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Báo cáo y học: "The Difficult-to-Control Asthmatic: A Systematic Approach"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học General Psychiatry cung cấp cho các bạn kiến thức về ngành y đề tài: The Difficult-to-Control Asthmatic: A Systematic Approach. | Review Article The Difficult-to-Control Asthmatic A Systematic Approach Annie V. Le MD Ronald A. Simon MD Abstract With the judicious use of inhaled corticosteroids P2 agonists and leukotriene modifiers most patients with asthma are easily controlled and managed. However approximately 5 of asthmatics do not respond to standard therapy and are classified as difficult to control. 1 Typically these are patients who complain of symptoms interfering with daily living despite long-term treatment with inhaled corticosteroids in doses up to 2 000 g daily. Many factors can contribute to poor response to conventional therapy and especially for these patients a systematic approach is needed to identify the underlying causes. First the diagnosis of asthma and adherence to the medication regimen should be confirmed. Next potential persisting exacerbating triggers need to be identified and addressed. Concomitant disorders should be discovered and treated. Lastly the impact and implications of socioeconomic and psychological factors on disease control can be significant and should be acknowledged and discussed with the individual patient. Less conventional and novel strategies for treating corticosteroid-resistant asthma do exist. However their use is based on small studies that do not meet evidence-based criteria therefore it is essential to sort through and address the above issues before reverting to other therapy. Incorrect Diagnosis It is important to remember that all that wheezes is not asthma Table 1 . When there is a lack of response to standard therapy the diagnosis of asthma should be questioned and revisited. Obtaining pulmonary function testing with flow volume curves both inspiratory and expiratory and documenting reversible airway obstruction or airway hyperresponsiveness become essential. A flat- A.V. Le R.A. Simon Division of Allergy Asthma and Immunology The Scripps Clinic and the Scripps Research Institute La Jolla CA Correspondence to R.A. Simon MD Division of