Bernstein David I
Department of Internal Medicine, Division of Immunology & Allergy, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267, USA.
Clin Cornerstone. 2008;8(4):9-25. doi: 10.1016/s1098-3597(08)80010-5.
Asthma results from chronic airway inflammation involving a diversity of activated cells including mast cells, eosinophils, T-lymphocytes, neutrophils, macrophages, and epithelial cells. These cells release proinflammatory cytokine mediators that augment and regulate airway inflammation, leading to airway hyperresponsiveness responsible for the chronic asthma symptoms of dyspnea, wheezing, and chest tightness. It is hypothesized, but unproven, that inflammatory effects can lead to irreversible structural and functional airway changes. Early intervention with anti-inflammatory agents mitigates inflammatory changes, reverses airway obstruction, and may possibly prevent progression of airway remodeling. Current asthma guidelines recommend that initial management should be based on pretreatment assessments of asthma severity as determined by measures of clinical and spirometric impairment in individual patients; subsequent adjustments of pharmacotherapy and avoidance recommendations should be performed at regular follow-up visits and guided by frequent assessments of asthma control. Physicians and providers should continually educate asthmatic patients about proper use of asthma controller medications, avoidance of asthma triggers, and self-management of asthma exacerbations.
哮喘是由慢性气道炎症引起的，涉及多种活化细胞，包括肥大细胞、嗜酸性粒细胞、T淋巴细胞、中性粒细胞、巨噬细胞和上皮细胞。这些细胞释放促炎细胞因子介质，增强并调节气道炎症，导致气道高反应性，引发慢性哮喘症状，如呼吸困难、喘息和胸闷。据推测，但未经证实，炎症作用可导致气道结构和功能发生不可逆变化。早期使用抗炎药物进行干预可减轻炎症变化，逆转气道阻塞，并可能预防气道重塑的进展。当前的哮喘指南建议，初始治疗应基于对个体患者临床和肺功能受损程度所确定的哮喘严重程度的预处理评估；后续药物治疗的调整和避免诱发因素的建议应在定期随访时进行，并以对哮喘控制情况的频繁评估为指导。医生和医疗服务提供者应持续对哮喘患者进行教育，使其了解哮喘控制药物的正确使用方法、避免哮喘诱发因素以及哮喘急性发作的自我管理。
