Bjermer Leif, Diamant Zuzana
Department of Respiratory Medicine and Allergology, Heart and Lung Division, University Hospital, Lund, Sweden.
Curr Opin Pulm Med. 2009 Jan;15(1):46-51. doi: 10.1097/MCP.0b013e32831da926.
For optimal asthma control, complementary strategies are advocated to cover several aspects of the disease. This mini-review highlights different complementary strategies with special focus on the combined use of inhaled corticosteroids (ICSs) and long-acting beta2 agonists and as an alternative, the combination of ICSs and antileukotrienes.
New data show that combinations of ICSs/long-acting beta2 agonists or ICSs with antileukotrienes improve disease stability with concomitant control of the underlying airway inflammation. Moreover, there is some evidence that combination therapy may prevent some aspects of airway remodelling. The use of a fixed combination of both a reliever and a controller medication may have certain advantages compared with a fixed dose regime with as-needed separate reliever therapy. Alternatively, in some asthma phenotypes, such as combined allergic rhinitis and asthma syndrome, the combination of ICSs with antileukotrienes offers a complementary anti-inflammatory treatment in combination with controller effects on both airway compartments.
This review compares different strategies of complementary therapy in asthma with special focus on how to achieve the best clinical control also aimed at controlling the underlying airway inflammation. We have chosen to focus on two major topics: the use of ICSs and long-acting beta2 agonists in two different strategies, that is, a symptom-driven versus a fixed symptom-preventive approach; and the use of ICSs with a long-acting beta2 agonist versus ICSs and a leukotriene receptor antagonist. What regime should be chosen is highly dependent on the individual phenotype and defined treatment goal.
为实现哮喘的最佳控制，提倡采用综合策略来涵盖该疾病的多个方面。本综述重点介绍了不同的综合策略，特别关注吸入性糖皮质激素（ICS）与长效β2受体激动剂的联合使用，以及作为替代方案的ICS与白三烯调节剂的联合使用。
新数据表明，ICS/长效β2受体激动剂组合或ICS与白三烯调节剂的联合使用可改善疾病稳定性，并同时控制潜在的气道炎症。此外，有证据表明联合治疗可能预防气道重塑的某些方面。与按需单独使用缓解药物的固定剂量方案相比，使用缓解药物和控制药物的固定组合可能具有某些优势。另外，在某些哮喘表型中，如合并过敏性鼻炎和哮喘综合征，ICS与白三烯调节剂的联合使用可提供一种补充性抗炎治疗，并对两个气道腔室均具有控制作用。
本综述比较了哮喘综合治疗的不同策略，特别关注如何实现最佳临床控制，同时也旨在控制潜在的气道炎症。我们选择重点关注两个主要主题：ICS与长效β2受体激动剂在两种不同策略中的使用，即症状驱动方法与固定症状预防方法；以及ICS与长效β2受体激动剂联合使用与ICS和白三烯受体拮抗剂联合使用。应选择何种方案高度依赖于个体表型和明确的治疗目标。
