Ahmad Tehireem, Barnes Peter J, Adcock Ian M
Imperial College London, National Heart and Lung Institute, Airways Disease Section, Dovehouse Street, London, SW3 6LY, UK.
Curr Opin Investig Drugs. 2008 May;9(5):470-7.
Asthma is successfully treated in most patients through the use of conventional corticosteroid therapy. The majority (90 to 95%) of patients respond effectively to moderate doses of inhaled corticosteroids with minimal side effects. Nevertheless, there is a small population of asthmatic patients, including present and ex-cigarette smokers, who fail to respond adequately to corticosteroid treatment even at high doses or with the addition of supplementary therapy. These patients account for a disproportionate amount of healthcare costs because they exacerbate more frequently and are more likely to be admitted to hospital due to their asthma. Cigarette smoking is an important factor associated with corticosteroid resistance in asthmatics, and there is scope for the development of novel therapies to target this subgroup of asthmatics. This review summarizes the various hypotheses underlying corticosteroid insensitivity in smoking asthmatics and discusses the development of potential novel therapies based on these concepts.
大多数患者通过使用传统的皮质类固醇疗法能够成功治疗哮喘。大多数（90%至95%）患者对中等剂量吸入性皮质类固醇有有效反应，且副作用最小。然而，有一小部分哮喘患者，包括目前和既往吸烟者，即使在高剂量或添加辅助治疗的情况下，对皮质类固醇治疗也没有充分反应。这些患者占医疗费用的比例过高，因为他们更频繁地病情加重，且因哮喘更有可能住院。吸烟是哮喘患者皮质类固醇抵抗的一个重要相关因素，开发针对这一亚组哮喘患者的新疗法仍有空间。本综述总结了吸烟哮喘患者皮质类固醇不敏感的各种潜在假说，并基于这些概念讨论了潜在新疗法的发展。
