哮喘联盟

   摘要
   儿童重症哮喘的特征是使用高剂量的吸入糖皮质激素或口服糖皮质激素治疗后症状仍持续存在。儿童的重症哮喘可分为两类，难治性哮喘或严重治疗抵抗性哮喘。难治性哮喘的定义为由于不正确的诊断或合并症存在而导致控制不佳，或由于不良的心理或环境因素导致依从性差。相对应的是，治疗抵抗性哮喘定义为尽管处理了以上因素，哮喘依然难治。人们逐渐认识到，重症哮喘是一个与多种临床和炎症表型相关的高度异质性疾病，这些表型已经在儿童重症哮喘中得到描述。指南推荐的儿童重症哮喘的药物治疗主要是基于成人研究数据的类推。重症哮喘儿童的推荐治疗方法为吸入高剂量或口服糖皮质激素联合长效β-受体激动剂及其他附加疗法，如抗白三烯和甲基黄嘌呤药物。识别并阐明哮喘难以控制的影响因素是很重要的，包括审视诊断并排除致病或加重的因素。对表型进行更好的定义以及根据患者个体的表型提供针对性的治疗可能会改善未来对哮喘的治疗。
 

（苏欣 审校）
JAllergyClinImmunolPract.2014Sep-Oct;2(5):489-500.doi:10.1016/j.jaip.2014.06.022.

 

Severe asthma in children.
 

Guilbert TW1, Bacharier LB2, Fitzpatrick AM3.
 

ABSTRACT
Severe asthma in children is characterized by sustained symptoms despite treatment with high doses of inhaled corticosteroids or oral corticosteroids. Children with severe asthma may fall into 2 categories, difficult-to-treat asthma or severe therapy-resistant asthma. Difficult-to-treat asthma is defined as poor control due to an incorrect diagnosis or comorbidities, or poor adherence due to adverse psychological or environmental factors. In contrast, treatment resistant is defined as difficult asthma despite management of these factors. It is increasingly recognized that severe asthma is a highly heterogeneous disorder associated with a number of clinical and inflammatory phenotypes that have been described in children with severe asthma. Guideline-based drug therapy of severe childhood asthma is based primarily on extrapolated data from adult studies. The recommendation is that children with severe asthma be treated with higher-dose inhaled or oral corticosteroids combined with long-acting β-agonists and other add-on therapies, such as antileukotrienes and methylxanthines. It is important to identify and address the influences that make asthma difficult to control, including reviewing the diagnosis and removing causal or aggravating factors. Better definition of the phenotypes and better targeting of therapy based upon individual patient phenotypes is likely to improve asthma treatment in the future.
 

JAllergyClinImmunolPract.2014Sep-Oct;2(5):489-500.doi:10.1016/j.jaip.2014.06.022.