Ruhl R, Halpern G M, Gershwin M E
Department of Internal Medicine, University of California Davis School of Medicine 95616.
Allergol Immunopathol (Madr). 1993 Mar-Apr;21(2):53-60.
Asthma is now considered as an inflammatory disease. A subset of severe asthmatic patients requires large doses of daily systemic steroids to achieve some control of the inflammation of the airways. To minimize the daily absorption of glucocorticoids, a number of medicaments have been studied for the last three decades. Methotrexate, dapsone, hydroxychloroquine, ciclosporine A, gold salts, intravenous gammaglobulins, ketotifen, triacetyloleandomycin, all demonstrated some positive effects in a small number of studies. However, our impression is that most "steroid-sparing" medications are either poorly effective in large series and/or have intolerable side effects in these chronically ill patients; many are very expensive. A revised, adjusted therapeutic strategy, using currently recommended anti-asthmatic drugs, making a major use of inhaled topical corticosteroids, should limit the number of "cortico-dependent" asthmatic patients.
哮喘现在被认为是一种炎症性疾病。一部分重度哮喘患者需要每日大剂量全身性使用类固醇，以实现对气道炎症的某种程度的控制。在过去三十年里，为了尽量减少糖皮质激素的每日吸收量，人们研究了多种药物。甲氨蝶呤、氨苯砜、羟氯喹、环孢素A、金盐、静脉注射丙种球蛋白、酮替芬、醋竹桃霉素，在少数研究中均显示出一些积极效果。然而，我们的印象是，大多数“类固醇节省”药物要么在大量病例中效果不佳，要么在这些慢性病患者中有难以耐受的副作用；许多药物还非常昂贵。采用目前推荐的抗哮喘药物，大量使用吸入性局部糖皮质激素，修订和调整治疗策略，应能减少“皮质激素依赖型”哮喘患者的数量。
