Objective

To provide an overview of the risk factors and mechanisms underlying asthma exacerbations and the role of inhaled corticosteroids (ICSs) in preventing exacerbations.

Data Sources

Queries for asthma exacerbations and ICSs were conducted using PubMed, searching for primary articles and reviews.

Study Selections

Studies written in English, with a focus on well-designed randomized controlled clinical trials.

Results

Asthma exacerbations remain a major source of morbidity, with future exacerbations most likely among patients with previous exacerbations and among those with peripheral blood eosinophilia. Exacerbations are often triggered by viral respiratory tract infections, but recent evidence supports nonviral triggers as well. In terms of exacerbation prevention, several approaches to ICS therapy have been found to be effective, including intermittent high-dose ICS without use of background controller in preschool children with recurrent episodic wheezing, intermittent high-dose ICS without use of background controller in adults with mild asthma, and as-needed ICS dosing whenever rescue treatment is needed among children, adolescents, and adults with mild asthma not receiving daily controller therapy.

Conclusion

ICSs are highly effective in preventing exacerbations of asthma. Multiple dosing strategies have been found to reduce exacerbation risk, allowing for a personalization of approaches based on individual patient phenotypes and preferences.

中文翻译：

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吸入皮质类固醇用于预防哮喘发作

客观的

概述哮喘发作的危险因素和机制，以及吸入皮质类固醇 (ICS) 在预防哮喘发作中的作用。

数据源

使用 PubMed 进行哮喘发作和 ICS 的查询，搜索主要文章和评论。

研究选择

用英语撰写的研究，重点是精心设计的随机对照临床试验。

结果

哮喘发作仍然是发病的主要来源，未来哮喘发作最有可能发生在既往发作过的患者和外周血嗜酸性粒细胞增多症患者中。恶化通常由病毒性呼吸道感染引发，但最近的证据也支持非病毒性触发。在预防加重方面，已发现几种 ICS 治疗方法是有效的，包括在患有反复发作性喘息的学龄前儿童中不使用背景控制器的间歇性大剂量 ICS，在成人患有不使用背景控制器的间歇性大剂量 ICS在未接受每日控制治疗的轻度哮喘儿童、青少年和成人中，当需要抢救治疗时，可按需给予 ICS 剂量。

结论

ICS 在预防哮喘恶化方面非常有效。已经发现多种给药策略可以降低恶化风险，允许基于个体患者表型和偏好的方法的个性化。