Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland).
Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China (mainland).
Am J Case Rep. 2020 Apr 18;21:e921120. doi: 10.12659/AJCR.921120.
BACKGROUND Despite the availability of inhaled corticosteroid and the development of various biological treatment agents, severe asthma patients are still at high risk of recurrent and life-threatening exacerbations, which results in morbidity and mortality. In addition to treatment response variability, incorrect inhaler technique, poor adherence, and major psychological problems, environmental factors such as climate change also are contributory factors for worsen symptoms of asthma and acute exacerbation. We present here, a case of a 63-year-old female patient who had oral corticosteroid-dependent severe asthma and recurrent attacks in spring and autumn. CASE REPORT A 63-year-old Chinese female was diagnosed with asthma when she was 3 years old. During 2007-2011, she was admitted to the hospital once a year because of asthma exacerbation; she was on a regular treatment regimen of inhaled corticosteroids (ICS) plus long-acting beta-agonist (LABA). In October 2018, she was admitted to our Department for aggravating symptoms due to "sudden climate change". She was discharged on tapering doses of oral methylprednisolone from 32 mg once daily, but the reduced methylprednisolone resulted in aggravation of wheezing. However, when the weather warmed up, her symptoms were relieved, and she stopped taking methylprednisolone (after the tapering). CONCLUSIONS This study suggests an association between the common causes of weather changes and acute severe asthma exacerbation. Patients and clinicians should be aware that keeping warm and avoiding exposure to cold air and airborne allergens might reduce the frequency of asthma exacerbations.
背景 尽管有吸入性皮质类固醇和各种生物治疗药物的发展，严重哮喘患者仍有反复发作和危及生命的加重的高风险，这导致发病率和死亡率增加。除了治疗反应的可变性、不正确的吸入器技术、较差的依从性和主要的心理问题外，气候变化等环境因素也是哮喘症状恶化和急性加重的促成因素。我们在此介绍一例 63 岁女性患者，她患有口服皮质类固醇依赖的严重哮喘，春秋两季反复发作。
病例报告 一位 63 岁的中国女性，3 岁时被诊断为哮喘。2007 年至 2011 年期间，她每年因哮喘加重而住院一次；她接受了吸入皮质类固醇（ICS）加长效β激动剂（LABA）的常规治疗方案。2018 年 10 月，她因“突然气候变化”导致症状加重而入住我科。她接受了每日 32 毫克口服甲泼尼龙的逐渐减量治疗，但甲泼尼龙的减少导致喘息加重。然而，当天气变暖时，她的症状得到缓解，她停止服用甲泼尼龙（逐渐减量后）。
结论 本研究提示气候变化的常见原因与急性严重哮喘加重之间存在关联。患者和临床医生应意识到保持温暖和避免接触冷空气和空气传播过敏原可能会减少哮喘加重的频率。
