Division of Respiratory Medicine, University Hospital "Policlinico Tor Vergata" , Rome, Italy.
Department of Experimental Medicine, University of Rome Tor Vergata , Rome, Italy.
Expert Opin Pharmacother. 2020 Dec;21(18):2305-2316. doi: 10.1080/14656566.2020.1807514. Epub 2020 Aug 18.
Asthma is one of the most frequent chronic diseases all over the world. Glucocorticoids (GCs), both inhaled (ICSs) and oral (OCSs), are the most effective treatment in asthma because they control symptoms and prevent exacerbations.
The present article reviews the new therapeutic indications of GCs for the treatment of asthma and focuses on new molecules and safety issues.
Most patients with asthma benefit from corticosteroid-based treatments. Side effects are mainly due to prolonged use of oral GCs, while they are minor with inhaled GCs. Interesting insights come from the new ICSs, which are characterized by lower oral bioavailability and higher lipophilicity and are more effective with less side effects. Recent trials have shown the efficacy of early use of ICSs in mild asthma. Furthermore, the possibility to prescribe targeted therapies using specific biomarkers in steroid-sensitive asthma can reduce doses and duration of treatment, while biological agents should be reserved for non-responding patients. All this evidence confirm the need to continue on the path toward precision medicine, in which the treatments are based on clinical and molecular traits.
哮喘是全世界最常见的慢性疾病之一。糖皮质激素（GCs），包括吸入性（ICSs）和口服（OCSs），是哮喘最有效的治疗方法，因为它们可以控制症状并预防恶化。
本文综述了 GCs 治疗哮喘的新治疗适应证，并重点介绍了新分子和安全性问题。
大多数哮喘患者从基于皮质类固醇的治疗中获益。副作用主要是由于长期使用口服 GCs 引起的，而吸入 GCs 的副作用较小。新型 ICSs 带来了有趣的见解，其特点是口服生物利用度较低、脂溶性较高，且具有更好的疗效和更少的副作用。最近的试验表明，在轻度哮喘中早期使用 ICSs 的疗效。此外，使用特定的生物标志物在皮质类固醇敏感的哮喘中进行靶向治疗的可能性，可以减少剂量和治疗持续时间，而生物制剂应保留给无反应的患者。所有这些证据都证实了需要继续朝着精准医学的方向发展，在这种医学中，治疗是基于临床和分子特征的。
