Faculty of Health Sciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
Section of Cardiorespiratory and Internal Medicine, Dept of Medical Sciences, University of Ferrara, Ferrara, Italy.
Eur Respir J. 2019 Jul 18;54(1). doi: 10.1183/13993003.00491-2019. Print 2019 Jul.
Overall, asthma mortality rates have declined dramatically in the last 30 years, due to improved diagnosis and to better treatment, particularly in the 1990s following the more widespread use of inhaled corticosteroids (ICSs). The impact of ICS on other long-term outcomes, such as lung function decline, is less certain, in part because the factors associated with these outcomes are incompletely understood. The purpose of this review is to evaluate the effect of pharmacological interventions, particularly ICS, on asthma progression and mortality. Furthermore, we review the potential mechanisms of action of pharmacotherapy on asthma progression and mortality, the effects of ICS on long-term changes in lung function, and the role of ICS in various asthma phenotypes.Overall, there is compelling evidence of the value of ICS in improving asthma control, as measured by improved symptoms, pulmonary function and reduced exacerbations. There is, however, less convincing evidence that ICS prevents the decline in pulmonary function that occurs in some, although not all, patients with asthma. Severe exacerbations are associated with a more rapid decline in pulmonary function, and by reducing the risk of severe exacerbations, it is likely that ICS will, at least partially, prevent this decline. Studies using administrative databases also support an important role for ICS in reducing asthma mortality, but the fact that asthma mortality is, fortunately, an uncommon event makes it highly improbable that this will be demonstrated in prospective trials.
总的来说，由于诊断水平的提高和治疗方法的改进，尤其是在 20 世纪 90 年代吸入性皮质类固醇（ICS）更广泛应用之后，过去 30 年来哮喘死亡率显著下降。ICS 对其他长期结果（如肺功能下降）的影响尚不确定，部分原因是这些结果相关的因素尚未完全了解。本综述的目的是评估药物干预，特别是 ICS，对哮喘进展和死亡率的影响。此外，我们还综述了药物治疗对哮喘进展和死亡率的潜在作用机制、ICS 对肺功能长期变化的影响，以及 ICS 在各种哮喘表型中的作用。总的来说，有强有力的证据表明 ICS 在改善哮喘控制方面具有价值，这可以通过改善症状、肺功能和减少发作来衡量。然而，令人信服的证据表明，ICS 可以预防一些（尽管不是所有）哮喘患者肺功能下降的证据较少。严重的加重与肺功能下降更快有关，通过降低严重加重的风险，ICS 可能会在一定程度上预防这种下降。使用管理数据库的研究也支持 ICS 在降低哮喘死亡率方面的重要作用，但幸运的是，哮喘死亡率是一种罕见的事件，这使得在前瞻性试验中证明这一点极不可能。
