Kupczyk Maciej, Bartuzi Zbigniew, Bodzenta-Łukaszyk Anna, Kulus Marek, Kuna Piotr, Kupryś-Lipińska Izabela, Mazurek Henryk
Clinic of Internal Diseases, Asthma and Allergies, N. Barlicki University Clinical Hospital, Medical University of Lodz, Lodz, Poland.
Department and Clinic of Allergology, Clinical Immunology and Internal Diseases, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland.
Postepy Dermatol Alergol. 2019 Apr;36(2):147-157. doi: 10.5114/ada.2019.84591. Epub 2019 May 14.
Severe asthma requires at least high doses of inhaled corticosteroids (ICS) in combination with a long-acting β-agonist (LABA) or systemic corticosteroids (SCS) for more than 50% of days/year to avoid loss of control, or remains uncontrolled despite the treatment described above. The diagnosis of severe asthma should be confirmed in a reference centre as it requires careful differential diagnosis and the exclusion of factors hindering the achievement of optimal control. Severe asthma represents a significant burden for the patient, their family and the healthcare system. This is due to the severity of the symptoms, drug costs, significant impairment of everyday functioning and life quality, and limitation in the professional work. In the case of ineffectiveness of the step 4 GINA treatment, the patient should be referred to a specialist centre to consider additional treatment, including anti-IgE receptor (omalizumab), anti-IL-5 receptor (mepolizumab), or an antibody directed against the α-subunit of receptor for IL-5 (benralizumab). In the case of severe asthma, intensification of therapy should first of all include biological therapy and not the use of SCS. Biological drugs are available in Poland as a part of the therapeutic programme for the treatment of severe asthma. In practice, the therapeutic programme may change with subsequent notices of the Ministry of Health and does not have to be consistent with the Summary of Product Characteristics for individual preparations. The current review presents the basic principles of differential diagnosis of severe asthma and the selection of the optimal biological therapy in Polish conditions.
重度哮喘患者每年至少有超过50%的天数需要使用高剂量吸入性糖皮质激素（ICS）联合长效β受体激动剂（LABA）或全身用糖皮质激素（SCS），以避免病情失控，或者尽管接受了上述治疗仍未得到控制。重度哮喘的诊断应在参考中心进行确认，因为这需要仔细的鉴别诊断并排除妨碍实现最佳控制的因素。重度哮喘给患者及其家庭以及医疗系统带来了沉重负担。这是由于症状严重、药物费用高、日常功能和生活质量受到严重损害以及职业工作受限所致。如果第4步全球哮喘防治创议（GINA）治疗无效，患者应转诊至专科中心，考虑采用其他治疗方法，包括抗IgE受体（奥马珠单抗）、抗IL-5受体（美泊利单抗）或抗IL-5受体α亚基抗体（贝那利珠单抗）。对于重度哮喘，强化治疗首先应包括生物治疗，而非使用SCS。在波兰，生物药物作为重度哮喘治疗方案的一部分可供使用。实际上，治疗方案可能会随着卫生部随后发布的通知而改变，不一定与各制剂的产品特性摘要一致。本综述介绍了波兰条件下重度哮喘鉴别诊断的基本原则以及最佳生物治疗方法的选择。
