Rebuck A S, Chapman K R
CMAJ. 1987 Mar 1;136(5):483-8.
The most reasonable first therapy for ambulatory asthmatic patients is regular use of a selective beta 2-adrenoreceptor agonist administered with a metered-dose inhaler. When asthma is of more than mild severity, a second agent that acts through a different pharmacologic pathway is added. Although theophylline has traditionally been this second agent, recent concerns about its safety have prompted increasing use of inhalational agents such as corticosteroids, anticholinergics and mast cell stabilizers as appropriate second-line therapy. The use of such combination regimens and newer strategies such as high-dose inhaled corticosteroid therapy will reduce the proportion of patients who require systemic corticosteroid therapy for adequate control of asthma. The use of combination inhalational therapy also has a role in the management of asthma in the emergency department, the combination of a nebulized adrenoreceptor agonist and a nebulized anticholinergic being more effective than either agent alone in acute, severe asthma. The role of newer xanthine derivatives, antihistamines, calcium channel blockers and selective anti-inflammatory agents remains investigational.
对于非卧床哮喘患者，最合理的初始治疗方法是定期使用定量吸入器给予选择性β2肾上腺素能受体激动剂。当哮喘严重程度超过轻度时，需添加一种通过不同药理途径起作用的第二种药物。传统上，茶碱一直是这种第二种药物，但最近对其安全性的担忧促使越来越多地使用吸入性药物，如皮质类固醇、抗胆碱能药物和肥大细胞稳定剂作为合适的二线治疗药物。使用这种联合治疗方案以及高剂量吸入皮质类固醇治疗等新策略，将减少为充分控制哮喘而需要全身使用皮质类固醇治疗的患者比例。联合吸入治疗在急诊科哮喘管理中也有作用，雾化肾上腺素能受体激动剂和雾化抗胆碱能药物联合使用在急性重度哮喘中比单独使用任何一种药物都更有效。新型黄嘌呤衍生物、抗组胺药、钙通道阻滞剂和选择性抗炎药的作用仍在研究中。
