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首页> 外文期刊>Seminars in Respiratory and Critical Care Medicine >Diagnosis and Management of Severe Asthma
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Diagnosis and Management of Severe Asthma

机译：严重哮喘的诊断和管理

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Severe therapy-resistant asthma has been defined as asthma which requires treatment with high dose inhaled corticosteroids (ICSs) plus a second controller (and/or systemic corticosteroids) to prevent it from becoming uncontrolled' or which remains uncontrolled' despite this therapy. Patients who usually present with difficult-to-treat asthma' should first be assessed to determine whether he/she has asthma with the exclusion of other diagnoses and if so, whether the asthma can be classified as severe therapy-resistant. This necessitates an assessment of adherence to medications, confounding factors, and comorbidities. Increasingly, management of severe therapy-resistant asthma will be helped by the determination of phenotypes to optimize responses to existing and new therapies. Severe asthma patients are usually on a combination of high dose ICS and long-acting -agonist (LABA) and, in addition, are often on a maintenance dose of oral corticosteroids. Phenotyping can be informed by measuring blood eosinophil counts and the level of nitric oxide in exhaled breath, and the use of sputum granulocytic counts. Severe allergic asthma and severe eosinophilic asthma are two defined phenotypes for which there are efficacious targeted biologic therapies currently available, namely anti-immunoglobulin E (IgE) and anti-interleukin (IL)-5 antibodies, respectively. Further progress will be realized with the definition of noneosinophilic or non-T2 phenotypes. It will be important for patients with severe asthma to be ultimately investigated and managed in specialized severe asthma centers.
机译：严重的治疗抗性哮喘被定义为需要用高剂量吸入的皮质类固醇（ICS）治疗的哮喘，以及第二个控制器（和/或全身皮质类固醇），以防止其不受控制的“或者仍然是不受控制的”。通常应首先评估通常存在难以治疗的哮喘的患者，以确定他/她是否具有排除其他诊断的哮喘，如果是的话，哮喘是否可以被归类为严重治疗抗性。这需要评估对药物，混淆因素和合并症的依从性。越来越多地，通过测定对现有和新疗法的反应进行优化的表型，将有助于对严重治疗抗性哮喘的管理。严重的哮喘患者通常是高剂量ICS和长效的主旨（LABA）的组合，此外，通常是在口腔皮质类固醇的维持剂量上。通过测量血液嗜酸血粒细胞计数和呼出气息中的一氧化氮水平，可以通过使用表型，以及使用痰粒细胞计数。严重的过敏性哮喘和严重的嗜酸性嗜嗜酸性哮喘是两种定义的表型，其中目前存在有效的靶向生物学治疗，即抗免疫球蛋白E（IgE）和抗白细胞介素（IL）-5抗体。将通过非环中粒细胞或非T2表型的定义来实现进一步的进展。对于最终进行严重的哮喘患者，在专门的严重哮喘中心进行管理患者将是重要的。

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