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重症哮喘表型

Author
Sally Wenzel, MD
Section Editor
Peter J Barnes, DM, DSc, FRCP, FRS
Deputy Editor
Helen Hollingsworth, MD
Translators
冯旰珠, 主任医师，教授

引言

哮喘通过临床症状和生理学异常共同界定和诊断，一般不依赖于病理学或生物学标志物。然而，哮喘的生理学界定相对来说具有非特异性，包括气道高反应性和呼气性气流受限，其多变和/或在支气管舒张剂的作用下可逆。在大多数哮喘患者中，气道高反应性的存在从未被客观地证实。

有数据显示重症哮喘这一分类中存在多种表型，本文就此进行总结。关于重症哮喘的分类、评估、诊断和治疗的详细内容见其他专题。 (参见“哮喘管理概述”和“青少年及成年人重症哮喘的评估”和“青少年及成人哮喘的诊断”和“青少年及成人重症哮喘的治疗”和“糖皮质激素抵抗型哮喘”)

重症哮喘的定义

哮喘的诊断是基于目前存在或者既往出现过由典型刺激因素引起的哮喘相关症状(最常见的症状包括发作性咳嗽、喘鸣或者呼吸困难)，并证实存在不同程度呼气性气流受限。重症哮喘是指在确诊哮喘和控制并存病的基础上，需要吸入大剂量糖皮质激素加第2种控制药物和/或全身性应用糖皮质激素来预防出现不可控制的哮喘，或者在此治疗下仍不能被控制的哮喘[1]。

哮喘表型鉴定的理由

重症哮喘患者表现出多种多样的临床病史、生理学改变[不仅仅包括第1秒用力呼气容积(forced expiratory volume in one second, FEV1)的改变]和气道炎症，提示重症哮喘产生多种多样的宿主反应，不是单一疾病或者单一病程。重症哮喘患者可能终生都表现为严重疾病，随时间推移进行性加重，或者可能从未发生过哮喘(患者尽可能回忆到的)直到成年期某一时间点之前，然后疾病迅速进展[2]。有些重症哮喘患者有明确的特应性病史，而其他患者几乎没有过敏的征象。

除了临床特征的多变性，哮喘患者对哮喘药物的反应不完全相同，尤其是对糖皮质激素和其他非特异性抗炎药/细胞毒性药物。目前人们希望通过对哮喘表型的探索加深对哮喘病理生理学的理解，并最优化药物选择[1,3]。

                

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Literature review current through: 2017-07 . | This topic last updated: 2016-06-27.
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