Singh Varinder
Department of Pediatrics, Lady Hardinge Medical College and Assoc Kalawati Saran Children's Hospital, New Delhi, India.
Indian J Pediatr. 2008 Aug;75(8):845-53. doi: 10.1007/s12098-008-0157-8.
The prevalence of asthma has increased in developed countries. The efficacy of available drugs in those with severe persistent disease is limited. This has led to a renewed search for the reasons for failures of the existing treatment and for novel concepts. Treatment with inhaled corticosteroids, and to a much lesser extent theophylline, can reduce the survival of inflammatory cells including eosinophils. Emerging trends in treatments for asthma could include strategies to alter the cytokine/chemokine balance. It is evident that the current ICS are already very efficient and safe, it will be difficult to introduce further improved formulations. Perhaps the most fruitful effort shall be in developing patient friendly easy to use targeted delivery systems. The newer therapies are planned for the several upstream targets and may have potential to prevent the disease. Various potential therapies are being worked upon like-targeting prevention of T cell activation, modulation of Th-1/Th-2 differentiation, inhibition of Th-2 related cytokines, Th-1/Th-2 modulation, inhibition of downstream mediators etc. The new strategy shall perhaps lie with matching the patients and their disease with the most suitable therapy.
发达国家哮喘的患病率有所上升。现有药物对重度持续性哮喘患者的疗效有限。这促使人们重新探寻现有治疗方法失败的原因以及新的治疗理念。吸入性糖皮质激素治疗，以及程度较轻的茶碱治疗，可降低包括嗜酸性粒细胞在内的炎性细胞的存活率。哮喘治疗的新趋势可能包括改变细胞因子/趋化因子平衡的策略。显然，目前的吸入性糖皮质激素已经非常有效且安全，很难推出进一步改进的制剂。或许最有成效的努力将在于开发方便患者使用的靶向给药系统。新疗法针对多个上游靶点，可能具有预防疾病的潜力。目前正在研究各种潜在疗法，如靶向预防T细胞活化、调节Th-1/Th-2分化、抑制Th-2相关细胞因子、Th-1/Th-2调节、抑制下游介质等。新策略或许在于将患者及其疾病与最合适的疗法相匹配。
