Various practice parameters have emphasized a step-wise approach to the treatment of asthma utilizing high doses of inhaled corticosteroids, i.e., 2000 ug per day for the most difficult-to-manage asthmatic patient, along with maximum bronchodilator therapy. The use of such vigorous therapy presupposes that various triggers that perpetuate asthma have been considered and hopefully eliminated or diminished, such as occupational incitants, gastroesophageal reflux, and concomitant medication such as beta blockers and perhaps difficult-to-recognize allergen stimulation. As new therapies emerge, their role in the treatment of a severe subgroup of the population remains uncategorized and will only be clarified with personal experience and appropriate double-blind studies. For example, there are data to support the concept that salmeterol plus moderate dose aerosol corticosteroids is superior to high dose corticosteroid aerosols. Theoretically, the use of anti-leukotrienes for a patient with aspirin idiosyncrasy may be superior to other combinations as would be conjectured from aspirin challenge data. Lidocaine has recently been employed in severe asthmatics, and preliminary data suggest benefit. The purpose of this review is to summarize some of our knowledge regarding medications that are either steroid-sparing or that might be useful in a subgroup of asthmatic patients with severe asthma.

译文

各种实践参数强调了使用高剂量的吸入皮质类固醇治疗哮喘的逐步方法,即对于最难管理的哮喘患者,每天2000 ug,以及最大的支气管扩张剂治疗。使用这种剧烈疗法的前提是,已经考虑并希望消除或减少了使哮喘持续存在的各种诱因,例如职业性诱因,胃食管反流以及伴随药物 (例如 β 受体阻滞剂和可能难以识别的过敏原刺激)。随着新疗法的出现,它们在严重人群亚组治疗中的作用仍然未分类,只有通过个人经验和适当的双盲研究才能阐明。例如,有数据支持沙美特罗加中等剂量气雾剂皮质类固醇优于高剂量皮质类固醇气雾剂的概念。从理论上讲,阿司匹林特质患者使用抗白三烯可能优于其他组合,这可以从阿司匹林激发数据中得出。利多卡因最近被用于严重哮喘患者,初步数据表明有益。这篇综述的目的是总结我们有关保留类固醇或可能对患有严重哮喘的哮喘患者亚组有用的药物的一些知识。

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