Department of Respiratory Medicine, The Children's Hospital at Westmead, NSW 2145, Australia.
Paediatr Drugs. 2013 Aug;15(4):291-302. doi: 10.1007/s40272-013-0020-x.
Asthma control remains a significant challenge in the pediatric age range in which ongoing loss of lung function in children with persistent asthma has been reported, despite the use of regular preventer therapy. This has important implications for observed mortality and morbidity during adulthood. Over the past decade, there has been an emergence of other treatment adjuncts, such as anti-Immunoglobulin E (IgE)-directed therapy, low dose theophylline, and the use of macrolide antibiotics, yet their exact role in asthma management remains unclear, despite omalizumab now being incorporated into several international asthma guidelines. As with many aspects of pediatric care, this is driven by a lack of appropriately designed pediatric trials. Extrapolation of data reported in adult studies may be appropriate for adolescent asthma, but is not for younger age groups, in which important pathophysiological differences exist. Novel drugs under development offer potential for benefit in the future, but to date existing data are in most cases limited to adults. Pediatric asthma also offers unique potential to prevent or modify the underlying pathophysiology. Although attempts to do so have been unsuccessful to date, advances may yet come from this approach, as our understanding about the interaction between genetics, environmental factors, and viral illness improve. This review provides an overview of the newer treatment options available for management of pediatric asthma and discusses the merits of other novel therapies in development, as we search to optimize management and improve future outcomes.
哮喘控制在儿科范围内仍然是一个重大挑战，尽管使用了常规预防治疗，但据报道，持续性哮喘儿童的肺功能仍在持续丧失。这对成年期观察到的死亡率和发病率有重要影响。在过去十年中，出现了其他治疗辅助手段，如抗免疫球蛋白 E（IgE）导向治疗、低剂量茶碱和大环内酯类抗生素的使用，但它们在哮喘管理中的确切作用仍不清楚，尽管奥马珠单抗现在已被纳入几个国际哮喘指南。与儿科护理的许多方面一样，这是由缺乏适当设计的儿科试验驱动的。在成人研究中报告的数据的推断可能适用于青少年哮喘，但不适用于年龄较小的儿童，因为这些儿童存在重要的病理生理学差异。正在开发的新药有望在未来带来益处，但迄今为止，现有数据在大多数情况下仅限于成人。儿科哮喘也为预防或改变潜在的病理生理学提供了独特的潜力。尽管迄今为止尝试这样做没有成功，但随着我们对遗传、环境因素和病毒感染之间相互作用的理解的提高，这种方法可能会取得进展。本文综述了儿科哮喘管理中可用的新治疗选择，并讨论了其他新型治疗方法的优势，因为我们正在寻求优化管理和改善未来的结果。
