Porsbjerg Celeste, Menzies-Gow Andrew
Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
Royal Brompton and Harefield NHS Foundation Trust, London, UK.
Respirology. 2017 May;22(4):651-661. doi: 10.1111/resp.13026. Epub 2017 Mar 22.
Patients with severe asthma represent a minority of the total asthma population, but carry a majority of the morbidity and healthcare costs. Achieving better asthma control in this group of patients is therefore of key importance. Systematic assessment of patients with possible severe asthma to identify treatment barriers and triggers of asthma symptoms, including co-morbidities, improves asthma control and reduces healthcare costs and is recommended by international guidelines on management of severe asthma. This review provides the clinician with an overview of the prevalence and clinical impact of the most common co-morbidities in severe asthma, including chronic rhinosinusitis, nasal polyposis, allergic rhinitis, dysfunctional breathing, vocal cord dysfunction, anxiety and depression, obesity, obstructive sleep apnoea syndrome (OSAS), gastroesophageal reflux disease (GERD), bronchiectasis, allergic bronchopulmonary aspergillosis (ABPA) and eosinophilic granulomatous with polyangiitis (EGPA). Furthermore, the review offers a summary of recommended diagnostic and management approaches for each co-morbidity. Finally, the review links co-morbid conditions to specific phenotypes of severe asthma, in order to guide the clinician on which co-morbidities to look for in specific patients.
重度哮喘患者在整个哮喘人群中占少数，但却承担了大部分的发病率和医疗费用。因此，在这组患者中实现更好的哮喘控制至关重要。对可能患有重度哮喘的患者进行系统评估，以识别治疗障碍和哮喘症状的触发因素，包括合并症，可改善哮喘控制并降低医疗费用，这是重度哮喘管理国际指南所推荐的。本综述为临床医生提供了重度哮喘最常见合并症的患病率及临床影响概述，包括慢性鼻-鼻窦炎、鼻息肉病、过敏性鼻炎、功能性呼吸障碍、声带功能障碍、焦虑和抑郁、肥胖、阻塞性睡眠呼吸暂停综合征（OSAS）、胃食管反流病（GERD）、支气管扩张症、变应性支气管肺曲霉病（ABPA）和嗜酸性肉芽肿性多血管炎（EGPA）。此外，该综述还总结了每种合并症的推荐诊断和管理方法。最后，本综述将合并症与重度哮喘的特定表型联系起来，以便指导临床医生在特定患者中寻找哪些合并症。
