Department of Biomedical Sciences, Humanitas University.
Personalized Medicine, Asthma and Allergy Unit, Istituto Clinico Humanitas, Humanitas Research Hospital, Milan.
Curr Opin Allergy Clin Immunol. 2019 Feb;19(1):61-67. doi: 10.1097/ACI.0000000000000493.
Severe asthmatics, despite the chronic use of high inhaled corticosteroids (ICS) doses and frequent intake of systemic corticosteroids, remains clinically and/or functionally uncontrolled. These patients are also often affected by rhinitis or chronic rhinosinusitis requiring frequent use of intranasal corticosteroids. Therefore, severe asthmatics are exposed to an overload of corticosteroids that is frequently associated with relevant and costly adverse events. This clinical problem and the strategies to overcome it are here summarized.
Different therapeutic options may help in reducing the corticosteroid load in asthmatics, ranging from allergy immunotherapy (nonsuitable for severe uncontrolled patients), immunosuppressant agents like methotrexate or cyclosporine, novel biologic drugs (mainly anti-IgE, anti-IL5 and anti-IL4-receptor-alpha), and aspirin desensitization (for patients with anti-inflammatory drugs exacerbated respiratory disease).
The evidence of even serious corticosteroid-related adverse events associated with consistent health-care costs, should prompt the entire scientific community and health regulatory authorities to promote actions to increase the use of well tolerated and effective strategies to reduce the corticosteroid need in asthmatics; the most promising option seems to be the add-on use of biologic agents.
尽管严重哮喘患者长期使用大剂量吸入性皮质类固醇（ICS）和频繁全身应用皮质类固醇，其临床和/或功能仍无法得到控制。这些患者还常患有鼻炎或慢性鼻-鼻窦炎，需要频繁使用鼻内皮质类固醇。因此，严重哮喘患者暴露于皮质类固醇过载下，常与相关且昂贵的不良反应相关。现就这一临床问题及其应对策略进行综述。
可通过多种治疗方案减少哮喘患者的皮质类固醇负荷，包括变应原免疫治疗（不适合严重未控制的患者）、免疫抑制剂（如甲氨蝶呤或环孢素）、新型生物药物（主要为抗 IgE、抗 IL5 和抗 IL4-受体-α）和阿司匹林脱敏（用于抗炎药物诱发的呼吸疾病患者）。
皮质类固醇相关严重不良反应的证据以及不断增加的医疗保健费用，应促使整个科学界和卫生监管机构采取行动，增加使用耐受良好且有效的策略来减少哮喘患者的皮质类固醇需求；最有前景的选择似乎是添加生物制剂。
