Magnan Antoine, Pipet Anaïs
Inserm U915, université de Nantes, faculté de médecine, CHU de Nantes, Institut du thorax, service de pneumologie, plate-forme transversale d'allergologie, 44000 Nantes, France.
Rev Prat. 2011 Mar;61(3):354-8.
Difficult to control severe asthma is characterized by the persistence of inacceptable symptoms of asthma despite a continuous treatment with at least high doses of inhaled steroids and long acting bronchodilators. The diagnosis is done after a period of observation and some investigations that will allow confirm the diagnosis of asthma, eliminate alternative diagnosis and etiological forms that would be difficult to treat intrinsically (allergic broncho-pulmonary aspergillosis, Churg and Strauss disease, chronic eosinophilic pneumonia, occupational asthma). At the end of this period devoted to diagnosis a systematic approach is set up to take care of these patients. Therapeutic education includes action plans and measures for triggering factors avoidance in order to prevent exacerbations. Comorbidities such as rhinitis, nasal polyposis, gastro-oesophageal reflux and obesity are taken into account. Lastly, the treatment must be adapted according to the patient's preferences and aims, and to the asthma severity. Ultimately in steroid-dependent asthma, the lowest efficient dose is tracked continuously. For these patients, new molecules are needed.
难治性重度哮喘的特点是，尽管持续使用至少高剂量吸入性糖皮质激素和长效支气管扩张剂进行治疗，但哮喘症状仍持续存在且难以接受。诊断需经过一段时间的观察及一些检查，以确诊哮喘、排除其他难以根治的替代诊断和病因形式（变应性支气管肺曲霉病、变应性肉芽肿性血管炎、慢性嗜酸性粒细胞性肺炎、职业性哮喘）。在这段诊断期结束时，需建立系统的方法来治疗这些患者。治疗教育包括行动计划和避免触发因素的措施，以预防病情加重。需考虑合并症，如鼻炎、鼻息肉、胃食管反流和肥胖。最后，治疗必须根据患者的偏好和目标以及哮喘的严重程度进行调整。最终，对于依赖糖皮质激素的哮喘患者，需持续追踪最低有效剂量。对于这些患者，需要新的药物分子。
