DOI QR코드

DOI QR Code

중증천식의 치료

Treatment of Severe Asthma

  • 이태훈 (울산대학교 의과대학 울산대병원 내과)
  • Lee, Taehoon (Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine)
  • 발행 : 2018.04.01

초록

Severe asthma represents 3-10% of all cases of asthma, but accounts for > 60% of total asthma-related medical costs. Uncontrolled asthma symptoms and frequent asthma exacerbations associated with severe asthma have profound adverse effects on patients' quality of life. The concepts of difficult-to-treat asthma and severe asthma are different; severe asthma represents one kind of difficult-to-treat asthma. Misdiagnosis, nonadherence, and comorbidities may also be causes of difficult-to-treat asthma. This review discusses important principles in the treatment of difficult-to-treat asthma and severe asthma.

키워드

참고문헌

  1. Chung KF, Wenzel SE, Brozek JL, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J 2014;43:343-373. https://doi.org/10.1183/09031936.00202013
  2. Hekking PP, Wener RR, Amelink M, Zwinderman AH, Bouvy ML, Bel EH. The prevalence of severe refractory asthma. J Allergy Clin Immunol 2015;135:896-902. https://doi.org/10.1016/j.jaci.2014.08.042
  3. Sadatsafavi M, Lynd L, Marra C, et al. Direct health care costs associated with asthma in British Columbia. Can Respir J 2010;17:74-80. https://doi.org/10.1155/2010/361071
  4. O'Neill S, Sweeney J, Patterson CC, et al. The cost of treating severe refractory asthma in the UK: an economic analysis from the British thoracic society difficult asthma registry. Thorax 2015;70:376-378. https://doi.org/10.1136/thoraxjnl-2013-204114
  5. Israel E, Reddel HK. Severe and difficult-to-treat asthma in adults. N Engl J Med 2017;377:965-976. https://doi.org/10.1056/NEJMra1608969
  6. National asthma education and prevention program: expert panel report III: guidelines for the diagnosis and management of asthma. 2007.
  7. 2017 GINA Report, Global Strategy for Asthma Management and Prevention.
  8. 2012 GINA Report, Global Strategy for Asthma Management and Prevention.
  9. Aaron SD, Vandemheen KL, Boulet LP, et al. Overdiagnosis of asthma in obese and nonobese adults. CMAJ 2008;179:1121-1131. https://doi.org/10.1503/cmaj.081332
  10. Robinson DS, Campbell DA, Durham SR, Pfeffer J, Barnes PJ, Chung KF. Systematic assessment of difficult-to-treat asthma. Eur Respir J 2003;22:478-483. https://doi.org/10.1183/09031936.03.00017003
  11. The Korean Academy of Asthma, Allergy and Clinical Immunology. Korean Guideline for Asthma. Seoul: The Korean Academy of Asthma, Allergy and Clinical Immunology, 2015.
  12. The Korean Academy of Asthma, Allergy and Clinical Immunology. Asthma Treatment Guideline. Seoul: The Korean Academy of Asthma, Allergy and Clinical Immunology, 2014.
  13. Boulet LP, Vervloet D, Magar Y, Foster JM. Adherence: the goal to control asthma. Clin Chest Med 2012;33:405-417. https://doi.org/10.1016/j.ccm.2012.06.002
  14. Bae YJ, Kim TB, Jee YK, et al. Severe asthma patients in Korea overestimate their adherence to inhaled corticosteroids. J Asthma 2009;46:591-595. https://doi.org/10.1080/02770900902980908
  15. Gamble J, Stevenson M, McClean E, Heaney LG. The prevalence of nonadherence in difficult asthma. Am J Respir Crit Care Med 2009;180:817-822. https://doi.org/10.1164/rccm.200902-0166OC
  16. Chapman KR, Voshaar TH, Virchow JC. Inhaler choice in primary practice. Eur Respir Rev 2005;14:117-122. https://doi.org/10.1183/09059180.05.00009607
  17. Basheti IA, Reddel HK, Armour CL, Bosnic-Anticevich SZ. Improved asthma outcomes with a simple inhaler technique intervention by community pharmacists. J Allergy Clin Immunol 2007;119:1537-1538. https://doi.org/10.1016/j.jaci.2007.02.037
  18. Bergeron C, Hamid Q. Relationship between asthma and rhinitis: epidemiologic, pathophysiologic, and therapeutic aspects. Allergy Asthma Clin Immunol 2005;1:81-87.
  19. ten Brinke A, Sterk PJ, Masclee AA, et al. Risk factors of frequent exacerbations in difficult-to-treat asthma. Eur Respir J 2005;26:812-818. https://doi.org/10.1183/09031936.05.00037905
  20. Pauwels R. Influence of treatment on the nose and/or the lungs. Clin Exp Allergy 1998;28 Suppl 2:37-40.
  21. Adams RJ, Fuhlbrigge AL, Finkelstein JA, Weiss ST. Intranasal steroids and the risk of emergency department visits for asthma. J Allergy Clin Immunol 2002;109:636-642. https://doi.org/10.1067/mai.2002.123237
  22. Koh YI. Diagnosis of allergic rhinitis. Korean J Med 2013;85:452-456. https://doi.org/10.3904/kjm.2013.85.5.452
  23. The Korean Academy of Asthma, Allergy and Clinical Immunology. Guidelines for clinicians: allergic rhinitis. Seoul: Medrang Ltd., 2015.
  24. Mastronarde JG, Anthonisen NR, Castro M, et al. Efficacy of esomeprazole for treatment of poorly controlled asthma. N Engl J Med 2009;360:1487-1499. https://doi.org/10.1056/NEJMoa0806290
  25. Chan WW, Chiou E, Obstein KL, Tignor AS, Whitlock TL. The efficacy of proton pump inhibitors for the treatment of asthma in adults: a meta-analysis. Arch Intern Med 2011;171:620-629.
  26. Irwin RS. Chronic cough due to gastroesophageal reflux disease: ACCP evidence-based clinical practice guidelines. Chest 2006;129(1 Suppl):80S-94S. https://doi.org/10.1378/chest.129.1_suppl.80S
  27. Scott HA, Gibson PG, Garg ML, et al. Dietary restriction and exercise improve airway inflammation and clinical outcomes in overweight and obese asthma: a randomized trial. Clin Exp Allergy 2013;43:36-49. https://doi.org/10.1111/cea.12004
  28. Korean Neuropsychiatric Association. Neuropsychiatry. Seoul: Hanauihagsa, 1998.
  29. Kim TH. Differential diagnosis and treatment of dyspnea. Korean J Med 2009;76:425-430.
  30. Dunn NM, Katial RK, Hoyte FCL. Vocal cord dysfunction: a review. Asthma Res Pract 2015;1:9. https://doi.org/10.1186/s40733-015-0009-z
  31. Cohen SM. Diagnosis and Management of vocal cord dysfunction. J Nurse Pract 2010;6: 675-682. https://doi.org/10.1016/j.nurpra.2010.04.004
  32. Heiser JM, Kahn ML, Schmidt TA. Functional airway obstruction presenting as stridor: a case report and literature review. J Emerg Med 1990;8:285-289. https://doi.org/10.1016/0736-4679(90)90007-I
  33. Goldman J, Muers M. Vocal cord dysfunction and wheezing. Thorax 1991;46:401-404. https://doi.org/10.1136/thx.46.6.401
  34. The Korean Academy of Asthma, Allergy and Clinical Immunology. Asthma and allergic diseases. Seoul: Yeomungag, 2012.
  35. Morgan WJ, Crain EF, Gruchalla RS, et al. Results of a home-based environmental intervention among urban children with asthma. N Engl J Med 2004;351:1068-1080. https://doi.org/10.1056/NEJMoa032097
  36. Crocker DD, Kinyota S, Dumitru GG, et al. Effectiveness of home-based, multi-trigger, multicomponent interventions with an environmental focus for reducing asthma morbidity: a community guide systematic review. Am J Prev Med 2011;41(2 Suppl 1):S5-S32. https://doi.org/10.1016/j.amepre.2011.05.012
  37. Beuther DA, Martin RJ. Efficacy of a heat exchanger mask in cold exercise-induced asthma. Chest 2006;129:1188-1193. https://doi.org/10.1378/chest.129.5.1188
  38. Berges-Gimeno MP, Simon RA, Stevenson DD. The natural history and clinical characteristics of aspirin-exacerbated respiratory disease. Ann Allergy Asthma Immunol 2002;89:474-478. https://doi.org/10.1016/S1081-1206(10)62084-4
  39. Adkinson. Middleton's Allergy: Principles and Practice. In: Hypersensitivity to Aspirin and Other Nonsteroidal Antiinflammatory Drugs. 8th ed. New York: Elsevier, 2014:1296-1309.
  40. Stevenson DD. Aspirin and NSAID sensitivity. Immunol Allergy Clin North Am 2004;24:491-505, vii. https://doi.org/10.1016/j.iac.2004.03.001
  41. Kim YJ, Lim KH, Kim MY, et al. Cross-reactivity to acetaminophen and eelecoxib according to the type of nonsteroidal anti-inflammatory drug hypersensitivity. Allergy Asthma Immunol Res 2014;6:156-162. https://doi.org/10.4168/aair.2014.6.2.156
  42. Dicpinigaitis PV. Angiotensin-converting enzyme inhibitorinduced cough: ACCP evidence-based clinical practice guidelines. Chest 2006;129(1 Suppl):169S-173S. https://doi.org/10.1378/chest.129.1_suppl.169S
  43. Baker-Smith CM, Benjamin DK Jr, Califf RM, Murphy MD, Li JS, Smith PB. Cough in pediatric patients receiving angiotensin-converting enzyme inhibitor therapy or angiotensin receptor blocker therapy in randomized controlled trials. Clin Pharmacol Ther 2010;87:668-671. https://doi.org/10.1038/clpt.2009.231
  44. Morales DR, Dreischulte T, Lipworth BJ, Donnan PT, Jackson C, Guthrie B. Respiratory effect of beta-blocker eye drops in asthma: population-based study and meta-analysis of clinical trials. Br J Clin Pharmacol 2016;82:814-822. https://doi.org/10.1111/bcp.13006
  45. Yoon HJ, Jee YK, Kim YY, Cho SH, Min KU. The prevalence of sensitivity to sulfiting agents in patients with bronchial asthma. Allergy 1994;14:311-317.
  46. Park HS, Cho YH, Kim SS, et al. Pervalence of sensiticity to aspirin (ASA) and food additives in subjects diagnosed as having intrinsic asthma. J Asthma Allergy Clin Immunol 1998;18:662-671.
  47. Tarlo SM, Balmes J, Balkissoon R, et al. Diagnosis and management of work-related asthma: American College Of Chest Physicians Consensus Statement. Chest 2008;134(3 Suppl):1S-41S.
  48. The national institute for occupational safety and health (NIOSH). Decision Logic for Work-Related Asthma [Internet]. Atlanta (GA): Centers for disease control and prevention, c2018 [cited 2018 Mar 1]. Available from: http://www.cdc.gov/niosh/topics/surveillance/ords/statebasedsurveillance/re-portingguidelines-wra.html# WRAGuidelines.
  49. Mapp CE, Boschetto P, Maestrelli P, Fabbri LM. Occupational asthma. Am J Respir Crit Care Med 2005;172:280-305. https://doi.org/10.1164/rccm.200311-1575SO
  50. Agusti A, Bel E, Thomas M, et al. Treatable traits: toward precision medicine of chronic airway diseases. Eur Respir J 2016;47:410-419. https://doi.org/10.1183/13993003.01359-2015
  51. Wenzel S. Severe asthma in adults. Am J Respir Crit Care Med 2005;172:149-160. https://doi.org/10.1164/rccm.200409-1181PP
  52. Pakhale S, Mulpuru S, Boyd M. Optimal management of severe/refractory asthma. Clin Med Insights Circ Respir Pulm Med 2011;5:37-47.
  53. Ayres JG, Bateman ED, Lundbäck B, Harris TA. High dose fluticasone propionate, 1 mg daily, versus fluticasone propionate, 2 mg daily, or budesonide, 1.6 mg daily, in patients with chronic severe asthma. International Study Group. Eur Respir J 1995;8:579-586.
  54. Pauwels RA, Lofdahl CG, Postma DS, et al. Effect of inhaled formoterol and budesonide on exacerbations of asthma. formoterol and corticosteroids establishing therapy (FACET) international study group. N Engl J Med 1997;337:1405-1411. https://doi.org/10.1056/NEJM199711133372001
  55. Aaronson D, Kaiser H, Dockhorn R, et al. Effects of budesonide by means of the turbuhaler on the hypothalmic-pituitary-adrenal axis in asthmatic subjects: a dose-response study. J Allergy Clin Immunol 1998;101:312-319. https://doi.org/10.1016/S0091-6749(98)70241-6
  56. Reddel HK, Jenkins CR, Marks GB, et al. Optimal asthma control, starting with high doses of inhaled budesonide. Eur Respir J 2000;16:226-235. https://doi.org/10.1034/j.1399-3003.2000.16b08.x
  57. Skinner C. Comparison of oral prednisolone and intramuscular depot triamcinolone in patients with severe chronic asthma. Thorax 1984;39:880.
  58. Ogirala RG, Aldrich TK, Prezant DJ, Sinnett MJ, Enden JB, Williams MH Jr. High-dose intramuscular triamcinolone in severe, chronic, life-threatening asthma. N Engl J Med 1991;324:585-589. https://doi.org/10.1056/NEJM199102283240903
  59. ten Brinke A, Zwinderman AH, Sterk PJ, Rabe KF, Bel EH. "Refractory" eosinophilic airway inflammation in severe asthma: effect of parenteral corticosteroids. Am J Respir Crit Care Med 2004;170:601-605. https://doi.org/10.1164/rccm.200404-440OC
  60. Corrigan CJ, Loke TK. Clinical and molecular aspects of glucocorticoid resistant asthma. Ther Clin Risk Manag 2007;3:771-787.
  61. Barnes PJ. Glucocorticosteroids: current and future directions. Br J Pharmacol 2011;163:29-43. https://doi.org/10.1111/j.1476-5381.2010.01199.x
  62. Adcock M. Mechanisms and clinical implications of glucocorticoid resistance in asthma [Internet]. Boston (MA): UpToDate, c2018 [cited 2018 Mar 1]. Available from: https://www.uptodate.com/contents/mechanisms-and-clinical-implications-of-glucocorticoid-resistance-in-asthma?cs=848efdd4-641c-4fa3-a2e5-e66dfc945a8a& source=contentShare.
  63. Woodruff PG, Modrek B, Choy DF, et al. T-helper type 2-driven inflammation defines major subphenotypes of asthma. Am J Respir Crit Care Med 2009;180:388-395. https://doi.org/10.1164/rccm.200903-0392OC
  64. Hanania NA, Wenzel S, Rosen K, et al. Exploring the effects of omalizumab in allergic asthma: an analysis of biomarkers in the EXTRA study. Am J Respir Crit Care Med 2013;187:804-811. https://doi.org/10.1164/rccm.201208-1414OC
  65. Wenzel S. Treatment of severe asthma in adolescents and adults, 2018 UpToDate [Internet]. Boston (MA): UpToDate, c2018 [cited 2018 Mar 1]. Available from: https://www.uptodate.com/contents/treatment-of-severe- asthma-in-adolescents-and-adults?csi=8e1a0ba4-694a-4743-88a8-d7617b4aef3f&source=contentShare.
  66. Bousquet J, Siergiejko Z, Swiebocka E, et al. Persistency of response to omalizumab therapy in severe allergic (IgEmediated) asthma. Allergy 2011;66:671-678. https://doi.org/10.1111/j.1398-9995.2010.02522.x
  67. Hur GY, Kim TB, Kim ST, et al. Allergy Immunotherapy. Korean J Asthma Allergy Clin Immunol 2010;30:153-183.
  68. Virchow JC, Backer V, Kuna P, et al. Efficacy of a house dust mite sublingual allergen immunotherapy tablet in adults with allergic asthma: a randomized clinical trial. JAMA 2016;315:1715-1725. https://doi.org/10.1001/jama.2016.3964
  69. Silva CI, Colby TV, Muller NL. Asthma and associated conditions: high-resolution CT and pathologic findings. AJR Am J Roentgenol 2004;183:817-824. https://doi.org/10.2214/ajr.183.3.1830817
  70. Donohue KM, Hoffman EA, Baumhauer H, et al. Asthma and lung structure on computed tomography: the multi-ethnic study of atherosclerosis lung study. J Allergy Clin Immunol 2013;131:361-368.e1-e11. https://doi.org/10.1016/j.jaci.2012.11.036
  71. Kim HG, Lee HK, Kweon BC, et al. Two cases of upper airway obstruction masquerading as asthma: one tracheal adenoid cystic carcinoma, the other foreign body aspiration. J Asthma Allergy Clin Immunol 1999;19:103-109.
  72. Global Initiative for Chronic Obstructive Lung Disease. GOLD 2017 Global Strategy for the Diagnosis, Management and Prevention of COPD [Internet]. Fontana (WI): Global Initiative for Chronic Obstructive Lung Disease, c2018 [cited 2018 Mar 1]. Available from:http://goldcopd.org/gold-2017-global-strategy-diagnosis-management-prevention-copd/.

피인용 문헌

  1. 심리 및 생리적 요인이 성인천식에 미치는 영향 vol.23, pp.2, 2020, https://doi.org/10.14695/kjsos.2020.23.2.13