University of Wisconsin School of Medicine and Public Health, Madison, Wis.
Washington University School of Medicine and St Louis Children's Hospital, St Louis, Mo.
J Allergy Clin Immunol Pract. 2017 Jul-Aug;5(4):889-898. doi: 10.1016/j.jaip.2017.04.031.
Severe asthma in children is associated with significant morbidity and is a highly heterogeneous disorder with multiple clinical phenotypes. Cluster analyses have been performed in several groups to explain some of the heterogeneity of pediatric severe asthma, which is reviewed in this article. The evaluation of a child with severe asthma includes a detailed diagnostic assessment and excluding other possible diagnoses and addressing poor control due to comorbidities, lack of adherence to asthma controller medications, poor technique, and other psychological and environmental factors. Children with severe asthma require significant resources including regular follow-up appointments with asthma education, written asthma action plan, and care by a multidisciplinary team. Management of pediatric severe asthma now includes emerging phenotypic-directed therapies; however, continued research is still needed to further study the long-term outcomes of pediatric severe asthma and its treatment.
儿童重度哮喘与显著的发病率相关,是一种高度异质性疾病,具有多种临床表型。在多个研究组中进行了聚类分析,以解释儿童重度哮喘的部分异质性,本文对此进行了综述。儿童重度哮喘的评估包括详细的诊断评估,排除其他可能的诊断,并针对因合并症导致的控制不佳、未遵医嘱使用哮喘控制药物、技术不佳以及其他心理和环境因素进行治疗。患有重度哮喘的儿童需要大量资源,包括定期随诊、哮喘教育、书面哮喘行动计划以及多学科团队的治疗。目前,儿童重度哮喘的治疗包括新兴的表型靶向治疗;然而,仍需要进一步的研究来深入探讨儿童重度哮喘及其治疗的长期结果。