Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA.
J Allergy Clin Immunol. 2011 Oct;128(4):740-50. doi: 10.1016/j.jaci.2011.08.014. Epub 2011 Aug 27.
Current approaches to the diagnosis and management of asthma are based on guideline recommendations, which have provided a framework for the efforts. Asthma, however, is emerging as a heterogeneous disease, and these features need to be considered in both the diagnosis and management of this disease in individual patients. These diverse or phenotypic features add complexity to the diagnosis of asthma, as well as attempts to achieve control with treatment. Although the diagnosis of asthma is often based on clinical information, it is important to pursue objective criteria as well, including an evaluation for reversibility of airflow obstruction and bronchial hyperresponsiveness, an area with new diagnostic approaches. Furthermore, there exist a number of treatment gaps (ie, exacerbations, step-down care, use of antibiotics, and severe disease) in which new direction is needed to improve care. A major morbidity in asthmatic patients occurs with exacerbations and in patients with severe disease. Novel approaches to treatment for these conditions will be an important advance to reduce the morbidity associated with asthma.
目前的哮喘诊断和管理方法基于指南建议，这些建议为努力提供了框架。然而，哮喘正在成为一种异质性疾病，在对个体患者进行诊断和管理时需要考虑这些特征。这些不同的或表型特征增加了哮喘诊断的复杂性，以及通过治疗实现控制的尝试。尽管哮喘的诊断通常基于临床信息，但也有必要寻求客观标准，包括评估气流阻塞和支气管高反应性的可逆性，这是一个具有新诊断方法的领域。此外，在一些治疗空白领域（即加重、降级治疗、抗生素使用和严重疾病）需要新的方向来改善治疗。哮喘患者的主要发病率与加重和严重疾病有关。针对这些情况的新型治疗方法将是减少与哮喘相关发病率的重要进展。
