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首页> 外文期刊>Hong Kong Journal of Paediatrics >Severe Therapy Resistant Asthma in Children
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Severe Therapy Resistant Asthma in Children

机译：小儿抗重度哮喘

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Most children with asthma respond to low doses of inhaled corticosteroids, but a few remain symptomatic despite being prescribed the routine usual asthma medications. The first steps are to ensure the diagnosis is correct, and that the inhaled medications are being given with an appropriate device. If the child continues to be symptomatic, with any or all of chronic symptoms, acute exacerbations, the need for regular oral corticosteroids, or persistent airflow limitation, then they are considered to have problematic, severe asthma . The next step is to perform a detailed evaluation, including a nurse-lead home visit, to determine if the child has difficult to treat asthma , which improves if the basics are got right, or severe, therapy resistant asthma , which latter group would be candidates for cytokine specific therapies. If severe, therapy resistant asthma is the likely issue, then detailed invasive investigation is performed, including a bronchoscopy, bronchoalveolar lavage and endobronchial biopsy, and trial of adherence with a single intramuscular injection of depot triamcinolone. After detailed phenotyping, an individualised treatment plan is determined. Future work will determine the roles of proximal and distal inflammation, as well as the relative importance of intramural (mucosal) and intraluminal infection. The stability of paediatric asthma phenotypes over time is more variable than those of adults, and the implications of a change of phenotype are yet to be determined.
机译：大多数哮喘儿童对吸入低剂量的皮质类固醇激素有反应，但尽管有常规的常规哮喘药物处方，但仍有少数仍然有症状。第一步是确保诊断正确，并且已通过适当的设备给予吸入药物。如果孩子继续出现症状，患有任何或所有慢性症状，急性加重，需要定期口服皮质类固醇激素或持续的气流受限，则认为他们患有有问题的严重哮喘。下一步是进行详细的评估，包括由护士带领的上门拜访，以确定孩子是否难以治疗哮喘，这将改善基础知识是否正确，或者是对治疗有抵抗力的哮喘，后者将是后者细胞因子特异性疗法的候选药物。如果可能是严重的，对治疗有抗药性的哮喘，则应进行详细的侵入性研究，包括支气管镜检查，支气管肺泡灌洗和支气管内活检，以及单次肌内注射曲安奈德进行依从性试验。详细的表型确定后，确定个性化的治疗计划。未来的工作将确定近端和远端炎症的作用，以及壁内（粘膜）和腔内感染的相对重要性。小儿哮喘表型随时间推移的稳定性比成人的稳定度更大，表型改变的影响尚待确定。

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