Department of Pediatric Respiratory Medicine, NHS Foundation Trust, King's College Hospital, Denmark Hill, London, UK.
King's College London, London, UK.
Indian J Pediatr. 2018 Sep;85(9):773-781. doi: 10.1007/s12098-018-2705-1. Epub 2018 Jun 9.
Asthma still causes considerable morbidity and mortality globally and minimal improvement has been seen in key outcomes over the last decade despite increasing treatment costs. This review summarizes recent advances in the management of asthma in children and adolescents. It focuses on the need for personalized treatment plans based on heterogenous asthma pathophysiology, the use of the terminology 'asthma attack' over exacerbation to instill widespread understanding of severity, and the need for every attack to trigger a structured review and focused strategy. The authors discuss difficulties in diagnosing asthma, accuracy and use of Fractional exhaled nitric oxide both as second line test and as a method to monitor treatment adherence or guide the choice of pharmacotherapy. The authors discuss acute and long-term management of asthma. Asthma treatment goals are to minimize symptom burden, prevent attacks and (where possible) reduce risk and impact of progressive pathophysiology and adverse outcomes. The authors discuss pharmacological management; optimal use of short acting β agonists, long acting muscarinic antagonist (tiotropium), use of which is relatively new in pediatrics, allergen specific immunotherapy, biological monoclonal antibody treatment, azalide antibiotic azithromycin, and the use of vitamin D. They also discuss electronic monitoring and adherence devices, direct observation of therapy via mobile device, temperature controlled laminar airflow device, and the importance of considering when symptoms may actually result from dysfunctional breathing rather than asthma.
哮喘在全球范围内仍导致相当高的发病率和死亡率，尽管治疗费用不断增加，但在过去十年中，关键结局几乎没有改善。本综述总结了儿童和青少年哮喘管理的最新进展。它侧重于根据异质性哮喘病理生理学制定个性化治疗计划的必要性，使用“哮喘发作”而非“加重”来灌输对严重程度的广泛理解，以及每次发作都需要触发结构化审查和重点策略的必要性。作者讨论了诊断哮喘的困难、呼出气一氧化氮分数的准确性和使用，既可以作为二线测试，也可以作为监测治疗依从性或指导药物治疗选择的方法。作者讨论了哮喘的急性和长期管理。哮喘治疗的目标是最大限度地减少症状负担，预防发作，并（在可能的情况下）降低进展性病理生理学和不良结局的风险和影响。作者讨论了药物治疗管理；短效β激动剂、长效毒蕈碱拮抗剂（噻托溴铵）的最佳使用，后者在儿科中相对较新，过敏原特异性免疫治疗、生物单克隆抗体治疗、氮杂内酯抗生素阿奇霉素以及维生素 D 的使用。他们还讨论了电子监测和依从性设备、通过移动设备进行治疗的直接观察、温度控制层流空气装置，以及考虑何时症状实际上可能是由于呼吸功能障碍而不是哮喘引起的重要性。
