Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
Korean J Intern Med. 2012 Jun;27(2):143-8. doi: 10.3904/kjim.2012.27.2.143. Epub 2012 May 31.
Inhaled glucocorticosteroids are currently the most effective anti-inflammatory controller medications for treating persistent asthma. The efficacies of glucocorticoids include reducing asthma symptoms, reducing exacerbation frequency, improving quality of life, improving lung function, decreasing airway hyperresponsiveness, controlling airway inflammation, and reducing mortality. However, the treatment response to glucocorticosteroids in asthmatics varies, and certain subtypes of asthma, such as refractory asthma, respond poorly to high-dose inhaled glucocorticoid and systemic steroids. The medical costs of treating refractory asthmatics represent about 50% of the total healthcare cost for asthma. A thorough understanding of the mechanisms of glucocorticoid action, patient responses to glucocorticoids, and steroid resistance observed in refractory asthmatics is necessary for the targeted development of therapeutic drugs. This review discusses the characteristics of severe refractory asthmatics and the mechanisms of steroid response and resistance in asthma treatment.
吸入性糖皮质激素是目前治疗持续性哮喘最有效的抗炎控制药物。糖皮质激素的疗效包括减轻哮喘症状、减少加重频率、提高生活质量、改善肺功能、降低气道高反应性、控制气道炎症和降低死亡率。然而，哮喘患者对糖皮质激素的治疗反应存在差异，某些亚型的哮喘，如难治性哮喘，对高剂量吸入性糖皮质激素和全身类固醇反应不佳。治疗难治性哮喘的医疗费用约占哮喘总医疗费用的 50%。深入了解糖皮质激素作用机制、患者对糖皮质激素的反应以及难治性哮喘中观察到的类固醇耐药性，对于有针对性地开发治疗药物是必要的。这篇综述讨论了严重难治性哮喘的特征以及哮喘治疗中类固醇反应和耐药性的机制。
