哮喘联盟

   摘要
   当需要缓解症状时，治疗轻度哮喘的推荐方案是定期维持吸入糖皮质激素(ICSs)和短效β-受体激动剂。然而在临床实际中依从性不佳和处方率低，使定期ICS的使用获益受限。替代疗法应该是能控制症状的（作为必须或随机），将联合ICS/短效 β受体激动剂或ICS/长效 β-受体激动剂吸入使用作为缓解治疗而不是定期维持治疗。这种方法的基本原理是根据需要确定ICS 和 β-受体激动剂的剂量，增加ICS在依从性不佳且依赖β-受体激动剂吸入缓解症状的患者中的运用。这一方法只有在β-受体激动剂快速缓解症状时才有效。有证据证明这一方法优于定期ICS的治疗，可能是治疗间歇性轻度哮喘的有效、安全、新颖的治疗方法。本文回顾相关证据，提出在间歇性轻度哮喘中根据这一方案研究不同的联合ICS/β-受体吸入药物的随机对照试验是重中之重。
 

（苏楠 审校）
J Allergy Clin Immunol. 2014 Jan;133(1):39-41. doi: 10.1016/j.jaci.2013.10.053.

 

Combination corticosteroid/β-agonist inhaler as reliever therapy: A solution for intermittent and mild asthma?
 

Beasley R1, Weatherall M2, Shirtcliffe P3, Hancox R4, Reddel HK5.
 

Abstract
The recommended treatment of mild asthma is regular maintenance inhaled corticosteroids (ICSs) with a short-acting β-agonist as a separate inhaler used when needed for symptom relief. However, the benefits of regular ICS use in actual clinical practice are limited by poor adherence and low prescription rates. An alternative strategy would be the symptom-driven (as-required or "prn") use of a combination ICS/short-acting β-agonist or ICS/long-acting β-agonist inhaler as a reliever rather than regular maintenance use. The rationale for this approach is to titrate both the ICS and β-agonist dose according to need and enhance ICS use in otherwise poorly adherent patients who overrely on their reliever β-agonist inhaler. This strategy will only work if the β-agonist component has a rapid onset of action for symptom relief. There is evidence to suggest that this regimen has advantages over regular ICS therapy and might represent an effective, safe, and novel therapy for the treatment of intermittent and mild asthma. In this commentary we review this evidence and propose that randomized controlled trials investigating different combination ICS/β-agonist inhaler products prescribed according to this regimen in intermittent and mild asthma are an important priority.
 

J Allergy Clin Immunol. 2014 Jan;133(1):39-41. doi: 10.1016/j.jaci.2013.10.053.