Moan M J, Fanta C H
Pulmonary and Critical Care Medicine Division, Brigham & Women's Hospital, Boston, MA 02115, USA.
Compr Ther. 1995 Aug;21(8):421-7.
Bronchodilator management of acute severe asthma has evolved considerably in recent years. beta-adrenergic agonists have emerged as the single most potent class of bronchodilator available, and the inhalational route of administration has proven to be the most effective and least toxic method of delivery except among apneic or highly uncooperative patients. Other bronchodilators, including aminophylline, inhaled anticholinergics, and intravenous magnesium sulfate, are significantly less potent drugs for reversal of bronchoconstriction. In most patients these agents do not promote significant bronchodilation beyond that achieved with an intensive regimen of inhaled beta agonists; subsets of patients that might benefit from these other agents remain to be identified. Questions remain as to the optimal dose, frequency of administration, and mode of inhalational delivery of the beta agonists in acute asthma. Finally, it is important to remember that bronchodilator therapy constitutes only one component in the treatment of acute severe asthma. Treatment of airway inflammation with systemic corticosteroids is another vital component, as are supplemental oxygen in the hypoxemic patient, close monitoring of lung function, attention to the possibility of hypercapnic respiratory failure, patient education, and a plan of care following emergency department discharge.
近年来，急性重症哮喘的支气管扩张剂治疗有了很大进展。β-肾上腺素能激动剂已成为现有的最有效的一类支气管扩张剂，除了呼吸暂停或极不配合的患者外，吸入给药途径已被证明是最有效且毒性最小的给药方法。其他支气管扩张剂，包括氨茶碱、吸入性抗胆碱能药物和静脉注射硫酸镁，在逆转支气管收缩方面的效力明显较低。在大多数患者中，这些药物除了强化吸入β激动剂方案所达到的效果外，不会促进显著的支气管扩张；可能从这些其他药物中获益的患者亚组仍有待确定。关于急性哮喘中β激动剂的最佳剂量、给药频率和吸入给药方式仍存在问题。最后，重要的是要记住，支气管扩张剂治疗只是急性重症哮喘治疗的一个组成部分。用全身性皮质类固醇治疗气道炎症是另一个重要组成部分，低氧血症患者补充氧气、密切监测肺功能、关注高碳酸血症呼吸衰竭的可能性、患者教育以及急诊科出院后的护理计划也是如此。
