Graham LeRoy M, Eid Nemr
Georgia Pediatric Pulmonology Associates, Morehouse School of Medicine , Atlanta, GA , USA.
Curr Med Res Opin. 2015 Apr;31(4):825-35. doi: 10.1185/03007995.2014.1001062. Epub 2015 Feb 9.
To review the pathophysiologic mechanisms underlying asthma exacerbations, the impact of exacerbations, and both current and future treatment strategies to establish asthma control and reduce the risk of future exacerbations.
Relevant adult data were identified via PubMed, with additional references obtained by reviewing bibliographies from selected articles.
Asthma exacerbations or 'attacks' are acute episodes of progressive worsening of symptoms which occur in patients with all degrees of asthma severity and are an important cause of morbidity and mortality. For patients, these asthma attacks constitute a considerable part of the disease burden in terms of both personal suffering and economic impact. Exacerbations are characterized in part by decreases in expiratory flow or lung function. The pathophysiologic mechanism underlying these changes is likely to be different depending on the specific asthma phenotype. Asthma exacerbations are commonly initiated by upper respiratory tract infections and/or environmental allergens, although there are other known factors which increase the risk of a patient developing exacerbations, such as cigarette smoking. Establishing asthma control and reducing the risk of future exacerbations is the main goal of asthma treatment. Inhaled corticosteroids alone or in combination with long-acting β2-agonists, in addition to other step-up strategies such as leukotriene receptor antagonists and theophylline, are recommended. The anti-immunoglobulin E monoclonal antibody omalizumab should also be considered in difficult-to-treat allergic asthma.
Despite the currently available treatments, many patients with asthma remain symptomatic and experience exacerbations regardless of disease severity. New therapies, including long-acting anticholinergics, anti-cytokines, and chemoattractant receptor-homologous molecules, are under investigation with some promising results. In addition to increased education and use of self-management plans, these novel therapies are essential to help improve asthma control and reduce exacerbation risk.
综述哮喘急性加重的病理生理机制、急性加重的影响以及当前和未来建立哮喘控制并降低未来急性加重风险的治疗策略。
通过PubMed识别相关成人数据，并通过查阅所选文章的参考文献获取其他资料。
哮喘急性加重或“发作”是症状进行性加重的急性发作，发生于所有哮喘严重程度的患者中，是发病和死亡的重要原因。对患者而言，这些哮喘发作在个人痛苦和经济影响方面都构成了相当大的疾病负担。急性加重部分表现为呼气流量或肺功能下降。这些变化背后的病理生理机制可能因特定的哮喘表型而异。哮喘急性加重通常由上呼吸道感染和/或环境过敏原引发，不过还有其他已知因素会增加患者发生急性加重的风险，如吸烟。建立哮喘控制并降低未来急性加重风险是哮喘治疗的主要目标。推荐单独使用吸入性糖皮质激素或与长效β2受体激动剂联合使用，此外还可采用其他逐步升级的策略，如白三烯受体拮抗剂和茶碱。对于难治性过敏性哮喘，也应考虑使用抗免疫球蛋白E单克隆抗体奥马珠单抗。
尽管有目前可用的治疗方法，但许多哮喘患者仍有症状，且无论疾病严重程度如何都会出现急性加重。包括长效抗胆碱能药物、抗细胞因子和趋化因子受体同源分子在内的新疗法正在研究中，取得了一些有前景的结果。除了加强教育和使用自我管理计划外，这些新疗法对于帮助改善哮喘控制和降低急性加重风险至关重要。
