Department of Medicine, Surgery and Dentistry, University of Salerno , Salerno, Italy.
Department of Medical and Surgical Sciences, Section of Respiratory Diseases, "Magna Græcia" University of Catanzaro , Catanzaro, Italy.
Expert Opin Pharmacother. 2020 Aug;21(12):1505-1515. doi: 10.1080/14656566.2020.1766023. Epub 2020 May 27.
'Critical Asthma Syndrome' (CAS) is an umbrella term proposed to include several forms of asthma, responsible for acute and life-threatening exacerbations. CAS requires urgent and adequate supportive and pharmacological treatments to prevent serious outcomes.
The purpose of this review is to discuss current knowledge on the pharmacotherapeutic strategies for treatment of CAS.
Airflow limitation, airway wall edema, and mucus plugs are the pathophysiological targets of pharmacological therapies. Strategies to achieve these goals are based on the use of various classes of drugs. Inhaled beta2-agonists are the mainstay of the initial therapy of CAS. Inhaled anticholinergic agents may be considered in the treatment of CAS in addition to beta 2 agonists. Systemic corticosteroids should be administered as soon as possible in order to counteract airway inflammation and restore normal airway sensitivity. The effectiveness of pharmacological therapies in CAS is linked not only to the timely use of drugsbut also to the dosage and route of administration. Early recognition and aggressive treatment are essential for the management of CAS; however, prevention is the best cure. Although significant progress has been made, further efforts are needed to implement an optimal exacerbation prevention strategy.
“危重症哮喘综合征”（Critical Asthma Syndrome，CAS）是一个伞式术语，用于包括几种哮喘形式，这些哮喘会导致急性和危及生命的恶化。CAS 需要紧急和充分的支持和药物治疗，以防止严重后果。
本综述的目的是讨论治疗 CAS 的药理学策略的最新知识。
气流受限、气道壁水肿和黏液栓是药物治疗的病理生理靶点。实现这些目标的策略基于使用各种类别的药物。吸入β2-激动剂是 CAS 初始治疗的主要药物。除了β2 激动剂外，吸入抗胆碱能药物也可考虑用于 CAS 的治疗。为了对抗气道炎症并恢复正常的气道敏感性，应尽快给予全身皮质类固醇。药物治疗在 CAS 中的有效性不仅与药物的及时使用有关，还与药物剂量和给药途径有关。早期识别和积极治疗对于 CAS 的管理至关重要；然而，预防是最好的治疗方法。尽管已经取得了重大进展，但仍需要进一步努力实施最佳的恶化预防策略。
