哮喘联盟

   摘要
   简介：几十年来激素一直被认为是哮喘治疗的金标准。本文将介绍一典型的激素抵抗性哮喘病例报告，以及当前共识对“重症难治性哮喘”，“ 难控制哮喘”和“激素抵抗性哮喘”的定义。
   方法：所引用的全文和摘要主要来自于MEDLINE(1966年到 2012年6月)的全面文献检索结果，此外也有临床对照试验中心注册数据库的检索结果。
   结果：对于哪些值得重视的诊断挑战而言，激素抵抗性哮喘患者只占了一小部分，但却造成了与之不对称的医疗成本支出。识别不同哮喘的表型有助于描述严重哮喘组群的特点以及更好地了解其病理生理学进程。激素作用的分子机制是复杂的，已证实有条通路可以解释药物的耐药机制，这也是药物研发的关键。吸烟可能是导致激素抵抗最重要单一因素。本研究提出了激素抵抗性哮喘管理中的新兴概念，主要包括药物靶向特异性的分子、受体、炎症细胞或免疫进程。
   结论：由于激素抵抗性哮喘的诊断挑战，可能导致低估其患病率，并影响病人的治疗。识别激素抵抗的不同表型和机制已经取得了很大的进展；因此将来哮喘管理中新药的开发是有前途的。
 

（刘国梁 审校）
J Asthma. 2013 Aug 8. [Epub ahead of print]

 

Steroid Resistant Asthma: More than Meets the Eye.
 

Reddy D, Little FF.
 

Abstract
 
INTRODUCTION: For decades steroids have been considered as the gold standard for the treatment of asthma. We present a case report of typical steroid resistant asthma and current consensus in definitions of 'severe refractory', 'difficult' and 'steroid resistant' asthma.
METHODS: Full-text papers and abstracts were identified on the basis of a comprehensive literature search primarily in MEDLINE (1966 to June 2012) but also in the Cochrane Central Register of Controlled Trials database.
RESULTS: Steroid resistant asthmatics are a small subset of patients who pose noteworthy diagnostic challenges while contributing disproportionately to health care costs. Recognition of various asthma phenotypes has aided in characterizing groups with severe asthma and given a better understanding of its pathophysiological process. The molecular mechanism of steroid action is complicated and several pathways have been identified to explain drug resistance, which in turn is crucial for drug development. Tobacco smoking appears to be the single most important contributor of steroid resistance. We present the emerging and promising concepts in the management of steroid resistant asthma, which mainly includes drugs targeting specific molecules, receptors, inflammatory cells or immune processes.
CONCLUSION: The challenges in making a diagnosis of Steroid resistant asthma may contribute to underestimating its prevalence and impact on patient care. Considerable progress has been made in identifying distinct phenotypes and mechanisms of steroid resistance; therefore the future of new drug development in management of asthma is promising.
 

J Asthma. 2013 Aug 8. [Epub ahead of print]