Busse W W, Maisiak R, Young K R
University of Wisconsin School of Medicine, Madison.
Am J Respir Crit Care Med. 1994 Feb;149(2 Pt 2):S44-50; discussion S51-3. doi: 10.1164/ajrccm/149.2_Pt_2.S44.
The severity of asthma can be judged by many features, including the need for medication and associated side effects. Since asthma has both acute and chronic characteristics, therapeutic regimens should be valuable as an instrument to define disease severity and the consequence of intervention. However, because of the variability of asthma severity within each patient, medication quantitation as an index of asthma severity is not without difficulty and limitation. Furthermore, the philosophy of asthma therapy has undergone changes over the past decade. Previously, anti-inflammatory therapy was reserved for only the most severely ill patients. Now, inflammation is recognized as a critical component of asthma, and all patients with active asthma (other than mild symptoms) are recommended to use anti-inflammatory therapy. Although there is little published experience with treatment regimens as an index of disease severity, those that have been used have found validity and reproducibility with this approach. In this paper, a scoring approach to medication use is recommended. Medication is classified into bronchodilator (beta-agonists, theophylline, and anticholinergic) or anti-inflammatory (corticosteroid and cromolyn sodium). Medication scores are given on either a per-use or a new-dosage basis. Furthermore, the eight medications are stratified according to potency (i.e., inhaled corticosteroid < oral corticosteroid < parenteral corticosteroid). From this approach, the severity of an individual patient's asthma can be quantitated, and this value can serve as one instrument to assess disease severity.
哮喘的严重程度可通过许多特征来判断，包括用药需求及相关副作用。由于哮喘兼具急性和慢性特征，治疗方案应作为界定疾病严重程度及干预效果的一种手段。然而，由于每位患者哮喘严重程度存在变异性，将药物用量作为哮喘严重程度的指标并非毫无困难和局限。此外，在过去十年中，哮喘治疗理念发生了变化。以前，抗炎治疗仅用于病情最严重的患者。现在，炎症被认为是哮喘的关键组成部分，建议所有有活动性哮喘（除轻度症状外）的患者使用抗炎治疗。尽管作为疾病严重程度指标的治疗方案的公开经验很少，但已使用的那些方案已发现这种方法具有有效性和可重复性。本文推荐一种用药评分方法。药物分为支气管扩张剂（β受体激动剂、茶碱和抗胆碱能药物）或抗炎药（皮质类固醇和色甘酸钠）。用药评分基于每次使用或新剂量给出。此外，这八种药物根据效力分层（即吸入性皮质类固醇＜口服皮质类固醇＜胃肠外皮质类固醇）。通过这种方法，可以对个体患者的哮喘严重程度进行量化，该值可作为评估疾病严重程度的一种手段。
