Montani D, Tillie-Leblond I, Crestani B, De Blic J, Humbert M, Tunon-De-Lara M, Magnan A, Roche N, Gati S, Chanez P
Université Paris-Sud 11, Hôpital Antoine Béclère, Clamart, France.
Rev Mal Respir. 2008 Oct;25(8):933-51. doi: 10.1016/s0761-8425(08)74411-5.
In asthma, symptoms are the main reason for recourse to healthcare and are a fundamental parameter for the evaluation of asthma control. Currently, asthma is defined as a chronic inflammatory disease. Uncontrolled asthmatics have an increased number of eosinophils in induced sputum and an increased production of exhaled NO. Control by anti-inflammatory treatment is accompanied by a reduction in bronchial eosinophilia and exhaled NO. Asthma symptoms are the result of complex mechanisms and many factors modify their perception. Experimental data suggests that there is a relationship between the perception of symptoms and eosinophilic inflammation, and that inhaled corticoid therapy improves this perception. Although they are still not applicable in routine practice, follow-up strategies based on the evaluation of inflammation are thought to be more effective in reducing exacerbations than those usually recommended based on retrospective evaluation of symptoms and sequential analysis of respiratory function. Inhaled corticosteroid therapy is the reference maintenance therapy for persistent asthma and adjustment of anti-inflammatory treatment based on symptoms is an effective strategy to prevent exacerbations and reduce the total dose of inhaled corticosteroids. A French expert group has undertaken a study of the association between inflammation and asthma symptoms by carrying out a critical review of the international literature.
在哮喘中，症状是寻求医疗保健的主要原因，也是评估哮喘控制情况的一个基本参数。目前，哮喘被定义为一种慢性炎症性疾病。未得到控制的哮喘患者诱导痰中的嗜酸性粒细胞数量增加，呼出一氧化氮（NO）的量也增加。抗炎治疗控制哮喘时，支气管嗜酸性粒细胞减少，呼出的NO也减少。哮喘症状是复杂机制的结果，许多因素会改变对这些症状的感知。实验数据表明，症状感知与嗜酸性粒细胞炎症之间存在关联，吸入糖皮质激素治疗可改善这种感知。基于炎症评估的随访策略虽然仍不适用于常规临床实践，但被认为在减少哮喘发作方面比通常基于症状回顾性评估和呼吸功能序贯分析所推荐的策略更有效。吸入糖皮质激素治疗是持续性哮喘的标准维持治疗方法，根据症状调整抗炎治疗是预防发作和减少吸入糖皮质激素总剂量的有效策略。一个法国专家小组通过对国际文献进行批判性综述，对炎症与哮喘症状之间的关联进行了研究。
