儿童难治性/重症哮喘的诊治进展
Advances in Diagnosis and Treatment of Difficult-to-Treat/Severe Asthma in Children
DOI: 10.12677/ACM.2024.143833, PDF,   
作者: 涂 艳*, 张明香, 符 州#:重庆医科大学附属儿童医院呼吸科/国家儿童健康与疾病临床医学研究中心/儿童发育疾病研究教育部重点实验室/儿科学重庆市重点实验室,重庆
关键词: 儿童难治性哮喘重症哮喘影响因素治疗Childhood Difficult-to-Treat Asthma Severe Asthma Influencing Factors Treatment
摘要: 儿童难治性/重症哮喘的发病率不高,但带来的疾病危害与家庭经济负担是巨大的。由于其影响疾病控制的因素繁多且作用复杂,其诊断和治疗是临床工作中的一大难题。本文针对儿童难治性哮喘的定义、影响哮喘控制的因素及儿童重症哮喘的新兴治疗作一综述,以期提高儿童难治性/重症哮喘的控制水平与生活质量,并为未来药物治疗研究方向提供思路。
Abstract: The incidence of difficult-to-treat/severe asthma in children is not high, but the harm and family economic burden from the disease are huge. Its diagnosis and treatment are a major problem in clinical work because of its lots of and complex influencing factors. In order to improve the control level and quality of life of difficult-to-treat/severe asthma in children and provide the research di-rection of drug therapy in the future, this article reviews the definition of difficult-to-treat/severe asthma in children, the factors influencing asthma control and the latest treatment methods of children with severe asthma.
文章引用:涂艳, 张明香, 符州. 儿童难治性/重症哮喘的诊治进展[J]. 临床医学进展, 2024, 14(3): 1229-1239. https://doi.org/10.12677/ACM.2024.143833

参考文献

[1] 洪建国. 儿童支气管哮喘规范化诊治建议(2020年版) [J]. 中华儿科杂志, 2020, 58(9): 708-717.
[2] Global Initia-tive for Asthma (2023) Difficult-to-Treat & Severe Asthma in Adolescent and Adult Patients.
https://ginasthma.org/wp-content/uploads/2023/09/GINA-Severe-Asthma-Guide-2023-WEB-WMS.pdf
[3] 洪建国. 重视儿童难治/重症哮喘的诊治[J]. 中华临床免疫和变态反应杂志, 2019, 13(4): 267-270.
[4] Haktanir, A.M. AND Phipatanakul, W. (2019) Severe Asthma in Children: Evaluation and Management. Allergology International, 68, 150-157. [Google Scholar] [CrossRef] [PubMed]
[5] Hodkinson, A., Bower, P., Grigoroglou, C., et al. (2020) Self-Management Interventions to Reduce Healthcare Use and Improve Quality of Life Among Patients with Asthma: Systematic Review and Network Meta-Analysis. BMJ, 370, m2521. [Google Scholar] [CrossRef] [PubMed]
[6] Moral, L., Vizmanos, G., Torres-Borrego, J., et al. (2019) Asthma Diagnosis in Infants and Preschool Children: A Systematic Review of Clinical Guidelines. Allergologia et Immunopathologia, 47, 107-121. [Google Scholar] [CrossRef] [PubMed]
[7] 迟磊, 单玉霞, 朱紫微. 多维评估在儿童难治性哮喘中的作用[J]. 中华实用儿科临床杂志, 2020, 35(4): 262-267.
[8] Chung, K.F., Wenzel, S.E., Brozek, J.L., et al. (2014) Inter-national ERS/ATS Guidelines on Definition, Evaluation and Treatment of Severe Asthma. European Respiratory Journal, 43, 343-373. [Google Scholar] [CrossRef] [PubMed]
[9] Papi, A., Brightling, C., Pedersen, S.E., et al. (2018) Asthma. Lancet, 391, 783-800. [Google Scholar] [CrossRef
[10] Chongmelaxme, B., Chaiyakunapruk, N. AND Dilokthorn-sakul, P. (2003) Association between Adherence and Severe Asthma Exacerbation: A Systematic Review and Me-ta-Analysis. Journal of the American Pharmacists Association, 60, 669-685.E2. [Google Scholar] [CrossRef] [PubMed]
[11] Boutopoulou, B., Koumpagioti, D., Matziou, V., et al. (2018) In-terventions on Adherence to Treatment in Children with Severe Asthma: A Systematic Review. Frontiers in Pediatrics, 6, Article 232. [Google Scholar] [CrossRef] [PubMed]
[12] Butz, A.M., Bollinger, M.E., Ogborn, J., et al. (2019) Children with Poorly Controlled Asthma: Randomized Controlled Trial of a Home-Based Environmental Control Intervention. Pediatric Pulmonology, 54, 245-256. [Google Scholar] [CrossRef] [PubMed]
[13] Zheng, X.Y., Orellano, P., Lin, H.L., et al. (2021) Short-Term Exposure to Ozone, Nitrogen Dioxide, and Sulphur Dioxide and Emergency Department Visits and Hospital Admissions Due to Asthma: A Systematic Review and Meta-Analysis. Environment International, 150, Article ID: 106435. [Google Scholar] [CrossRef] [PubMed]
[14] Davis, K.L. (2020) Rhinovirus Type in Severe Bronchiolitis and the Development of Asthma. Pediatrics, 146, S325-S326. [Google Scholar] [CrossRef
[15] Makrinioti, H., Hasegawa, K., Lakoumentas, J., et al. (2022) The Role of Respiratory Syncytial Virus- and Rhinovirus-Induced Bronchiolitis in Recurrent Wheeze and Asthma—A Sys-tematic Review and Meta-Analysis. Pediatric Allergy and Immunology, 33, e13741. [Google Scholar] [CrossRef] [PubMed]
[16] Dhariwal, J., Cameron, A., Wong, E., et al. (2021) Pulmonary Innate Lym-phoid Cell Responses during Rhinovirus-Induced Asthma Exacerbations in Vivo: A Clinical Trial. American Journal of Respiratory and Critical Care Medicine, 204, 1259-1273. [Google Scholar] [CrossRef
[17] Liu, S., Verma, M., Michalec, L., et al. (2018) Steroid Resistance of Airway Type 2 Innate Lymphoid Cells from Patients with Severe Asthma: The Role of Thymic Stromal Lymphopoietin. Journal of Allergy and Clinical Immunology, 141, 257-268.E6. [Google Scholar] [CrossRef] [PubMed]
[18] 刘秋怡, 张沛林, 郭蓉, 等. 900例哮喘急性发作期住院患儿临床特征分析[J]. 临床儿科杂志, 2023, 41(5): 353-359.
[19] Tay, T.R., Radhakrishna, N., Hore-Lacy, F., et al. (2016) Comorbidities in Difficult Asthma Are Independent Risk Factors for Frequent Exacerbations, Poor Control and Diminished Quality of Life. Respirology, 21, 1384-1390. [Google Scholar] [CrossRef] [PubMed]
[20] Ricciardolo, F., Levra, S., Sprio, A.E., et al. (2020) A Real-World As-sessment of Asthma with Chronic Rhinosinusitis. Annals of Allergy, Asthma & Immunology, 125, 65-71. [Google Scholar] [CrossRef] [PubMed]
[21] Davies, S.E., Bishopp, A., Wharton, S., et al. (2019) The Associa-tion between Asthma and Obstructive Sleep Apnea (OSA): A Systematic Review. Journal of Asthma, 56, 118-129. [Google Scholar] [CrossRef] [PubMed]
[22] Davies, S.E., Bishopp, A., Wharton, S., et al. (2018) Does Continuous Positive Airway Pressure (CPAP) Treatment of Obstructive Sleep Apnoea (OSA) Improve Asthma-Related Clinical Outcomes in Patients with Co-Existing Conditions? A Systematic Review. Respiratory Medicine, 143, 18-30. [Google Scholar] [CrossRef] [PubMed]
[23] Forno, E., Acosta-Pérez, E., Brehm, J.M., et al. (2014) Obesity and Adiposity Indicators, Asthma, and Atopy in Puerto Rican Children. Journal of Allergy and Clinical Immunology, 133, 1308-1314.E5. [Google Scholar] [CrossRef] [PubMed]
[24] Sansone, F., Attanasi, M., Di Pillo, S. and Chiarelli, F. (2020) Asthma and Obesity in Children. Biomedicines, 8, Article 231. [Google Scholar] [CrossRef] [PubMed]
[25] Deng, X., Ma, J., Yuan, Y., et al. (2019) Association between Overweight or Obesity and the Risk for Childhood Asthma and Wheeze: An Updated Meta-Analysis on 18 Articles and 73 252 Children. Pediatric Obesity, 14, e12532. [Google Scholar] [CrossRef] [PubMed]
[26] Nasiri, K.R., Ataee, P., Mansori, M., et al. (2017) Serum Levels of Adi-ponectin and Leptin in Asthmatic Patients and Its Relation with Asthma Severity, Lung Function and BMI. Allergologia et Immunopathologia, 45, 258-264. [Google Scholar] [CrossRef] [PubMed]
[27] Sánchez-Ortega, H., Jiménez-Cortegana, C., Novalbos-Ruiz, J.P., et al. (2022) Role of Leptin as a Link between Asthma and Obesity: A Systematic Review and Meta-Analysis. Interna-tional Journal of Molecular Sciences, 24, Articel 546. [Google Scholar] [CrossRef] [PubMed]
[28] Pijnenburg, M.W. and Fleming, L. (2020) Advances in Understanding and Reducing the Burden of Severe Asthma in Children. The Lancet Respiratory Medicine, 8, 1032-1044. [Google Scholar] [CrossRef
[29] Brew, B.K., Osvald, E.C., Gong, T., et al. (2022) Paediatric Asthma and Non-Allergic Comorbidities: A Review of Current Risk and Pro-posed Mechanisms. Clinical & Experimental Allergy, 52, 1035-1047. [Google Scholar] [CrossRef] [PubMed]
[30] Ye, G., Baldwin, D.S. and Hou, R. (2021) Anxiety in Asthma: A System-atic Review and Meta-Analysis. Psychological Medicine, 51, 11-20. [Google Scholar] [CrossRef
[31] Shankar, M., Fagnano, M., Blaakman, S.W., et al. (2019) De-pressive Symptoms among Urban Adolescents with Asthma: A Focus for Providers. Academic Pediatrics, 19, 608-614. [Google Scholar] [CrossRef] [PubMed]
[32] O’Neill, M.B., Laval, G., Teixeira, J.C., et al. (2020) Genetic Sus-ceptibility to Severe Childhood Asthma and Rhinovirus-C Maintained by Balancing Selection in Humans for 150 000 Years. Human Molecular Genetics, 29, 736-744. [Google Scholar] [CrossRef] [PubMed]
[33] Liu, L., Yue, D., Hu, L., et al. (2020) Relationship between Interleukin-13 Rs20541 Single Nucleotide Polymorphisms and Therapeutic Efficacy in Children with Asthma. Journal of International Medical Research, 48. [Google Scholar] [CrossRef] [PubMed]
[34] Zein, J., Gaston, B., Bazeley, P., et al. (2020) HSD3B1 Genotype Identifies Glucocorticoid Responsiveness in Severe Asthma. Proceedings of the National Academy of Sciences of the United States of America, 117, 2187-2193. [Google Scholar] [CrossRef] [PubMed]
[35] Hohmann, C., Keller, T., Gehring, U., et al. (2019) Sex-Specific In-cidence of Asthma, Rhinitis and Respiratory Multimorbidity Before and After Puberty Onset: Individual Participant Me-ta-Analysis of Five Birth Cohorts Collaborating in MeDALL. BMJ Open Respiratory Research, 6, e000460. [Google Scholar] [CrossRef] [PubMed]
[36] Newcomb, D.C., Cephus, J.Y., Boswell, M.G., et al. (2015) Estrogen and Progesterone Decrease Let-7f MicroRNA Expression and Increase IL-23/IL-23 Receptor Signaling and IL-17A Production in Patients with Severe Asthma. Journal of Allergy and Clinical Immunology, 136, 1025-1034.E11. [Google Scholar] [CrossRef] [PubMed]
[37] Arathimos, R., Granell, R., Haycock, P., et al. (2019) Genetic and Observational Evidence Supports A Causal Role of Sex Hormones on the Development of Asthma. Thorax, 74, 633-642. [Google Scholar] [CrossRef] [PubMed]
[38] Hinks, T., Levine, S.J. and Brusselle, G.G. (2021) Treatment Options in Type-2 Low Asthma. European Respiratory Journal, 57, Article ID: 2000528. [Google Scholar] [CrossRef] [PubMed]
[39] Mitchell, P.D., Salter, B.M., Oliveria, J.P., et al. (2018) IL-33 and Its Receptor ST2 after Inhaled Allergen Challenge in Allergic Asthmatics. International Archives of Allergy and Im-munology, 176, 133-142. [Google Scholar] [CrossRef] [PubMed]
[40] 邓云天, 李雪梅. 儿童难治性哮喘生物靶向治疗研究进展[J]. 儿科药学杂志, 2022, 28(2): 56-60.
[41] McGregor, M.C., Krings, J.G., Nair, P., et al. (2019) Role of Biologics in Asthma. American Journal of Respiratory and Critical Care Medicine, 199, 433-445. [Google Scholar] [CrossRef
[42] Mavissakalian, M. and Brady, S. (2020) The Current State of Biologic Therapies for Treatment of Refractory Asthma. Clinical Reviews in Allergy & Immunology, 59, 195-207. [Google Scholar] [CrossRef] [PubMed]
[43] Agache, I., Akdis, C.A., Akdis, M., et al. (2021) EAACI Bio-logicals Guidelines-Recommendations for Severe Asthma. Allergy, 76, 14-44. [Google Scholar] [CrossRef] [PubMed]
[44] Bousquet, J., Humbert, M., Gibson, P.G., et al. (2021) Real-World Effec-tiveness of Omalizumab in Severe Allergic Asthma: A Meta-Analysis of Observational Studies. The Journal of Allergy and Clinical Immunology: In Practice, 9, 2702-2714. [Google Scholar] [CrossRef] [PubMed]
[45] Bleecker, E.R., FitzGerald, J.M., Chanez, P., et al. (2016) Efficacy and Safety of Benralizumab for Patients with Severe Asthma Uncon-trolled with High-Dosage Inhaled Corticosteroids and Long-Acting β(2)-Agonists (SIROCCO): A Randomised, Multi-centre, Placebo-Controlled Phase 3 Trial. Lancet, 388, 2115-2127. [Google Scholar] [CrossRef
[46] Ortega, H.G., Liu, M.C., Pavord, I.D., et al. (2014) Mepoli-zumab Treatment in Patients with Severe Eosinophilic Asthma. The New England Journal of Medicine, 371, 1198-1207. [Google Scholar] [CrossRef
[47] Busse, W.W., Bleecker, E.R., FitzGerald, J.M., et al. (2019) Long-Term Safety and Efficacy of Benralizumab in Patients with Severe, Uncontrolled Asthma: 1-Year Results from the BORA Phase 3 Extension Trial. The Lancet Respiratory Medicine, 7, 46-59. [Google Scholar] [CrossRef
[48] Chupp, G.L., Bradford, E.S., Albers, F.C., et al. (2017) Ef-ficacy of Mepolizumab Add-on Therapy on Health-Related Quality of Life and Markers of Asthma Control in Severe Eosinophilic Asthma (MUSCA): A Randomised, Double-Blind, Placebo-Controlled, Parallel-Group, Multicentre, Phase 3b Trial. The Lancet Respiratory Medicine, 5, 390-400. [Google Scholar] [CrossRef
[49] Castro, M., Corren, J., Pavord, I.D., et al. (2018) Dupi-lumab Efficacy and Safety in Moderate-to-Severe Uncontrolled Asthma. The New England Journal of Medicine, 378, 2486-2496. [Google Scholar] [CrossRef
[50] Porsbjerg, C.M., Sverrild, A., Lloyd, C.M., et al. (2020) Anti-Alarmins in Asthma: Targeting the Airway Epithelium with Next-Generation Biologics. European Respiratory Journal, 56, Article ID: 2000260. [Google Scholar] [CrossRef] [PubMed]
[51] Menzies-Gow, A., Corren, J., Bourdin, A., et al. (2021) Teze-pelumab in Adults and Adolescents with Severe, Uncontrolled Asthma. The New England Journal of Medicine, 384, 1800-1809. [Google Scholar] [CrossRef
[52] Diver, S., Khalfaoui, L., Emson, C., et al. (2021) Effect of Tezepelumab on Airway Inflammatory Cells, Remodelling, and Hyperresponsiveness in Patients with Moder-ate-To-Severe Uncontrolled Asthma (CASCADE): A Double-Blind, Randomised, Placebo-Controlled, Phase 2 Trial. The Lancet Respiratory Medicine, 9, 1299-1312. [Google Scholar] [CrossRef
[53] Wechsler, M.E., Ruddy, M.K., Pavord, I.D., et al. (2021) Ef-ficacy and Safety of Itepekimab in Patients with Moderate-to-Severe Asthma. The New England Journal of Medicine, 385, 1656-1668. [Google Scholar] [CrossRef
[54] Mainardi, A.S., Castro, M. and Chupp, G. (2019) Bronchial Ther-moplasty. Clinics in Chest Medicine, 40, 193-207. [Google Scholar] [CrossRef] [PubMed]
[55] Chaudhuri, R., Rubin, A., Sumino, K., et al. (2021) Safety and Ef-fectiveness of Bronchial Thermoplasty after 10 Years in Patients with Persistent Asthma (BT10+): A Follow-Up of Three Randomised Controlled Trials. The Lancet Respiratory Medicine, 9, 457-466. [Google Scholar] [CrossRef
[56] Goorsenberg, A., D’Hooghe, J., Srikanthan, K., et al. (2021) Bronchial Thermoplasty Induced Airway Smooth Muscle Reduction and Clinical Response in Severe Asthma. The TASMA Randomized Trial. American Journal of Respiratory and Critical Care Medicine, 203, 175-184. [Google Scholar] [CrossRef
[57] Thomson, N.C. (2018) Bronchial Thermoplasty as a Treatment for Severe Asthma: Controversies, Progress and Uncertainties. Expert Review of Respiratory Medicine, 12, 269-282. [Google Scholar] [CrossRef] [PubMed]
[58] Kim, L., Saleh, C., Whalen-Browne, A., et al. (2021) Triple vs Dual Inhaler Therapy and Asthma Outcomes in Moderate to Severe Asthma: A Systematic Review and Meta-Analysis. JAMA, 325, 2466-2479. [Google Scholar] [CrossRef] [PubMed]
[59] Hiles, S.A., McDonald, V.M., Guilhermino, M., et al. (2019) Does Maintenance Azithromycin Reduce Asthma Exacerbations? An Individual Participant Data Meta-Analysis. European Respiratory Journal, 54, Article ID: 1901381. [Google Scholar] [CrossRef] [PubMed]
[60] Forno, E., Bacharier, L.B., Phipatanakul, W., et al. (2020) Ef-fect of Vitamin D3 Supplementation on Severe Asthma Exacerbations in Children with Asthma and Low Vitamin D Lev-els: The VDKA Randomized Clinical Trial. JAMA, 324, 752-760. [Google Scholar] [CrossRef] [PubMed]