Division of Pulmonary and Critical Care Medicine, Department of Medicine, New York University School of Medicine, 550 1st Avenue, New York, NY 10016, USA.
Ther Adv Respir Dis. 2011 Dec;5(6):397-408. doi: 10.1177/1753465811398721. Epub 2011 Apr 13.
Following a peak in asthma mortality in the late 1980s and early 1990s, we have been fortunate to see a substantial decrease in asthma deaths in recent years. Although most asthma deaths occur outside the hospital, near-fatal events are commonplace, with anywhere from 2-20% of patients with acute asthma admitted to intensive care, and 2-4% intubated for respiratory failure. Standard therapies for acute severe and near-fatal asthma include administration of systemic corticosteroids, and frequent or continuous inhaled beta agonists. Controversy remains regarding the optimal therapy of those who fail to respond to these initial treatments, those who remain at risk of acute respiratory failure, and patients requiring mechanical ventilation. There remain significant gaps in our knowledge regarding relative benefits of intravenous versus oral corticosteroids, intermittent versus continuous beta agonists, and the role of various adjunctive treatments including intravenous magnesium, systemic beta agonists, aminophylline, and helium-oxygen mixtures. Using models and radiolabeled aerosols, there is a greater understanding regarding effective administration of inhaled beta-agonists in ventilated patients. There is limited available evidence for treatment of near-fatal asthma, a fact reflected by the significant variability in asthma critical care practice. Much of the data guiding treatment in this setting has been generalized from studies of acute asthma in the ED and from general populations of hospitalized patients with acute asthma. This review will focus on pharmacologic approaches to life-threatening asthma by reviewing current guideline recommendations, reviewing the scientific basis of the guidelines, and highlighting gaps in our knowledge in treatment of refractory acute or near-fatal asthma.
自 20 世纪 80 年代末和 90 年代初哮喘死亡率达到峰值以来，近年来我们有幸看到哮喘死亡率大幅下降。尽管大多数哮喘死亡发生在医院外，但接近致命的事件很常见，约有 2-20%的急性哮喘患者入住重症监护病房，2-4%的患者因呼吸衰竭而插管。急性重症和接近致命性哮喘的标准治疗包括全身皮质类固醇的给药，以及频繁或持续吸入β激动剂。对于那些对这些初始治疗无反应的患者、那些仍有急性呼吸衰竭风险的患者以及需要机械通气的患者，最佳治疗方法仍存在争议。关于静脉与口服皮质类固醇、间歇性与连续性β激动剂以及各种辅助治疗（包括静脉内镁、全身β激动剂、氨茶碱和氦-氧混合物）的相对益处，我们的知识仍存在重大差距。通过使用模型和放射性标记气雾剂，我们对通气患者吸入β激动剂的有效给药有了更深入的了解。对于接近致命性哮喘的治疗，证据有限，这反映在哮喘重症监护实践中存在显著的变异性。指导该治疗的大部分数据是从急诊科急性哮喘研究和住院急性哮喘患者的一般人群中概括出来的。本综述将通过审查当前指南建议、审查指南的科学依据以及突出治疗难治性急性或接近致命性哮喘的知识差距，重点关注危及生命的哮喘的药物治疗方法。
