Tillie-Leblond I, Montani D, Crestani B, de Blic J, Humbert M, Tunon-de-Lara M, Magnan A, Roche N, Ostinelli J, Chanez P
Respiratory Diseases Department, Hôpital Albert Calmette, Lille, France.
Allergy. 2009 Mar;64(3):354-67. doi: 10.1111/j.1398-9995.2009.01971.x. Epub 2009 Feb 6.
Asthma symptoms are the main reason for healthcare utilization and are a fundamental parameter for the evaluation of asthma control. Currently, asthma is defined as a chronic inflammatory disease. A French expert group studied the association between inflammation and asthma symptoms by carrying out a critical review of the international literature. Uncontrolled asthmatics have an increased number of polynuclear eosinophils in the 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 suggest 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 symptoms and sequential analysis of respiratory function. Inhaled corticosteroid therapy is the reference disease-modifying therapy for persistent asthma. Recent studies demonstrated that adjustment of anti-inflammatory treatment based on symptoms is an effective strategy to prevent exacerbations and reduce the total number of doses of inhaled corticosteroids.
哮喘症状是医疗利用的主要原因，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。一个法国专家小组通过对国际文献进行批判性综述，研究了炎症与哮喘症状之间的关联。未得到控制的哮喘患者诱导痰中的多形核嗜酸性粒细胞数量增加，呼出一氧化氮的量也增加。通过抗炎治疗实现控制后，支气管嗜酸性粒细胞增多以及呼出一氧化氮的情况会有所减少。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，吸入皮质激素疗法可改善这种感知。尽管基于炎症评估的随访策略目前仍不适用于常规临床实践，但人们认为其在减少哮喘发作方面比通常基于症状和呼吸功能序贯分析所推荐的策略更有效。吸入糖皮质激素疗法是持续性哮喘的标准疾病改善疗法。最近的研究表明，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。
