Abrams Elissa M, Raissy Hengameh H
Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, Canada.
Department of Pediatrics, School of Medicine, University of New Mexico, Albuquerque, New Mexico.
Pediatr Allergy Immunol Pulmonol. 2019 Jun 1;32(2):78-80. doi: 10.1089/ped.2019.1043. Epub 2019 Jun 17.
Phenotypic variation in asthma, especially early childhood asthma, is increasingly recognized. Although inhaled corticosteroids are recommended as first-line therapy, it has less efficacy in controlling intermittent wheeze due to viral-induced symptoms in early childhood. This article reviews 2 emerging therapies in particular for early childhood wheeze: azithromycin and bacterial lysate therapy. Azithromycin's effects are both antibacterial and anti-inflammatory, and it has been shown in 2 studies in preschoolers to prevent progression to severe respiratory tract infection and decrease duration of wheeze. Bacterial lysates work at multiple stages in the innate and adaptive immune response and have been shown to decrease mean wheeze duration in particular in the preschool age. More research is required although both therapies offer a promising future approach, in particular in the nonatopic preschool wheezer, as we move toward a more personalized approach to childhood asthma.
哮喘的表型变异，尤其是儿童早期哮喘，越来越受到人们的认识。尽管吸入性糖皮质激素被推荐作为一线治疗药物，但它在控制儿童早期由病毒引起症状的间歇性喘息方面疗效较差。本文特别综述了两种针对儿童早期喘息的新兴疗法：阿奇霉素和细菌溶解产物疗法。阿奇霉素具有抗菌和抗炎作用，两项针对学龄前儿童的研究表明，它能预防进展为严重呼吸道感染并缩短喘息持续时间。细菌溶解产物在先天性和适应性免疫反应的多个阶段发挥作用，尤其在学龄前儿童中已显示能缩短平均喘息持续时间。尽管这两种疗法都提供了一种有前景的未来治疗方法，特别是对于非特应性学龄前喘息患儿，随着我们朝着更个性化的儿童哮喘治疗方法发展，仍需要更多的研究。
