Falk Nathan
Florida Hospital Family Medicine Residency, 133 Benmore Drive, Winter Park, FL 32792.
FP Essent. 2018 Sep;472:25-29.
Asthma is a heterogeneous condition involving various levels of chronic airway inflammation, bronchoconstriction, airway hyperresponsiveness, and mucus production. Although inhaled corticosteroids and long-acting bronchodilators have improved patient outcomes, asthma remains uncontrolled for at least 10% of patients, even when use of these therapies is maximized. Improved understanding of the biology, genetics, and role of immune cell signaling in asthma has led to the development of immunobiologic therapies. They are administered subcutaneously or intravenously and target immunoglobulin E or interleukins that are involved in the allergic response. In patients with allergic asthma, immunotherapy has been shown to reduce exacerbations, decrease the need for drug use, and reduce the overall cost of care. Allergy immunotherapy, traditionally administered via subcutaneous injections, can be effective in the management of allergic asthma. Sublingual allergy immunotherapy is an option for treating adults with asthma due to dust mite allergy. Bronchial thermoplasty is a procedure used to treat some patients with severe asthma that remains uncontrolled despite appropriate use of traditional asthma drugs. Asthma action plans have been shown to decrease exacerbations and emergency department admissions. These plans incorporate self-monitoring for symptoms, appropriate drug use, and self-management plans for acute symptoms.
哮喘是一种异质性疾病，涉及不同程度的慢性气道炎症、支气管收缩、气道高反应性和黏液分泌。尽管吸入性糖皮质激素和长效支气管扩张剂改善了患者的治疗效果，但即使将这些疗法的使用最大化，仍有至少10%的患者哮喘控制不佳。对哮喘生物学、遗传学以及免疫细胞信号传导作用的深入了解，促使了免疫生物疗法的发展。这些疗法通过皮下或静脉注射给药，靶向参与过敏反应的免疫球蛋白E或白细胞介素。在过敏性哮喘患者中，免疫疗法已被证明可减少病情加重、降低药物使用需求并降低总体护理成本。传统上通过皮下注射给药的变应原免疫疗法，在过敏性哮喘的管理中可能有效。舌下变应原免疫疗法是治疗因尘螨过敏引起哮喘的成人患者的一种选择。支气管热成形术是一种用于治疗部分严重哮喘患者的手术，这些患者尽管适当使用了传统哮喘药物，但病情仍未得到控制。哮喘行动计划已被证明可减少病情加重和急诊入院。这些计划包括症状自我监测、适当的药物使用以及急性症状的自我管理计划。
