Scotney Elizabeth, Fleming Louise, Saglani Sejal, Sonnappa Samatha, Bush Andrew
National Heart and Lung Institute, Imperial College London, London, UK.
Royal Brompton Hospital, London, UK.
BMJ Med. 2023 Jun 25;2(1):e000367. doi: 10.1136/bmjmed-2022-000367. eCollection 2023.
The diversity of pathology of severe paediatric asthma demonstrates that the one-size-fits-all approach characterising many guidelines is inappropriate. The term "asthma" is best used to describe a clinical syndrome of wheeze, chest tightness, breathlessness, and sometimes cough, making no assumptions about underlying pathology. Before personalising treatment, it is essential to make the diagnosis correctly and optimise basic management. Clinicians must determine exactly what type of asthma each child has. We are moving from describing symptom patterns in preschool wheeze to describing multiple underlying phenotypes with implications for targeting treatment. Many new treatment options are available for school age asthma, including biological medicines targeting type 2 inflammation, but a paucity of options are available for non-type 2 disease. The traditional reliever treatment, shortacting β2 agonists, is being replaced by combination inhalers containing inhaled corticosteroids and fast, longacting β2 agonists to treat the underlying inflammation in even mild asthma and reduce the risk of asthma attacks. However, much decision making is still based on adult data extrapolated to children. Better inclusion of children in future research studies is essential, if children are to benefit from these new advances in asthma treatment.
重度小儿哮喘的病理多样性表明，许多指南所采用的一刀切方法并不合适。“哮喘”一词最好用于描述喘息、胸闷、呼吸急促，有时还伴有咳嗽的临床综合征，而不预设潜在的病理情况。在进行个性化治疗之前，正确诊断并优化基本管理至关重要。临床医生必须准确确定每个孩子患的是哪种类型的哮喘。我们正从描述学龄前喘息的症状模式，转向描述具有多种潜在表型并对靶向治疗有指导意义的情况。对于学龄期哮喘，有许多新的治疗选择，包括针对2型炎症的生物药物，但对于非2型疾病，可用的选择却很少。传统的缓解药物短效β2激动剂，正被含有吸入性糖皮质激素和快速长效β2激动剂的联合吸入器所取代，以治疗甚至轻度哮喘的潜在炎症，并降低哮喘发作的风险。然而，许多决策仍基于外推至儿童的成人数据。如果儿童要从哮喘治疗的这些新进展中受益，未来研究更好地纳入儿童至关重要。
