Pediatric Asthma Research Program and The Breathing Institute, Children's Hospital Colorado, University Colorado School of Medicine, Aurora, Colorado.
Capital Allergy & Respiratory Disease Center, Sacramento, California.
Ann Allergy Asthma Immunol. 2018 Apr;120(4):382-388. doi: 10.1016/j.anai.2018.01.003.
Despite the availability of effective treatments, asthma control in children and adolescents remains inadequate and rates of health care use are high. This follow-up to a recent review (O'Byrne et al, Eur Respir J. 2017;50[3]) examines a number of challenges in current pediatric asthma management compared with that of an adult perspective and discusses possible alternative strategies that might improve pediatric asthma management and control.
The evidence base for this review is limited because, historically, much of the research has been performed in adults.
Not applicable.
Pediatric asthma management is complicated by variability in asthma severity and control and difficulty in measuring pulmonary function and airway inflammation. Current challenges in pediatric asthma management include the recommended initial therapy treating only the symptoms rather than the underlying inflammation and switching to controller therapy only when asthma subsequently worsens.
Alternative strategies that might improve pediatric asthma management and control include replacement of short-acting β-agonist relievers by an inhaled corticosteroid plus a fast-acting β-agonist (short-acting β-agonist or fast- and long-acting β-agonist) combination at Global Initiative for Asthma step 1 or 2 to ensure that patients receive an inhaled corticosteroid whenever they feel the need for symptomatic relief. Such an approach could eliminate the problem of learned overuse or over-reliance on short-acting β-agonist reliever medication and address the other challenges in current pediatric asthma management. Clinical studies in pediatric patients or large studies involving a proportion of pediatric patients are required to provide the supporting evidence needed to help advance such new approaches and improve asthma control from a pediatric perspective.
尽管有有效的治疗方法，但儿童和青少年的哮喘控制仍然不理想，且卫生保健利用率居高不下。本研究是对最近一篇综述（O'Byrne 等，Eur Respir J. 2017;50[3]）的跟进，该综述从成人角度出发，探讨了当前儿童哮喘管理中存在的一些挑战，并讨论了可能改善儿童哮喘管理和控制的替代策略。
由于历史上大部分研究都是在成人中进行的，因此本次综述的证据基础有限。
不适用。
儿童哮喘管理较为复杂，其严重程度和控制情况存在差异，且肺功能和气道炎症的测量存在困难。目前儿童哮喘管理面临的挑战包括，推荐的初始治疗仅针对症状，而非潜在炎症，以及仅在哮喘随后恶化时才转为控制治疗。
可能改善儿童哮喘管理和控制的替代策略包括，在全球哮喘倡议（GINA）第 1 或 2 步，用吸入皮质激素加快速起效的β-激动剂（短效β-激动剂或快速和长效β-激动剂）替代短效β-激动剂缓解剂，以确保患者在需要缓解症状时就使用吸入皮质激素。这种方法可以消除因学会过度使用或过度依赖短效β-激动剂缓解药物而导致的问题，并解决当前儿童哮喘管理中的其他挑战。需要在儿科患者中开展临床研究或涉及一定比例儿科患者的大型研究，以提供必要的支持证据，从而帮助推进这些新方法，并从儿科角度改善哮喘控制。
