Department of Pediatrics, Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.
Department of Pediatrics, The Breathing Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.
Semin Respir Crit Care Med. 2018 Feb;39(1):36-44. doi: 10.1055/s-0037-1608707. Epub 2018 Feb 10.
Strategies to control the risk domain of NHLBI EPR-3 (National Heart, Lung, and Blood Institute Expert Panel Report-3) asthma guidelines, which includes exacerbations requiring systemic corticosteroids, reduction in lung growth, and progressive loss of lung function, and treatment-related adverse effects, are evolving in children and adolescents. Increasing evidence demonstrates that children and adolescents with asthma are at risk of a reduction in lung growth, leading to lower lung function and potentially chronic obstructive pulmonary disease as adults. Readily available clinical biomarkers for atopy, including aeroallergen testing, total serum IgE, blood eosinophilia, and spirometry, are being utilized to phenotype difficult-to-treat pediatric patients, to assess risk for seasonal exacerbations, and to predict response to controller therapies. The Composite Asthma Severity Index is a novel, freely available scoring system to define asthma control, incorporating NHLBI EPR-3 risk and impairment domains. As new asthma controller therapies, such as tiotropium, are introduced for pediatric use, the safety of established controller therapies including inhaled corticosteroid and long-acting beta-agonist are being reexamined. Macrolide antibiotics may be an oral corticosteroid sparing alternative for the treatment of severe respiratory tract infection in preschool-aged children. Seasonally directed courses of omalizumab may provide an alternative approach to prevent fall asthma exacerbations in children. Combining these pharmaceuticals and biomarker-directed therapies provide potential new options and personalized approaches to gain asthma control in pediatric patients failing current management.
控制 NHLBI EPR-3（美国国立心肺血液研究所专家小组报告-3）哮喘指南风险领域的策略正在儿童和青少年中不断发展，该指南的风险领域包括需要全身皮质类固醇治疗的恶化、肺生长减少以及肺功能进行性丧失和与治疗相关的不良影响。越来越多的证据表明，哮喘儿童和青少年有肺生长减少的风险，导致肺功能降低，成年后可能发展为慢性阻塞性肺疾病。易于获得的特应性临床生物标志物，包括气传过敏原检测、总血清 IgE、血嗜酸性粒细胞计数和肺功能检查，正在被用于对治疗困难的儿科患者进行表型分析，评估季节性恶化的风险，并预测对控制器治疗的反应。综合哮喘严重程度指数是一种新的、免费的评分系统，用于定义哮喘控制，包括 NHLBI EPR-3 的风险和损害领域。随着新型哮喘控制器治疗药物，如噻托溴铵，被引入儿科使用，吸入皮质类固醇和长效β激动剂等已确立的控制器治疗药物的安全性正在重新评估。大环内酯类抗生素可能是治疗学龄前儿童严重呼吸道感染的皮质类固醇替代药物。季节性奥马珠单抗治疗可能是预防儿童秋季哮喘恶化的替代方法。将这些药物和生物标志物导向的治疗方法相结合，为当前管理失败的儿科患者获得哮喘控制提供了潜在的新选择和个性化方法。
