Department of Pneumology/Interdis ciplinary Intensive Care Unit, University of Rostock; Department of Internal Medicine III (Hematology, Oncology, Pneumology), University Medical Center, Johannes Gutenberg University Mainz.
Dtsch Arztebl Int. 2020 Jun 19;117(25):434-444. doi: 10.3238/arztebl.2020.0434.
Asthma is a chronic inflammatory airway disease that usually causes variable airway obstruction. It affects 5-10% of the German population.
This review is based on relevant publications retrieved by a selective search, as well as on national and international guidelines on the treatment of mild and moderate asthma in adults.
The goal of treatment is to attain optimal asthma control with a minimal risk of exacerbations and mortality, loss of pulmonary function, and drug side effects. This can be achieved with a combination of pharmacotherapy and non-drug treatment including patient education, exercise, smoking cessation, and rehabilitation. Pharmacohterapy is based on inhaled corticosteroids (ICS) and bronchodilators. It is recommended that mild asthma should be treated only when needed, either with a fixed combination of ICS and formoterol or with short-acting bronchodilators. For moderate asthma, maintenance treatment is recommended, with an inhaled fixed combinations of ICS and long-acting beta-mimetics, possibly supplemented with longacting anticholinergic agents. Allergen immunotherapy, i.e., desensitization treatment, should be considered if the allergic component of asthma is well documented and the patient is not suffering from uncontrolled asthma. Asthma control should be monitored at regular intervals, and the treatment should be adapted accordingly.
The treatment of asthma in adults should be individually tailored, with anti-inflammatory treatment as its main component.
哮喘是一种慢性炎症性气道疾病,通常会导致气道的可变阻塞。它影响德国 5-10%的人口。
本综述基于选择性搜索中检索到的相关出版物,以及关于成人轻度和中度哮喘治疗的国家和国际指南。
治疗的目标是通过最小化恶化和死亡率、肺功能丧失以及药物副作用的风险来实现最佳的哮喘控制。这可以通过药物治疗和非药物治疗的结合来实现,包括患者教育、运动、戒烟和康复。药物治疗基于吸入性皮质类固醇(ICS)和支气管扩张剂。建议仅在需要时治疗轻度哮喘,要么使用 ICS 和福莫特罗的固定组合,要么使用短效支气管扩张剂。对于中度哮喘,建议进行维持治疗,使用 ICS 和长效β激动剂的吸入固定组合,可能需要补充长效抗胆碱能药物。如果哮喘的过敏成分有充分记录且患者未患有未控制的哮喘,应考虑过敏原免疫治疗,即脱敏治疗。应定期监测哮喘控制情况,并相应调整治疗方案。
成人哮喘的治疗应个体化,以抗炎治疗为主要成分。