Partners Asthma Center, Boston, Massachusetts, USA.
Allergy Asthma Proc. 2012 Jul-Aug;33(4):313-23. doi: 10.2500/aap.2012.33.3577.
Patients with severe asthma have considerable morbidity related to their asthma and are at risk for serious, life-threatening exacerbations. Their management requires an intensive and comprehensive approach, including attention to reducing exposure to environmental inciters of airway inflammation and triggers of symptoms, patient education (including an asthma action plan), and opportunity for close patient-provider communication. Approved medical options include the lipoxygenase inhibitor, zileuton; the anti-immunoglobulin E monoclonal antibody, omalizumab; and bronchial thermoplasty. Nonapproved interventions of potential benefit are ultrahigh-dose inhaled corticosteroids, anticholinergic bronchodilators (tiotropium), macrolide antibiotics, and vitamin D supplementation for the vitamin D-deficient patient. Potentially toxic, "steroid-sparing" therapies such as methotrexate, cyclosporine, and etanercept are best reserved for patients participating in clinical trials. Recognition of specific subtypes of patients with therapy-resistant asthma permits more targeted treatment approaches, such as for aspirin-sensitive asthma, persistent eosinophilic asthma, asthma complicated by allergic bronchopulmonary aspergillosis, asthma with persistent airflow obstruction, and asthma with life-threatening (near fatal) asthmatic attacks. Novel therapies based on an improved understanding of the pathobiology of therapy-resistant asthma are greatly needed.
严重哮喘患者的哮喘相关发病率较高，且有发生严重、危及生命的哮喘加重的风险。他们的治疗需要采用强化和综合的方法，包括减少接触气道炎症和症状触发因素的环境诱因、患者教育（包括哮喘行动计划），以及为患者和医护人员提供密切交流的机会。已批准的治疗选择包括脂氧合酶抑制剂齐留通；抗免疫球蛋白 E 单克隆抗体奥马珠单抗；以及支气管热成形术。潜在有益的非批准干预措施包括超高剂量吸入皮质类固醇、抗胆碱能支气管扩张剂（噻托溴铵）、大环内酯类抗生素和维生素 D 缺乏患者的维生素 D 补充剂。对于参加临床试验的患者，最好保留潜在毒性的“类固醇节省”疗法，如甲氨蝶呤、环孢素和依那西普。识别治疗抵抗性哮喘的特定亚型可允许更具针对性的治疗方法，例如阿司匹林敏感哮喘、持续嗜酸性粒细胞性哮喘、伴有变应性支气管肺曲霉病的哮喘、持续性气流阻塞性哮喘和危及生命（近乎致命）哮喘发作的哮喘。基于对治疗抵抗性哮喘的病理生物学的更好理解，迫切需要新的治疗方法。
