Michel F B, Godard P, Bousquet J
Ann Med Interne (Paris). 1986;137(1):14-6.
Curiously enough, a kind of curse combined with therapeutic fatalism still hovers over bronchial asthma and a sense of hopelessness may be encountered when faced with this illness. This pessimism is totally unfounded. However, our therapeutic possibilities depend partly on a better understanding of the asthma syndrome. In the past, this condition may not have been recognised for what it is, that is to say a multi factorial syndrome resulting from the innate and the acquired, from specific (allergic) and/or non-specific factors. Undoubtedly, too much responsibility has been placed on the allergic factor in asthma. Although important, it has made us overlook the fact that, allergic or not, asthma is an inflammatory illness of the bronchi provoked by the liberation of mediators. The role of histamine has been well known for a long time and we now realise the importance of the actions of the metabolites of arachidonic acid (prostaglandins and thromboxanes on the one hand, leukotrienes on the other). The characteristics bronchial hyperreactivity observed in asthma may certainly be congenital but this factor may also be acquired as in professional and post-viral asthma. If bronchial asthma remains under-diagnosed and under-treated in France and in Europe it is due to the fact that the artificial distinction between paroxysmal (bronchitis called "asthmatic"), and persistent (that is to say a so-called asthmatic illness), is is often maintained. There is no real ground for maintaining this distinction. Every child with wheezy dyspnea must therefore be the object of a thorough, initial medical examination, including in particular a respiratory function exploration followed by the institution of a long-term, coherent therapeutic strategy.
说来也怪，一种与治疗宿命论相结合的诅咒仍然笼罩着支气管哮喘，面对这种疾病时可能会感到绝望。这种悲观情绪毫无根据。然而，我们的治疗可能性部分取决于对哮喘综合征的更好理解。过去，这种病症可能未被正确认识，也就是说它是一种由先天和后天、特定（过敏）和/或非特定因素导致的多因素综合征。毫无疑问，在哮喘中，过敏因素被赋予了过多责任。尽管它很重要，但却使我们忽视了这样一个事实，即无论是否过敏，哮喘都是一种由介质释放引发的支气管炎症性疾病。组胺的作用早已为人所知，我们现在也认识到了花生四烯酸代谢产物（一方面是前列腺素和血栓素，另一方面是白三烯）作用的重要性。哮喘中观察到的特征性支气管高反应性可能确实是先天性的，但这个因素也可能是后天获得的，如职业性哮喘和病毒感染后哮喘。在法国和欧洲，支气管哮喘仍然诊断不足且治疗不充分，这是因为阵发性（称为“哮喘性”支气管炎）和持续性（即所谓的哮喘病）之间的人为区分常常被维持。维持这种区分没有实际依据。因此，每个患有喘息性呼吸困难的儿童都必须接受全面的初始医学检查，尤其包括呼吸功能检查，随后制定长期、连贯的治疗策略。
