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

各种实践参数都强调了逐步治疗哮喘的方法,即使用大剂量吸入皮质类固醇,即最难以治疗的哮喘患者每天2000 ug,同时采用最大的支气管扩张剂治疗。使用这种有力的治疗方法的前提是,已经考虑了各种可以使哮喘病永存的诱因,并希望这些诱因得以消除或减少,例如职业诱因,胃食管反流以及伴随的药物(例如β受体阻滞剂),以及可能难以识别的过敏原刺激。随着新疗法的出现,它们在治疗重症人群中的作用仍未分类,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剂量气溶胶皮质类固醇优于大剂量皮质类固醇气溶胶的概念。从理论上讲,针对阿司匹林特质的患者使用抗白三烯可能优于其他组合,正如从阿司匹林挑战数据中推测的那样。利多卡因最近已被用于严重哮喘患者,初步数据表明其获益。这篇综述的目的是总结一些我们对类固醇或对重度哮喘的亚型哮喘患者可能有用的药物的认识。

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