頁籤選單縮合
題名 | 小兒氣喘處置之最新發展=Recent Advances in the Treatment of Asthma |
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作者 | 徐世達; Shyur, Shyh-dar; |
期刊 | 中華民國小兒科醫學會雜誌 |
出版日期 | 19990400 |
卷期 | 40:增刊A 民88.04 |
頁次 | 頁10-15 |
分類號 | 417.5343 |
語文 | chi |
關鍵詞 | 小兒氣喘; |
英文摘要 | Asthma is a polygenic, inherited chronic airways inflammatory disease with interaction between genetic and environmental factors. The Pathophysiology of asthma appear to be very complex with the interactions of many types of structural and inflammatory cells(especially mast cells, eosinophils, and T lymphocytes)and their released mediators and cytokines. In susceptible individuals this inflammation causes recurrent episodes of wheezing, breathlessness, fchest tightness, and cough particularly at night and/or in the early morning. These symptoms are usually associated with widespread but variable airflow limitation that is at least partly reversible either spontaneously or with treatment. All current national and international guidelines for asthma management recommend that persistent asthma should be managed with avoidance of triggers(especially house dust mites)in addition to 2 pharmacological agents, i.e., 1)a regular inhaled anti-inflammatory agent, preferably an inhaled glucocorticoid(Controller) ;and 2) a short acting bronchodilator, preferably a short acting β - 2 agonist, to be taken only when needed (reliever). It is suggested that asthma, if not properly treated with preventive measures and/or anti-inflammatory agents, amy indeed be associated with the development of a chronic irreversible airflow limitation and with reduced life expectancy. Of the anti-inflammatory therapies, inhaled corticosteroids are the most potent and effective agents. Orgiinally the most widely used inhaled steroid was beclomethasone and subsequently budesonide and Fluticasone were developed. Fluticasone propionate(Flixotide/FP) is a highly potent and topically active inhaled corticosteroid. FP undergoes rapid systemic clearance and virtually complete first pass metabolism. FP has an oral systemic bioavailability of < 1% compared with 10% for budesonide. Inhaled beta 2 agonists such as Salbutamol, Terbutaline, or Fenoterol have a length of action of four to six hours. Long acting inhaled beta 2 agonists with length of action extended to 12 to 24 hours, such as salmeterol and Formoterol are particularly effective for exercise-induced asthma and nocturnal asthma as well as for use in combination with inhaled steroids in patients with chronic asthma not well controlled with inhaled steroids alone. Two leukotriene modifieers, Zafirlukast and Zileuton, have recently become available orally for clinical use. Zafirlukast is a leukotriene receptor antagonist. Zileuton is a 5-lipoxygenase ihnibitor. They casue improvement in lung functions, prevent asthma exacerbation, and decrease airway inflammation to a lesser degree. the positioning of leukotriene modifiers is, at present, under evaluation. However, the updated "US Exper Panel Repot Ⅱ :Guidelines for the Diagnosis and Management of Asthma" published on February 1997, recommended that leukotriene modifiers may be considered as an alternative to low-dose inhaled corticosteroid therapy for patients with mild persistent asthma. In conclusion, the choice of asthma management should be guided by the severity of the patient's symptoms, the benefits and the adverse effects of each treatment, the cost-effectiveness and the availability of the various forms of therapy. In addition to avoidance of triggers and aggressively early management of asthma, recent advances in the introducing of FP, long-acting beta 2 agonists, and leukotriene modifiers into the therapeutic strategies for asthma, will let us make a big progress to accomplish the goals of asthma therapy. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。