Division of Pediatric Pulmonology, Penn State Milton S. Hershey Children's Hospital, Penn State College of Medicine, Hershey, Pennsylvania 17033-0850, USA.
Curr Opin Pediatr. 2010 Jun;22(3):290-5. doi: 10.1097/MOP.0b013e328337cb0c.
This article reviews current concepts regarding the clinical and scientific rationale for the combined use of glucocorticosteroids and beta-2-adrenoreceptor (beta2AR) agonists in the treatment of childhood asthma.
Several studies have demonstrated that inhaled corticosteroids (ICS) and beta2AR agonists are the most effective medications for the management of asthma in children. Given substantial evidence of an increased clinical benefit when these agents are used together, new studies are being pursued to establish the efficacy and safety of this combinational therapy in infants and children. Ongoing research is also investigating the mechanisms of beta2AR and glucocorticosteroids signaling and their molecular interactions. This new knowledge will likely lead to novel therapeutic approaches to asthma control.
There is increasing evidence demonstrating that the combination of long-acting beta2AR agonists and ICS may be more effective than high-dose ICS therapy alone in the management of children with uncontrolled asthma. In addition, the use of a single inhaler containing ICS and a quick-acting beta2AR agonist might be a convenient alternative to prevent and treat asthma exacerbations. Future investigations should be designed to more specifically evaluate the efficacy and safety of these therapies in the different asthmatic phenotypes of infants and children.
本文综述了糖皮质激素和β2-肾上腺素能受体（β2AR）激动剂联合应用于儿童哮喘治疗的临床和科学依据。
多项研究表明吸入性皮质类固醇（ICS）和β2AR 激动剂是治疗儿童哮喘最有效的药物。鉴于这些药物联合使用可显著提高临床疗效，目前正在进行新的研究以确定该联合治疗在婴儿和儿童中的疗效和安全性。目前正在进行的研究还在探讨β2AR 和糖皮质激素信号转导及其分子相互作用的机制。这些新知识可能会为哮喘控制提供新的治疗方法。
越来越多的证据表明，长效β2AR 激动剂和 ICS 的联合应用可能比高剂量 ICS 治疗更有效，可用于治疗未得到控制的哮喘患儿。此外，使用含有 ICS 和快速起效的β2AR 激动剂的单一吸入器可能是预防和治疗哮喘急性发作的一种方便的替代方法。未来的研究应专门评估这些治疗方法在婴儿和儿童不同哮喘表型中的疗效和安全性。
