[慢性支气管疾病短程皮质类固醇疗法的疗效和毒性]。

IF 0.5 4区 医学 Q4 RESPIRATORY SYSTEM Revue des maladies respiratoires Pub Date : 2024-11-01 Epub Date: 2024-10-10 DOI:10.1016/j.rmr.2024.09.002
L Regard, P C Lazureanu, B Pascal, G Laurichesse, C Rolland-Debord
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引用次数: 0

摘要

哮喘和慢性阻塞性肺病(COPD)等慢性呼吸道疾病的特点是气道炎症。虽然皮质类固醇(CS)是这些疾病加重时的常用处方药,但反复使用会产生许多副作用。本综述旨在综合近期有关这两种疾病短期 CS 治疗的适应症、益处和风险的文献。法国指南建议将短期 CS 作为哮喘加重期的一线治疗(0.5 至 1 毫克/千克/天,不超过 60 毫克/天,至少持续 5 至 7 天),或作为慢性阻塞性肺疾病加重期的二线治疗(5 天,30 至 40 毫克/天)。然而,这些建议并非没有局限性;它们主要基于在医院环境中进行的研究,这使人们对其结果在初级保健中的推广性产生了疑问,而且由于它们采用了 "一刀切 "的策略,因此没有考虑到不同患者的表型异质性。此外,反复使用短期 CS 会产生副作用,即使是低剂量,也会在年轻的哮喘患者中过早出现,并且会加重慢性阻塞性肺病患者原有的合并症。为了准确评估副作用的风险,在日常实践中应采用阈值剂量的概念。在不久的将来,重要的是要考虑最近发表的支持使用预测性生物标志物来预测对 CS 的反应的数据,尤其是在慢性阻塞性肺病病例中。
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[Efficacy and toxicity of short-course corticosteroid therapy in chronic bronchial diseases].

Chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD) are characterized by airway inflammation. While corticosteroids (CS) are frequently prescribed during exacerbations of these conditions, their repeated use is associated with numerous side effects. The aim of this review is to synthesize the recent literature on the indications, benefits, and risks of short-term CS therapy for these two diseases. French guidelines recommend short-term CS as a first-line treatment during asthma exacerbation (0,5 to 1mg/kg/day, not exceeding 60mg/day, for at least 5 to 7 days) or as a second-line treatment for COPD exacerbation (5 days, 30 to 40mg/day). However, these recommendations are not without limitations; they are primarily based on studies conducted in hospital settings, raising questions about the generalizability of their results to primary care, and as they employ a "one size fits all" strategy, they do not take into account the phenotypic heterogeneity of different patients. Moreover, repeated short-term CS courses generate side effects that even at low doses can appear early in young asthma patients, and they can exacerbate pre-existing comorbidities in COPD patients. The concept of a threshold dose should be employed in routine practice in view of accurately assessing the risk of side effects. In the near future, it will be important to consider recently published data supporting the use of predictive biomarkers for responses to CS, particularly in COPD cases.

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来源期刊
Revue des maladies respiratoires
Revue des maladies respiratoires 医学-呼吸系统
CiteScore
1.10
自引率
16.70%
发文量
168
审稿时长
4-8 weeks
期刊介绍: La Revue des Maladies Respiratoires est l''organe officiel d''expression scientifique de la Société de Pneumologie de Langue Française (SPLF). Il s''agit d''un média professionnel francophone, à vocation internationale et accessible ici. La Revue des Maladies Respiratoires est un outil de formation professionnelle post-universitaire pour l''ensemble de la communauté pneumologique francophone. Elle publie sur son site différentes variétés d''articles scientifiques concernant la Pneumologie : - Editoriaux, - Articles originaux, - Revues générales, - Articles de synthèses, - Recommandations d''experts et textes de consensus, - Séries thématiques, - Cas cliniques, - Articles « images et diagnostics », - Fiches techniques, - Lettres à la rédaction.
期刊最新文献
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