Department of Respiratory Paediatrics, The Royal Brompton Hospital London and Imperial College London, London, UK.
Paediatr Drugs. 2013 Jun;15(3):171-9. doi: 10.1007/s40272-013-0025-5.
Asthma continues to be one of the greatest burdens to healthcare resources throughout the developed world. In most cases, good symptom control can be achieved with low-dose inhaled corticosteroids, and can be cared for in the primary and secondary healthcare systems. However, there is a group in whom control is not achieved despite high-dose inhaled corticosteroids and maximal add-on therapies; these are children with problematic severe asthma that should be referred to a specialist team for further investigation and management. In this review we aimed to provide an evidence-based guide for pediatricians providing care for children with asthma in secondary healthcare settings. The review focuses on a proposed investigation and management strategy for children aged between 6 and 16 years with problematic severe asthma, and is supported as far as possible by evidence from the literature. We first address recent advances in nomenclature and then discuss our proposed course of investigation and management of these children. Distinction of children with true, severe, therapy-resistant asthma from those with asthma that is difficult to treat because of unaddressed underlying modifiable factors is critical and is discussed in detail.
哮喘仍然是发达国家医疗资源的最大负担之一。在大多数情况下，低剂量吸入皮质类固醇可以很好地控制症状，并可以在初级和二级医疗保健系统中进行治疗。然而，有一群患者尽管使用了高剂量吸入皮质类固醇和最大附加治疗仍无法控制病情；这些儿童患有严重的哮喘问题，应转介给专科团队进行进一步的检查和管理。在本次综述中，我们旨在为在二级医疗保健环境中为哮喘患儿提供护理的儿科医生提供循证指南。该综述重点关注 6 至 16 岁患有严重哮喘问题的儿童的拟议检查和管理策略，并尽可能地以文献中的证据为依据。我们首先介绍命名法的最新进展，然后讨论我们对这些儿童的检查和管理建议。区分真正的、严重的、治疗抵抗性哮喘儿童与那些因未解决的可改变的潜在因素而导致难以治疗的哮喘儿童至关重要，我们将详细讨论。
