLINE、EMBASE和Cochrane图书馆的系统文献检索来确定相关研究。在对重症哮喘及其治疗进行简要概述后，我们的研究表明OCS治疗哮喘呈剂量-反应关系，接着考虑了OCS依赖性哮喘患者在临床和流行病学研究中所显示对器官的不良反应。与对照组相比，长期服用OCS的患者出现各种OCS相关并发症(包括感染、糖尿病、骨质疏松症以及精神障碍)的风险更高。研究还表明OCS治疗显著提高医疗资源使用率。因此，在处方长期应用OCS之前，每位临床医生都有职责仔细权衡利弊，既要使哮喘得到良好的控制，又要避免长期服用OCS带来的副作用。必须遵循保留有益的皮质激素策略，以最低的有效剂量短期使用为目标，并尽快开始逐渐减量直至停药。
Consequences of long-term OCS therapy and its side effects in severe asthma in adults - A focused review of the impact data in the literature.
Volmer T, et al. Eur Respir J. 2018 Sep 12
Abstract
This review provides an overview of the role of long-term treatment of severe asthma with oral corticosteroids (OCS) and its associated side effects in adults. It is based on a systematic literature search conducted in MEDLINE, EMBASE, and the Cochrane Library to identify relevant studies. After a short overview of severe asthma and its treatment we present studies showing a dose-response relationship in asthmatic patients treated with OCS and then consider by organ systems the undesired effects demonstrated in clinical and epidemiological studies in patients with OCS-dependent asthma. It was found that the risk of developing various OCS-related complications, including infections, diabetes and osteoporosis as well as psychiatric disorders, was higher for patients with long-term exposure to OCS compared with control groups. Studies also showed a significant increase in health care resource utilisation due to OCS treatment. Therefore, it is incumbent on every clinician to carefully weigh the potential benefit - preventing loss of asthma control - against this risk before opting to prescribe long-term OCS therapy. Effective corticosteroid-sparing strategies must be used and one should aim at short-term use with the lowest effective dose and start tapering as soon as possible until OCS therapy is terminated.
本文综述了长期口服糖皮质激素(OCS)治疗成人重症哮喘的作用及其相关副作用。通过MEDLINE、EMBASE和Cochrane图书馆的系统文献检索来确定相关研究。在对重症哮喘及其治疗进行简要概述后，我们的研究表明OCS治疗哮喘呈剂量-反应关系，接着考虑了OCS依赖性哮喘患者在临床和流行病学研究中所显示对器官的不良反应。与对照组相比，长期服用OCS的患者出现各种OCS相关并发症(包括感染、糖尿病、骨质疏松症以及精神障碍)的风险更高。研究还表明OCS治疗显著提高医疗资源使用率。因此，在处方长期应用OCS之前，每位临床医生都有职责仔细权衡利弊，既要使哮喘得到良好的控制，又要避免长期服用OCS带来的副作用。必须遵循保留有益的皮质激素策略，以最低的有效剂量短期使用为目标，并尽快开始逐渐减量直至停药。
（复旦大学附属中山医院呼吸与危重症医学科 魏婷婷 摘译 毕晶 审校）
（Eur Respir J. 2018 Sep 12）
（Eur Respir J. 2018 Sep 12）
Consequences of long-term OCS therapy and its side effects in severe asthma in adults - A focused review of the impact data in the literature.
Volmer T, et al. Eur Respir J. 2018 Sep 12
Abstract
This review provides an overview of the role of long-term treatment of severe asthma with oral corticosteroids (OCS) and its associated side effects in adults. It is based on a systematic literature search conducted in MEDLINE, EMBASE, and the Cochrane Library to identify relevant studies. After a short overview of severe asthma and its treatment we present studies showing a dose-response relationship in asthmatic patients treated with OCS and then consider by organ systems the undesired effects demonstrated in clinical and epidemiological studies in patients with OCS-dependent asthma. It was found that the risk of developing various OCS-related complications, including infections, diabetes and osteoporosis as well as psychiatric disorders, was higher for patients with long-term exposure to OCS compared with control groups. Studies also showed a significant increase in health care resource utilisation due to OCS treatment. Therefore, it is incumbent on every clinician to carefully weigh the potential benefit - preventing loss of asthma control - against this risk before opting to prescribe long-term OCS therapy. Effective corticosteroid-sparing strategies must be used and one should aim at short-term use with the lowest effective dose and start tapering as soon as possible until OCS therapy is terminated.
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