Fitzpatrick Anne M, Teague William Gerald
Emory University Department of Pediatrics, Atlanta, Georgia.
Pediatr Allergy Immunol Pulmonol. 2010 Jun;23(2):131-138. doi: 10.1089/ped.2010.0021.
Severe asthma in children is a complicated disorder characterized by ongoing symptoms and persistent airway inflammation despite treatment with high doses of inhaled and oral corticosteroids. Although knowledge of asthma and its associated mechanisms has increased substantially over the past decade, significant gaps remain about the determinants of severe asthma in children and the progression of the disorder across the lifespan. This review highlights recent insights into severe asthma in children derived from the National Heart, Lung, and Blood Institute's Severe Asthma Research Program (SARP), with an emphasis on age-specific findings and differences from severe asthma in adults. While the existence of a true severe asthma phenotype in children is subject to some debate, given the results of SARP and other investigators, we conclude that there is indeed a subgroup of children with severe asthma who have extreme morbidity and differentiating clinical features that are identifiable very early in life. However, unlike adults with severe asthma, children with severe asthma are more likely to fall in a more narrow cluster that is characterized by marked atopy and reversible airflow obstruction. While SARP has advanced knowledge of severe asthma in children, considerable gaps remain for which additional studies are needed.
儿童重度哮喘是一种复杂的疾病，其特征是尽管使用了高剂量的吸入和口服皮质类固醇进行治疗，但仍持续出现症状和气道炎症。尽管在过去十年中，人们对哮喘及其相关机制的了解有了大幅增加，但在儿童重度哮喘的决定因素以及该疾病在整个生命周期中的进展方面，仍存在重大差距。本综述重点介绍了美国国立心肺血液研究所重度哮喘研究项目（SARP）对儿童重度哮喘的最新见解，重点关注特定年龄段的研究结果以及与成人重度哮喘的差异。虽然儿童中是否存在真正的重度哮喘表型存在一些争议，但根据SARP和其他研究人员的结果，我们得出结论，确实存在一小部分患有重度哮喘的儿童，他们具有极高的发病率和可在生命早期识别的独特临床特征。然而，与成人重度哮喘不同的是，儿童重度哮喘更可能属于一个更狭窄的类别，其特征是明显的特应性和可逆性气流阻塞。虽然SARP推进了对儿童重度哮喘的认识，但仍存在相当大的差距，需要进一步研究。
