National Jewish Health, Denver, Colorado.
Ann Allergy Asthma Immunol. 2016 Dec;117(6):582-588. doi: 10.1016/j.anai.2016.07.035.
Inhaled corticosteroids (ICSs) are the mainstay of daily controller treatment for persistent and uncontrolled asthma. However, many clinicians are wary of ICSs because of safety concerns. Clinicians need to know the underlying efficacy data that support the use of ICSs to weigh efficacy against safety.
To discuss efficacy data from pivotal trials to aid clinicians in their decisions to use ICSs.
Key efficacy studies were selected to augment discussion.
Clinical studies have revealed that ICSs are effective in reducing the risk of exacerbations in both children and adults. ICSs also reduce the risk of hospitalization and asthma-related death, improve asthma symptoms, and improve quality of life. In addition, ICSs improve lung function and airway responsiveness and reduce airway inflammation and remodeling. In young children, ICSs improve daytime and nighttime symptoms, improve lung function, reduce the risk of exacerbations, and reduce the need for rescue medications. To date, evidence is conflicting about whether intermittent ICS treatment is as effective as daily ICS treatment. The possibility of lower efficacy of intermittent therapy needs to be weighed against a reduced risk of slowed growth in children.
ICSs effectively reduce the risk of exacerbations, hospitalizations, and asthma-related death and improve asthma symptoms, quality of life, lung function, and airway responsiveness. ICSs also reduce airway inflammation and remodeling. Intermittent therapy may not be as effective as daily therapy, and clinicians should weigh reduced efficacy against reduced risk of adverse effects, particularly slowed growth in children.
吸入性皮质类固醇（ICSs）是持续性和未控制哮喘的日常控制药物治疗的主要药物。然而，许多临床医生因为安全性问题而对 ICSs 持谨慎态度。临床医生需要了解支持 ICSs 使用的基本疗效数据，以便权衡疗效和安全性。
讨论关键性试验的疗效数据，以帮助临床医生做出使用 ICSs 的决策。
选择了关键的疗效研究来进行讨论。
临床研究表明，ICSs 可有效降低儿童和成人发生加重的风险。ICSs 还降低了住院和哮喘相关死亡的风险，改善了哮喘症状，并提高了生活质量。此外，ICSs 改善了肺功能和气道反应性，并减少了气道炎症和重塑。在幼儿中，ICSs 改善了日间和夜间症状，改善了肺功能，降低了加重的风险，并减少了急救药物的需求。迄今为止，关于间歇性 ICS 治疗是否与每日 ICS 治疗同样有效，证据存在争议。需要权衡间歇性治疗效果较低的可能性与儿童生长发育迟缓风险降低的可能性。
ICSs 可有效降低加重、住院和哮喘相关死亡的风险，改善哮喘症状、生活质量、肺功能和气道反应性。ICSs 还减少了气道炎症和重塑。间歇性治疗可能不如每日治疗有效，临床医生应权衡疗效降低与不良反应风险降低（尤其是儿童生长发育迟缓）的可能性。
