Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada.
Department of Pediatrics, Section of Pediatric Pulmonary Medicine, University of Colorado School of Medicine, Aurora, CO, USA; Children's Hospital Colorado, Aurora, CO, USA.
Lancet Respir Med. 2017 Oct;5(10):827-834. doi: 10.1016/S2213-2600(17)30295-3. Epub 2017 Aug 2.
Although early childhood wheeze is common, persistent asthma is less common. However, of those children who do progress to persistent asthma, lung function abnormalities and airway remodelling can already be seen early in life and can increase in magnitude with time. There has been a general expectation that early use of inhaled corticosteroid (ICS) could change the natural history of asthma if started in the young child with wheeze. Despite this expectation, the role of ICS therapy in altering the natural course of disease in children with emerging asthma is not well defined. Here we discuss the potential use of ICS therapy to alter the natural disease course in children at risk of persistent asthma (defined as wheeze and presence of airflow limitation or airway hyper-reactivity, or both). We present new information suggesting a more personalised treatment approach in which children might benefit from daily or intermittent ICS therapy. We also provide an overview of other emerging therapies that might be useful in disease modification for the wheezing young child at risk of persistent asthma.
虽然儿童期早期喘息很常见，但持续性哮喘则较为少见。然而，对于那些确实发展为持续性哮喘的儿童，肺功能异常和气道重塑在生命早期就已经可见，并随着时间的推移而逐渐加重。人们普遍期望，如果在有喘息的幼儿中早期使用吸入性皮质类固醇（ICS），可以改变哮喘的自然病程。尽管有这种期望，但ICS 治疗在改变患有新发哮喘儿童疾病自然病程中的作用尚不清楚。在这里，我们讨论了使用 ICS 治疗来改变有持续性哮喘风险（定义为喘息和存在气流受限或气道高反应性，或两者兼有）儿童自然疾病病程的可能性。我们提供了新的信息，表明在治疗可能受益于每日或间歇性 ICS 治疗的儿童时，可以采用更个性化的治疗方法。我们还概述了其他新兴疗法，这些疗法可能对有持续性哮喘风险的喘息幼儿的疾病改善有用。
