Airway inflammation in asthma and its consequences: Implications for treatment in children and adults
Airway inflammation in asthma and its consequences: Implications for treatment in children and adults
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DOI：
10.1067/mai.2002.124568
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发表时间：
2002-06-01
影响因子：
14.2
通讯作者：
Djukanovic, R
中科院分区：
文献类型：
--
作者：
Djukanovic, R
新型研究技术的发展和广泛应用，如支气管镜检查和诱导痰，增强了我们对哮喘病理生理学的理解。对哮喘的炎症性质和与慢性疾病相关的重塑的认识无疑改善了疾病管理，并更好地理解了抗哮喘药物的作用机制。虽然缺乏关于儿童炎症及其后遗症的广泛数据，但慢性炎症和气道重塑更有可能参与这一年轻人群哮喘的发展和进展。事实上，有证据表明气道重构发生在早期。因此，儿童和成人之间炎症和重塑的任何差异对治疗的影响可能是重要的。尽管皮质类固醇被认为是一线抗炎治疗，特别是在慢性哮喘中，但对于许多患者来说，吸入或口服皮质类固醇治疗都不能充分控制炎症。在儿童中，添加长效β 2受体激动剂治疗或皮质类固醇剂量加倍均未产生与成人相同的益处。对成人和儿童哮喘的病理生理机制有了更清楚的了解，将为不同哮喘表型提供新的见解。因此，开发和应用相对简单和安全的方法来评估气道炎症和改变的标志物是至关重要的，特别是对儿童。
The development and wide availability of novel research techniques such as bronchoscopy and induced sputum have enhanced our understanding of the pathophysiology of asthma. The appreciation of the inflammatory nature of asthma and the remodeling associated with chronic disease have undoubtedly led to improved disease management and a better understanding of how anti-asthma drugs work. Although extensive data about inflammation and its sequelae in children are lacking, both chronic inflammation and airway remodeling are more than likely to be involved in the development and progression of asthma in this young population. Indeed, evidence suggests that airway restructuring occurs early. The implications for treatment in any differences of inflammation and remodeling between children and adults, then, are likely to be important. Although corticosteroids are considered as first-line anti-inflammatory treatment, especially in chronic asthma, for many patients neither inhaled nor oral corticosteroid therapy can control inflammation adequately. In children, neither the addition of long-acting beta(2)-agonist therapy nor doubling of the corticosteroid dose has produced the same benefits seen in adults. A clearer understanding of the pathophysiologic mechanisms of asthma in adults and pediatric patients should provide new insights into different asthma phenotypes. Therefore, the development and application of relatively simple and safe methods for assessing markers of inflammation and alterations in the airways are vital, especially for children.