중증난치성 천식의 치료
Management of Severe Refractory Asthma
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대부분의 천식은 치료에 반응이 좋다. 하지만 최대 용량의 천식 치료제에도 반응하지 않는 중증난치성 천식 환자는 정확한 천식 진단이 필요하며, 약물에 대한 순응도를 파악하고, 각 환자마다 악화인자를 확인하여 관리하는 체계적이고 조직적인 접근이 필요하다. 천식의 표현형을 구분하고, 이를 바탕으로 치료한다면 개인에게 적합한 치료를 함으로써 치료 효과를 극대화할 수 있을 것으로 기대된다. 아직도 대부분의 난치성 중증 천식 환자는 천식 조절을 위해 전신 스테로이드 처방을 필요로 하고, 이와 관련된 부작용이 문제가 되고 있다. 스테로이드 사용을 줄이기 위해 면역 조절제, 생물학적 치료제가 개발 중이나, 일부 환자에게서 매우 다양한 효과와 부작용이 보고되고 있어 지속적인 연구가 필요하다. Omalizumab과 기관지 열성형술은 중증 천식 환자를 대상으로 FDA 승인을 받은 치료법으로, 기존의 약물 치료에 반응이 없는 경우 대체 치료법으로 고려해 볼 수 있다.
Abstract
Most patients with asthma have mild to moderate disease and are well controlled by regular use of inhaled corticosteroids with or without long-acting β2-agonists. However, about 5-10% patients with severe asthma remain poorly controlled despite optimal treatment, and these patients have greater morbidity and mortality than mild to moderate asthmatics. Patients with severe refractory asthma (SRA) often require regular systemic corticosteroid use, which increase risk of steroid-related adverse events and require more health care support. A systematic approach is necessary to establish a correct diagnosis, identify coexisting disorders, and evaluate aggravating factors. The management of SRA remains extremely challenging, and many clinical studies are currently in progress. Anti-IgE antibody (omalizumab) and bronchial thermoplasty may be alternative treatment for SRA approved by US Food and Drug Administration. SRA is a heterogeneous disease, which is classified in to distinct clinical phenotypes. A better understanding of these subtypes may lead to improved treatment of SRA. (Korean J Med 2012;83:438-443)
참고문헌 (22)
- Wenzel SE, "National Heart, Lung, and Blood Institute's Severe Asthma Research Program. Severe asthma: lessons from the Severe Asthma Research Program", J Allergy Clin Immunol, 119, pp.14~21 (2007)
- Godard P, "Costs of asthma are correlated with severity: a 1-yr prospective study", Eur Respir J, 19, pp.61~67 (2002)
- Barnes PJ., "Severe asthma: advances in current management and future therapy", J Allergy Clin Immunol, 129, pp.48~59 (2012)
- Hashimoto S, "Current treatment of severe asthma", Clin Exp Allergy, 42, pp.693~705 (2012)
- Pakhale S, "Optimal management of severe", refractory asthma, 2011, pp.5, 37~47
- Morjaria JB, "Recommendation for optimal management of severe refractory asthma", J Asthma Allergy, 3, pp.43~56 (2010)
- Firszt R, "Pharmacotherapy of severe asthma", Curr Opin Pharmacol, 10, pp.266~271 (2010)
- Banh HL, "Unconventional treatment options in severe asthma: an overivew", J Pharm Pharm Sci, 14, pp.387~399 (2011)
- Price D, "Leukotriene antagonists as first-line or add-on asthma-controller therapy", N Engl J Med, 364, pp.1695~1707 (2011)
- Heaney LG, "Predictors of therapy resistant asthma: outcome of a systematic evaluation protocol", Thorax, 58, pp.561~566 (2003)
- Robinson DS, "Systematic assessment of difficult-to-treat asthma", Eur Respir J, 22, pp.478~483 (2003)
- Bresciani M, "Rhinosinusitis in severe asthma", J Allergy Clin Immunol, 107, pp.73~80 (2001)
- Sin DD, "Obesity and the lung: 4. obesity and asthma", Thorax, 63, pp.1018~1023 (2008)
- American Thoracic Society, "Proceedings of the ATS workshop on refractory asthma: current understanding, recommendations, and unanswered questions", Am J Respir Crit Care Med, 162, pp.2341~2351 (2000)
- Moore WC, "Identification of asthma phenotypes using cluster analysis in the Severe Asthma Research Program", Am J Respir Crit Care Med, 181, pp.315~323 (2010)
- Haldar P, "Cluster analysis and clinical asthma phenotypes", Am J Respir Crit Care Med, 178, pp.218~224 (2008)
- Tonelli M, "Short-term effect of the addition of leukotriene receptor antagonists to the current therapy in severe asthmatics", Pulm Pharm Ther, 16, pp.237~240 (2003)
- Vatrella A, "Bronchodilating effects of salmeterol, theophylline and their combination in patients with moderate to severe asthma", Pulm Pharmacol Ther, 18, pp.89~92 (2005)
- Roberts G, "Intravenous salbutamol bolus compared with an aminophylline infusion in children with severe asthma: a randomised controlled trial", Thorax, 58, pp.306~310 (2003)
- Castro M, "Effectiveness and safety of bronchial thermoplasty in the treatment of severe asthma: a multicenter, randomized, double-blind, shamcontrolled clinical trial", Am J Respir Crit Care Med, 181, pp.116~124 (2010)
- Thomson NC, "Long-term (5 year) safety of bronchial thermoplasty: Asthma Intervention Research (AIR) trial", BMC Pulm Med, 11, pp.8~ (2011)
- Holgate S, "Effects of omalizumab on markers of inflammation in patients with allergic asthma", Allergy, 64, pp.1728~1736 (2009)