Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada.
Department of Pediatrics, Section of Pulmonology, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado.
Ann Allergy Asthma Immunol. 2016 Dec;117(6):627-633. doi: 10.1016/j.anai.2016.09.438. Epub 2016 Oct 27.
To provide an evidence-based review on the role of pharmacologic (inhaled corticosteroids, leukotriene receptor antagonists, biologic therapies, aeroallergen immunotherapy) and nonpharmacologic therapies (environmental modifications, microbiome) in secondary and tertiary asthma prevention.
A PubMed search for English-language publications regarding asthma and secondary or tertiary prevention was performed. Some articles cited in selected studies were also considered for inclusion in this review.
Studies were included that were original research and specifically addressed the question of asthma prevention and use of pharmacologic or nonpharmacologic therapies. When possible, we selected the articles with the most robust level of evidence.
More than 100 articles were initially identified, 79 were reviewed in depth, and 60 were included in this review. Several studies suggest no disease-modifying effect for inhaled corticosteroids. Small studies suggest a tertiary preventive effect for leukotriene receptor antagonists. Biological therapies have somewhat conflicting evidence with a paucity of pediatric data, although some have tremendous promise. A role of allergen immunotherapy (specifically pollen) in secondary asthma prevention has been suggested, with no firm conclusions possible for tertiary prevention. One large trial suggests a role for environmental modifications in secondary asthma prevention, whereas the preponderance of evidence does not suggest a role in tertiary prevention. The microbiome is an active area of research that has promise for a disease-modifying effect.
Further work needs to be performed to allow physicians to intervene early and alter the natural course of asthma in children.
提供一篇关于药物治疗（吸入皮质激素、白三烯受体拮抗剂、生物疗法、变应原免疫疗法）和非药物治疗（环境改变、微生物组）在二级和三级哮喘预防中的作用的循证综述。
对有关哮喘二级和三级预防的英文文献进行了 PubMed 检索。对一些选定研究中引用的文章也进行了考虑，以纳入本综述。
纳入了关于哮喘预防和使用药物或非药物治疗的原始研究，并专门探讨了这个问题。在可能的情况下，我们选择了最具说服力的证据水平的文章。
最初确定了 100 多篇文章，对其中 79 篇进行了深入审查，有 60 篇被纳入了本综述。有几项研究表明吸入皮质激素对疾病没有改善作用。一些小型研究表明白三烯受体拮抗剂对三级预防有作用。生物疗法的证据存在一定的矛盾，而且缺乏儿科数据，尽管有些具有巨大的潜力。有研究提示变应原免疫疗法（特别是花粉）对二级哮喘预防有作用，但对三级预防则无定论。一项大型试验提示环境改变对二级哮喘预防有作用，但大多数证据表明其对三级预防无作用。微生物组是一个活跃的研究领域，有改善疾病的潜力。
需要进一步开展工作，使医生能够及早干预，并改变儿童哮喘的自然病程。
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