哮喘联盟

   摘要
   儿童时期的哮喘控制仍然面临着重大的挑战，有报道称在持续性哮喘患儿中，即便进行了规律的预防治疗，也仍会有进行性的肺功能丧失。这对于观测成年时期的发病率和死亡率具有重要意义。过去十年里出现了其他的辅助治疗，例如抗IgE靶向治疗、使用低剂量茶碱和大环内酯类抗生素治疗，尽管几项国际性哮喘指南已将奥马珠单抗纳入其中，但是他们在哮喘管理中的确切作用尚不明确。正如儿科护理的许多方面一样，造成该原因的驱动因素是缺乏适当的小儿临床试验的研究设计。成人研究数据的推断可能适用于青少年哮喘，但是不适用于存在重要病理生理学差异的年幼儿童。研发中的新药虽为将来提供了潜在的获益，但是迄今为止已获得的数据在大多数情况下仅限于成年人。儿童哮喘也具有独特的潜在干预靶点来预防或改变潜在的病理生理。虽然目前为止这种尝试并未获得成功，但这些方法可能仍然有助于我们了解遗传、环境因素和病毒性疾病改善之间的相互作用的进展。本篇综述概述了用于儿童哮喘管理中可用的新治疗选择，并进一步讨论其他研发中的新治疗方法的优缺点，以为我们寻求优化管理和改善未来预后提供帮助。
 

（刘国梁 审校）
Paediatr Drugs. 2013 Jun 11. [Epub ahead of print]

 

Newer Treatments in the Management of Pediatric Asthma.
 

Robinson PD, Van Asperen P.
 

Abstract
Asthma control remains a significant challenge in the pediatric age range in which ongoing loss of lung function in children with persistent asthma has been reported, despite the use of regular preventer therapy. This has important implications for observed mortality and morbidity during adulthood. Over the past decade, there has been an emergence of other treatment adjuncts, such as anti-Immunoglobulin E (IgE)-directed therapy, low dose theophylline, and the use of macrolide antibiotics, yet their exact role in asthma management remains unclear, despite omalizumab now being incorporated into several international asthma guidelines. As with many aspects of pediatric care, this is driven by a lack of appropriately designed pediatric trials. Extrapolation of data reported in adult studies may be appropriate for adolescent asthma, but is not for younger age groups, in which important pathophysiological differences exist. Novel drugs under development offer potential for benefit in the future, but to date existing data are in most cases limited to adults. Pediatric asthma also offers unique potential to prevent or modify the underlying pathophysiology. Although attempts to do so have been unsuccessful to date, advances may yet come from this approach, as our understanding about the interaction between genetics, environmental factors, and viral illness improve. This review provides an overview of the newer treatment options available for management of pediatric asthma and discusses the merits of other novel therapies in development, as we search to optimize management and improve future outcomes.
 

Paediatr Drugs. 2013 Jun 11. [Epub ahead of print]