Fainardi Valentina, Saglani Sejal
Cystic Fibrosis Unit, Children University Hospital, Parma.
Department of Respiratory Paediatrics, Royal Brompton and Harefield NHS Foundation Trust, London, UK..
Acta Biomed. 2020 Sep 7;91(3):e2020055. doi: 10.23750/abm.v91i3.9603.
Children with poor asthma control despite high levels of prescribed treatment are described as having problematic severe asthma. Most of these children have steroid sensitive disease which improves with adherence to daily inhaled corticosteroids and after having removed modifiable factors like poor inhalation technique, persistent adverse environmental exposures and psychosocial factors. These children are described as having "difficult-to-treat asthma" while children with persistent symptoms despite above-mentioned factors having been addressed are described as having "severe therapy-resistant asthma". In this review, we will describe the 6-step approach to the diagnosis and management of a child with problematic severe asthma adopted by The Royal Brompton Hospital (London, UK). The role of a multidisciplinary team is crucial for identification and treatment of modifiable factors and comorbidities in order to avoid invasive examinations and useless pharmacological treatments. The current knowledge on add-on therapies will be discussed.
尽管接受了高水平的规定治疗，但哮喘控制不佳的儿童被描述为患有难治性重度哮喘。这些儿童中的大多数患有类固醇敏感型疾病，通过坚持每日吸入皮质类固醇以及消除诸如吸入技术不佳、持续的不良环境暴露和心理社会因素等可改变因素后，病情会有所改善。这些儿童被描述为患有“难治性哮喘”，而尽管上述因素已得到解决但仍有持续症状的儿童则被描述为患有“重度治疗抵抗性哮喘”。在本综述中，我们将描述英国伦敦皇家布朗普顿医院采用的针对难治性重度哮喘儿童的诊断和管理的六步法。多学科团队的作用对于识别和治疗可改变因素及合并症至关重要，以避免进行侵入性检查和无用的药物治疗。我们还将讨论关于附加疗法的现有知识。
