Isala Hospital, Zwolle.
Eur Respir J. 2014 Apr;43(4):1172-7. doi: 10.1183/09031936.00199913. Epub 2014 Feb 13.
Since the publication of the European Respiratory Society Task Force report in 2008, significant new evidence has become available on the classification and management of preschool wheezing disorders. In this report, an international consensus group reviews this new evidence and proposes some modifications to the recommendations made in 2008. Specifically, the consensus group acknowledges that wheeze patterns in young children vary over time and with treatment, rendering the distinction between episodic viral wheeze and multiple-trigger wheeze unclear in many patients. Inhaled corticosteroids remain first-line treatment for multiple-trigger wheeze, but may also be considered in patients with episodic viral wheeze with frequent or severe episodes, or when the clinician suspects that interval symptoms are being under reported. Any controller therapy should be viewed as a treatment trial, with scheduled close follow-up to monitor treatment effect. The group recommends discontinuing treatment if there is no benefit and taking favourable natural history into account when making decisions about long-term therapy. Oral corticosteroids are not indicated in mild-to-moderate acute wheeze episodes and should be reserved for severe exacerbations in hospitalised patients. Future research should focus on better clinical and genetic markers, as well as biomarkers, of disease severity.
自 2008 年欧洲呼吸学会工作组报告发布以来，关于学龄前喘息性疾病的分类和管理，已经有了大量新的重要证据。在本报告中，一个国际共识小组回顾了这些新证据，并对 2008 年提出的建议进行了一些修改。具体而言，共识小组承认，幼儿的喘息模式随时间和治疗而变化，使得许多患者的偶发性病毒性喘息和多触发喘息之间的区别变得不明确。吸入性皮质类固醇仍然是多触发喘息的一线治疗药物，但对于偶发性病毒性喘息、频繁或严重发作的患者，或当临床医生怀疑间隔期症状报告不足时，也可考虑使用。任何控制药物治疗都应视为治疗试验，需要进行密切的随访以监测治疗效果。如果没有获益，该小组建议停止治疗，并在做出长期治疗决策时考虑有利的自然病史。轻度至中度急性喘息发作时，不建议使用口服皮质类固醇，应保留给住院患者严重恶化时使用。未来的研究应侧重于更好的临床和遗传标志物，以及疾病严重程度的生物标志物。
