哮喘联盟

   摘要
   全球老龄化预示老年人哮喘负担加重。这要求在临床实际中实现哮喘识别、诊断和管理的优化。本研究旨在为临床医生提供更新的信息，强调老龄化进展的认识和免疫衰老及其对哮喘诊断和治疗前景的适用性。年龄增加影响气道反应性，免疫功能以及新型表型特异性治疗的疗效。区分嗜酸性粒细胞和嗜中性粒细胞疾病可辨别特异性疾病、分辨迟发型哮喘与哮喘持续状态。虽然有助于充分监测吸入剂治疗疗效和依从性的新型记录装置比以往可用的装置更准确，但在给药、治疗依从性和老年人长期不良反应方面仍面临挑战。抗细胞因子治疗能改善脆性哮喘控制，而支气管热成形术在难治性病例也是一种选择。多维干预措施被证明是最好的老年哮喘的管理方法，不过，这一疾病虽不少见却仍然很少在老年人中获得诊断。
 

（苏楠 审校）
Am J Med. 2013 Dec 28. pii: S0002-9343(13)01110-8. doi: 10.1016 /j.amjmed. 2013. 12.013. [Epub ahead of print]


 

Advances in the Diagnosis and Management Of Asthma in Older Adults.
 

Al-Alawi M1, Hassan T2, Chotirmall SH3.
 

Abstract
Global estimates on ageing predict an increased burden of asthma in the older population. Consequently, its recognition, diagnosis and management in clinical practice require optimization. This review aims to provide an update for clinicians highlighting advances in the understanding of the ageing process and immunosenescence together with their applicability to asthma from a diagnostic and therapeutic perspective. Ageing impacts airway responses, immune function and influences efficacy of emerging phenotype-specific therapies when applied to the elderly patient. Differentiating eosinophilic and neutrophilic disease accounts for atopic illness and distinguishes long-standing from late-onset asthma. Therapeutic challenges in drug delivery, treatment adherence and side effect profiles persist in the older patient while novel recording devices developed to aid detection of an adequate inhalation evaluates treatment effectiveness and compliance more accurately than previously attainable. Anti-cytokine therapies improve control of brittle asthma while bronchial thermoplasty is an option in refractory cases. Multi-dimensional intervention strategies prove best in the management of asthma in the older adult which remains a condition that is not rare but rarely diagnosed in this patient population.
 

Am J Med. 2013 Dec 28. pii: S0002-9343(13)01110-8. doi: 10.1016 /j.amjmed. 2013. 12.013. [Epub ahead of print]