哮喘联盟

   摘要
   急诊室(ED)或临床哮喘急性发作(AEA)患者受到来自严重程度以及治疗反应的不同严峻挑战。高剂量、频繁或持续雾化吸入短效β2受体激动剂(SABA)治疗联合短效抗胆碱能药物(SAMA)是主要的治疗方案。当患者吸入SABA/SAMA没有得到快速的临床疗效，应考虑尽早口服或注射糖皮质激素，其可满足ICU患者直接需求乃至住院患者的需求。应考虑如静脉注射镁剂、吸入氦/氧联合气体以及雾化器驱动吸入SABA和(或)SAMA的辅助治疗，如果其有可能影响患者的临床进程最好在治疗计划中尽早使用。其它药物如茶碱、白三烯调节剂、吸入糖皮质激素、长效β2受体激动剂和长效抗胆碱能药物的使用在临床或急诊室的AEA快速治疗中目前并未起到重要的作用，但临床医师应意识到以上是重要的治疗选择，并且应在患者离开门诊、住院部或急诊室后启用上述药物治疗，以减少日后临床恶化以及ED和医院的再入院。本文对目前被批准用于治疗哮喘和其它气道症状的可用呼吸系统药物提供了全面的总结。临床医生必须配备好治疗哮喘急性发作、以及预防病情恶化或再次急性发作的所有可用药物，并需熟知所用药物的主要潜在毒性。
 

（林江涛 审校）
Clin Rev Allergy Immunol. 2014 Sep 12. [Epub ahead of print]


 

The Acute Management of Asthma.
 

Albertson TE1, Sutter ME, Chan AL.
 

ABSTRACT
Patients presenting to the emergency department (ED) or clinic with acute exacerbation of asthma (AEA) can be very challenging varying in both severity and response to therapy. High-dose, frequent or continuous nebulized short-acting beta2 agonist (SABA) therapy that can be combined with a short-acting muscarinic antagonist (SAMA) is the backbone of treatment. When patients do not rapidly clinically respond to SABA/SAMA inhalation, the early use of oral or parenteral corticosteroids should be considered and has been shown to impact the immediate need for ICU admission or even the need for hospital admission. Adjunctive therapies such as the use of intravenous magnesium and helium/oxygen combination gas for inhalation and for driving a nebulizer to deliver a SABA and or SAMA should be considered and are best used early in the treatment plan if they are likely to impact the patients' clinical course. The use of other agents such as theophylline, leukotriene modifiers, inhaled corticosteroids, long-acting beta2 agonist, and long-acting muscarinic antagonist currently does not play a major role in the immediate treatment of AEA in the clinic or the ED but is an important therapeutic option for physicians to be aware of and to consider initiating at the time of discharge from clinic, hospital, or ED to reduce later clinical worsening and readmission to the ED and hospital. A comprehensive summary is provided of the currently available respiratory pharmaceuticals approved for asthma and other airway syndromes. Clinicians must be prepared to use the entire spectrum of medications available for the treatment of acute asthma exacerbations and the agents that should be initiated to prevent worsening or additional exacerbations. They need to be familiar with the major potential drug toxicities associated with their use.
 

Clin Rev Allergy Immunol. 2014 Sep 12. [Epub ahead of print]