Magnussen Helgo
Center for Pneumology and Thoracic Surgery, Grosshansdorf Hospital, Grosshansdorf, Germany.
Curr Opin Pulm Med. 2003 Apr;9 Suppl 1:S3-7. doi: 10.1097/00063198-200304001-00002.
Bronchial asthma is associated with symptoms, reversible airflow obstruction, airway hyper-responsiveness and inflammation along large and small airways. Inhalation therapy with bronchodilators (relievers) and anti-inflammatory agents (controllers) forms the basis of treatment for most patients with asthma of different severities. Conventionally, therapeutic efficacy is assessed on the basis of improvements in symptoms and lung function. However, airway hyper-responsiveness as a primary outcome may change therapeutic strategies. There are problems associated with this concept which need to be addressed, such as the heterogeneity of airway inflammation in the asthmatic lung. The goals for inhalation therapy should be to determine the site of airway inflammation for each degree of asthma severity, to improve inhaler technology, ensuring that the drug can reach the site of inflammation, and to improve compliance. New inhalers need to do the following: contain appropriate therapeutic agents; have particle dimensions small enough to be deposited in distal airways; and minimize the effects of incorrect inhalation and low compliance.
支气管哮喘与症状、可逆性气流受限、气道高反应性以及大小气道的炎症相关。使用支气管扩张剂（缓解药物）和抗炎药物（控制药物）进行吸入治疗是大多数不同严重程度哮喘患者治疗的基础。传统上，治疗效果是根据症状和肺功能的改善情况来评估的。然而，将气道高反应性作为主要结局可能会改变治疗策略。这个概念存在一些需要解决的问题，比如哮喘患者肺部气道炎症的异质性。吸入治疗的目标应该是针对每个哮喘严重程度级别确定气道炎症的部位，改进吸入器技术，确保药物能够到达炎症部位，并提高依从性。新型吸入器需要做到以下几点：含有合适的治疗药物；颗粒尺寸足够小以便沉积在远端气道；并将不正确吸入和低依从性的影响降至最低。
