Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart Rome, Italy.
Front Pharmacol. 2011 Jul 14;2:35. doi: 10.3389/fphar.2011.00035. eCollection 2011.
In studies comparing regular versus on-demand treatment for patients with mild persistent asthma, on-demand treatment seems to have a similar efficacy on clinical and functional outcomes, but it does not suppress chronic airway inflammation or airway hyper-responsiveness (AHR) associated with asthma. Data on the efficacy of a continuous treatment with inhaled corticosteroids (ICS) in preventing the progression of asthma are conflicting. There is the possibility that patients without a regular treatment with ICS may develop a more severe asthma associated with airway structural changes (remodeling) and a progressive loss of lung function. However, the possible clinical and functional consequences of persistent, not controlled, airway inflammation in patients with asthma have to be established. Assessment of asthma control should include inflammatory outcomes, such as fraction of exhaled nitric oxide and sputum eosinophil counts. Until the relationships between symptoms, lung function tests, AHR, airway inflammation, exacerbations, and airway remodeling are clarified, regular treatment seems to be generally more appropriate than on-demand treatment to warrant a greater control of asthma. Select subgroups of patients with mild asthma who are well controlled by regular treatment might adopt the on-demand treatment plan as an intermediate step toward the suspension of controller medication. The increasing evidence for heterogeneity of asthma, the growing emphasis on asthma subphenotypes, including molecular phenotypes identified by omics technologies, and their possible implications for different asthma severity and progression and therapeutic response, are changing the paradigm of treating patients with asthma only based on classification of their disease severity to a pharmacological strategy more focused on the individual asthmatic patient. Pharmacological treatment of asthma is going toward a personalized approach.
在比较轻度持续性哮喘患者常规治疗与按需治疗的研究中，按需治疗在临床和功能结局方面似乎具有相似的疗效，但它不能抑制与哮喘相关的慢性气道炎症或气道高反应性（AHR）。关于吸入皮质类固醇（ICS）连续治疗预防哮喘进展的疗效数据存在争议。有可能未经 ICS 常规治疗的患者可能会发展为更严重的哮喘，与气道结构变化（重塑）和肺功能进行性丧失相关。然而，哮喘患者持续存在、未得到控制的气道炎症的可能临床和功能后果尚需确定。哮喘控制的评估应包括炎症结果，如呼气一氧化氮分数和痰嗜酸性粒细胞计数。在明确症状、肺功能测试、AHR、气道炎症、加重和气道重塑之间的关系之前，常规治疗似乎比按需治疗更适合，以保证更好地控制哮喘。对于通过常规治疗得到良好控制的轻度哮喘的选择亚组患者，他们可能会采用按需治疗计划作为停止控制器药物的中间步骤。哮喘异质性的证据越来越多，对哮喘亚表型的重视程度越来越高，包括通过组学技术确定的分子表型，以及它们对不同哮喘严重程度和进展以及治疗反应的可能影响，正在改变仅基于疾病严重程度对哮喘患者进行分类的治疗模式，转向更关注个体哮喘患者的药理学策略。哮喘的药物治疗正在朝着个体化方法发展。
