Brussino Luisa, Solidoro Paolo, Rolla Giovanni
Allergy and Clinical Immunology, University of Torino and Mauriziano Hospital.
SC Pneumologia U, AOU Città della Salute e della Scienza, Torino, Italy.
J Asthma Allergy. 2017 Nov 29;10:303-305. doi: 10.2147/JAA.S150462. eCollection 2017.
Severe asthma is defined as asthma that requires treatment with high-dose inhaled corticosteroids (ICSs) plus a second controller and/or systemic corticosteroids to prevent it from becoming uncontrolled or that remains uncontrolled despite this therapy. This definition has limitations: 1) it does not define any biological characteristic that distinguishes severe asthma from asthma in general and 2) it relies on the clinical interpretation of asthma symptoms that are not specific. Actually, wheezing, dyspnea, cough and chest tightness may be caused by the comorbidities (such as rhinosinusitis, obesity and vocal cord dysfunction [VCD]) which are associated with asthma. In clinical practice, clinicians are often prone to diagnose uncontrolled asthma and increase doses of ICSs without considering the comorbidities, resulting in poor control of symptoms. This commentary wishes the clinicians to focus on the comorbidities of asthma, particularly in patients with severe asthma, because the correct diagnosis of these comorbidities implies specific treatments that lead to a better asthma control.
需要使用高剂量吸入性糖皮质激素（ICS）加第二种控制药物和/或全身用糖皮质激素进行治疗，以防止病情失控，或尽管进行了这种治疗仍未得到控制的哮喘。这个定义存在局限性：1）它没有定义任何将重度哮喘与一般哮喘区分开来的生物学特征；2）它依赖于对非特异性哮喘症状的临床解读。实际上，喘息、呼吸困难、咳嗽和胸闷可能由与哮喘相关的合并症（如鼻-鼻窦炎、肥胖和声带功能障碍[VCD]）引起。在临床实践中，临床医生往往倾向于在不考虑合并症的情况下诊断哮喘控制不佳并增加ICS剂量，导致症状控制不佳。本评论希望临床医生关注哮喘的合并症，尤其是重度哮喘患者，因为正确诊断这些合并症意味着采取特定治疗方法，从而更好地控制哮喘。
