Problemi correnti
Quando iniziare e quando sospendere i farmaci antiasmatici
WHEN TO START AND TO STOP ANTI-ASHMATIC THERAPY: A RATIONALE BEYOND GUIDELINES
LAURA TRAVAN, IRENE BERTI, GIORGIO LONGO
Clinica Pediatrica, IRCCS “Burlo Garofolo”, Trieste
Marzo 2005 - pagg. 157 -163
Abstract
The understanding of the chronic bronchial inflammation characterizing asthma led us to a
more convinced and accurate use of inhaled corticosteroids such as long lasting therapy.
Although times and ways for this treatment have been defined by several guidelines proposed
by the most respected World Scientific Institutions, at the moment there are no clear answers
concerning “when to start and to stop anti-asthmatic therapy”. As a consequence,
there is a large variability in physicians’ behaviours that certainly contributes to the frequent
poor adherence of patients to this long lasting treatment. The current evidence on the inefficacy
of all pharmacological treatments in modifying persistently the natural history of asthma
might lead to a less aggressive pharmacological approach, with regard of length and dosages,
and might also lead to a less frequent clinical and instrumental evaluation. Finally, it
still needs to be proved that an early steroid therapy, started in very young ages at the beginning
of ashtma, could permanently modify the course of asthma and avoid the irreversible
obstructive damages of the respiratory tract (remodelling).
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
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4. Boulet LP, Bai TR, Becker A, Berube D, Beveridge R, Bowie DM, Chapman KR, Cote J, Cockcroft D, Ducharme FM, Ernst P, FitzGerald JM, Kovesi T, Hodder RV, O’Byrne P, Rowe B, Sears MR, Simons FE, Spier S. What is new since the last (1999) Canadian Asthma Consensus Guidelines? Can Respir J 2001;8 Suppl A:5A-27A.
5. Warner JO, Naspitz CK.Third International Pediatric Consensus statement on the management of childhood asthma. International Pediatric Asthma Consensus Group. Pediatr Pulmonol 1998;25(1):1-17.
6. British Guidelines on Management of Asthma. Thorax 2003;58(suppl 1):S1-S96.
7. van Essen-Zandvliet EE, Hughes MD, Waalkens HJ, Duiverman EJ, Kerrebijn KF. Remission of childhood asthma after longterm treatment with an inhaled corticosteroid (budesonide): can it be achieved? Dutch CNSLD Study Group. Eur Respir J 1994;7(1):63-8.
8. Haahtela T, Jarvinen M, Kava T, Kiviranta K, Koskinen S, Lehtonen K, Nikander K, Persson T, Selroos O, Sovijarvi A, et al. Effects of reducing or discontinuing inhaled budesonide in patients with mild asthma. N Engl J Med 1994;331(11):700-5 (vedi anche editoriale relativo, pag. 737 dello stesso numero).
9. Boulet LP, Becker A, Berube D, Beveridge R, Ernst P. Canadian Asthma Consensus Group. Canadian Asthma Consensus Report,
1999. CMAJ 1999;161(11):25.
10. McQuaid EL, Kopel SJ, Klein RB, Fritz GK. Medication adherence in pediatric asthma: reasoning, responsibility, and behavior. J Pediatr Psychol 2003;28(5):323-33.
11. Hofstra WB, Neijens HJ, Duiverman EJ, Kouwenberg JM, Mulder PG, Kuethe MC, Sterk PJ. Dose-responses over time to inhaled fluticasone propionate treatment of exercise- and methacholine-induced bronchoconstriction in children with asthma. Pediatr Pulmonol 2000;29(6):415-23.
12. Sont JK, Willems LN, Bel EH, van Krieken JH, Vandenbroucke JP, Sterk PJ. Clinical control and histopathologic outcome of asthma when using airway hyperresponsiveness as an additional guide to long-term treatment. The AMPUL Study Group. Am J Respir Crit Care Med 1999;159(4 Pt 1):1043-51.
13. Haahtela T. Early treatment of asthma. Allergy 1999;54(49):74-81.
14. Long-term effects of budesonide or nedocromil in children with asthma. The Childhood Asthma Management Program Research Group. N Engl J Med 2000; 343(15): 1054-63.
15. Pauwels RA, Pedersen S, Busse WW, Tan WC, Chen YZ, Ohlsson SV, Ullman A, Lamm CJ, O’Byrne PM for START Investigators Group. Early intervention with budesonide in mild persistent asthma: a randomised, double- blind trial. Lancet 2003;361(9363):1071-6 (vedi anche editoriale relativo, pag. 1066 dello stesso numero).
16. Oswald H, Phelan PD, Lanigan A, Hibbert M, Carlin JB, Bowes G, Olinsky A. Childhood asthma and lung function in mid-adult life. Pediatr Pulmonol 1997;23(1):14-20.
17. Sears MR, Greene JM, Willan AR, Wiecek EM, Taylor DR, Flannery EM, Cowan JO, Herbison GP, Silva PA, Poulton R. A longitudinal, population-based, cohort study of childhood asthma followed to adulthood. N Engl J Med 2003;349(15):1414-22.
18. Covar RA, Spahn JD, Murphy JR, Szefler SJ. Childhood Asthma Management Program Research Group. Progression of asthma measured by lung function in the childhood asthma management program. Am J Respir Crit Care Med 2004;170(3):234-41.
19. Sears MR, Greene JM, Willan AR, Wiecek EM, Taylor DR, Flannery EM, Cowan JO, Herbison GP, Silva PA, Poulton R. Airway mucosal inflammation even in patients with newly diagnosed asthma. Am Rev Respir Dis 1993; 147(3):697-704.
20. Martinez FD, Wright AL, Taussig LM, Holberg CJ, Halonen M, Morgan WJ. Asthma and wheezing in the first six years of life. The Group Health Medical Associates. N Engl J Med 1995;332:133-8.
21. National Asthma Education and Prevention Program. Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma Update on Selected Topics 2002. J Allergy Clin Immunol 2002;110(5):S141-219.
22. Castro-Rodriguez JA, Holberg CJ, Wright AL, Martinez FD. A clinical index to define risk of asthma in young children with recurrent wheezing. Am J Respir Crit Care Med 2000; 162(4 Pt 1):1403-6.
23. Strachan D, Gerritsen J. Long-term outcome of early childhood wheezing: population data. Eur Respir J 1996;21(Suppl):42s-47s.
24. Pedersen S. Why does airway inflammation persist? Is it failure to treat early. Am J Respir Crit Care Med 2000;161:S182-S185.
25. Guilbert TW, Morgan WJ, Zeiger RS, Bacharier LB, Boehmer SJ, Krawiec M, Larsen G, Lemanske RF, Liu A, Mauger DT, Sorkness C, Szefler SJ, Strunk RC, Taussig LM, Martinez FD. Atopic characteristics of children with recurrent wheezing at high risk for the development of childhood asthma. J Allergy Clin Immunol 2004;114(6):1282-7.
26. McKean M, Ducharme F. Inhaled steroids for episodic viral wheeze of childhood. Cochrane Database Syst Rev 2000(2):CD001107.
27. Allen DB. Inhaled corticosteroid therapy for asthma in preschool children: growth issues. Pediatrics 2002;109(2):373-80.
28. Tschanz SA, Haenni B, Burri PH. Glucocorticoid induced impairment of lung structure assessed digital image analysis by. Eur J Pediatr 2002;161(1):26-30.
29. Tal A, Golan H, Grauer N. Deposition pattern of radiolabeled salbutamol inhaled from a metered-dose inhaler by means of a spacer with mask in young children with airway obstruction. J Pediatr 1996;128(4):479-84.
30. Busse WW, Rosenwasser LJ. Mechanisms of asthma. J Allergy Clin Immunol 2003; 11(3):S799-804.
31. Roth M, Johnson PR, Borger P, Bihl MP, Rudiger JJ, King GG, Ge Q, Hostettler K, Burgess JK, Black JL, Tamm M. Dysfunctional interaction of C/EBPalpha and the glucocorticoid receptor in asthmatic bronchial smoothmuscle cells. N Engl J Med 2004;351(6):560- 74.
32. Reddel HK, Jenkins CR, Marks GB, Ware SI, Xuan W, Salome CM, Badcock CA, Woolcock AJ. Optimal asthma control, starting with high doses of inhaled budesonide. Eur Respir J 2000;16(2):226-35.
33. Knorr B, Matz J, Bernstein JA, Nguyen H, Seidenberg BC, Reiss TF, Becker A. Montelukast for chronic asthma in 6- to 14-year-old children: a randomized, double-blind trial. Pediatric Montelukast Study Group. JAMA 1998 5;279(15):1181-6.
34. Ducharme FM, Hicks GC. Anti-leukotriene agents compared to inhaled corticosteroids in the management of recurrent and/or chronic asthma in adults and children. Cochrane Database Syst Rev 2002(3):CD002314.
35. Vidal C, Fernandez-Ovide E, Pineiro J, Nunez R, Gonzalez-Quintela A. Comparison of montelukast versus budesonide in the treatment of exercise-induced bronchoconstriction. Ann Allergy Asthma Immunol 2001; 86(6):655-8.
2. Global Iniziative for asthma (GINA). Global strategy for asthma management and prevention. National Heart, Lung and Blood Institute/ WHO Workshop Report 2002.
3. Expert panel report II: guidelines for the diagnosis and management of asthma. Bethesda, Md: National Asthma Education and Prevention Program 1997 (NIH publication no 97- 4051).
4. Boulet LP, Bai TR, Becker A, Berube D, Beveridge R, Bowie DM, Chapman KR, Cote J, Cockcroft D, Ducharme FM, Ernst P, FitzGerald JM, Kovesi T, Hodder RV, O’Byrne P, Rowe B, Sears MR, Simons FE, Spier S. What is new since the last (1999) Canadian Asthma Consensus Guidelines? Can Respir J 2001;8 Suppl A:5A-27A.
5. Warner JO, Naspitz CK.Third International Pediatric Consensus statement on the management of childhood asthma. International Pediatric Asthma Consensus Group. Pediatr Pulmonol 1998;25(1):1-17.
6. British Guidelines on Management of Asthma. Thorax 2003;58(suppl 1):S1-S96.
7. van Essen-Zandvliet EE, Hughes MD, Waalkens HJ, Duiverman EJ, Kerrebijn KF. Remission of childhood asthma after longterm treatment with an inhaled corticosteroid (budesonide): can it be achieved? Dutch CNSLD Study Group. Eur Respir J 1994;7(1):63-8.
8. Haahtela T, Jarvinen M, Kava T, Kiviranta K, Koskinen S, Lehtonen K, Nikander K, Persson T, Selroos O, Sovijarvi A, et al. Effects of reducing or discontinuing inhaled budesonide in patients with mild asthma. N Engl J Med 1994;331(11):700-5 (vedi anche editoriale relativo, pag. 737 dello stesso numero).
9. Boulet LP, Becker A, Berube D, Beveridge R, Ernst P. Canadian Asthma Consensus Group. Canadian Asthma Consensus Report,
1999. CMAJ 1999;161(11):25.
10. McQuaid EL, Kopel SJ, Klein RB, Fritz GK. Medication adherence in pediatric asthma: reasoning, responsibility, and behavior. J Pediatr Psychol 2003;28(5):323-33.
11. Hofstra WB, Neijens HJ, Duiverman EJ, Kouwenberg JM, Mulder PG, Kuethe MC, Sterk PJ. Dose-responses over time to inhaled fluticasone propionate treatment of exercise- and methacholine-induced bronchoconstriction in children with asthma. Pediatr Pulmonol 2000;29(6):415-23.
12. Sont JK, Willems LN, Bel EH, van Krieken JH, Vandenbroucke JP, Sterk PJ. Clinical control and histopathologic outcome of asthma when using airway hyperresponsiveness as an additional guide to long-term treatment. The AMPUL Study Group. Am J Respir Crit Care Med 1999;159(4 Pt 1):1043-51.
13. Haahtela T. Early treatment of asthma. Allergy 1999;54(49):74-81.
14. Long-term effects of budesonide or nedocromil in children with asthma. The Childhood Asthma Management Program Research Group. N Engl J Med 2000; 343(15): 1054-63.
15. Pauwels RA, Pedersen S, Busse WW, Tan WC, Chen YZ, Ohlsson SV, Ullman A, Lamm CJ, O’Byrne PM for START Investigators Group. Early intervention with budesonide in mild persistent asthma: a randomised, double- blind trial. Lancet 2003;361(9363):1071-6 (vedi anche editoriale relativo, pag. 1066 dello stesso numero).
16. Oswald H, Phelan PD, Lanigan A, Hibbert M, Carlin JB, Bowes G, Olinsky A. Childhood asthma and lung function in mid-adult life. Pediatr Pulmonol 1997;23(1):14-20.
17. Sears MR, Greene JM, Willan AR, Wiecek EM, Taylor DR, Flannery EM, Cowan JO, Herbison GP, Silva PA, Poulton R. A longitudinal, population-based, cohort study of childhood asthma followed to adulthood. N Engl J Med 2003;349(15):1414-22.
18. Covar RA, Spahn JD, Murphy JR, Szefler SJ. Childhood Asthma Management Program Research Group. Progression of asthma measured by lung function in the childhood asthma management program. Am J Respir Crit Care Med 2004;170(3):234-41.
19. Sears MR, Greene JM, Willan AR, Wiecek EM, Taylor DR, Flannery EM, Cowan JO, Herbison GP, Silva PA, Poulton R. Airway mucosal inflammation even in patients with newly diagnosed asthma. Am Rev Respir Dis 1993; 147(3):697-704.
20. Martinez FD, Wright AL, Taussig LM, Holberg CJ, Halonen M, Morgan WJ. Asthma and wheezing in the first six years of life. The Group Health Medical Associates. N Engl J Med 1995;332:133-8.
21. National Asthma Education and Prevention Program. Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma Update on Selected Topics 2002. J Allergy Clin Immunol 2002;110(5):S141-219.
22. Castro-Rodriguez JA, Holberg CJ, Wright AL, Martinez FD. A clinical index to define risk of asthma in young children with recurrent wheezing. Am J Respir Crit Care Med 2000; 162(4 Pt 1):1403-6.
23. Strachan D, Gerritsen J. Long-term outcome of early childhood wheezing: population data. Eur Respir J 1996;21(Suppl):42s-47s.
24. Pedersen S. Why does airway inflammation persist? Is it failure to treat early. Am J Respir Crit Care Med 2000;161:S182-S185.
25. Guilbert TW, Morgan WJ, Zeiger RS, Bacharier LB, Boehmer SJ, Krawiec M, Larsen G, Lemanske RF, Liu A, Mauger DT, Sorkness C, Szefler SJ, Strunk RC, Taussig LM, Martinez FD. Atopic characteristics of children with recurrent wheezing at high risk for the development of childhood asthma. J Allergy Clin Immunol 2004;114(6):1282-7.
26. McKean M, Ducharme F. Inhaled steroids for episodic viral wheeze of childhood. Cochrane Database Syst Rev 2000(2):CD001107.
27. Allen DB. Inhaled corticosteroid therapy for asthma in preschool children: growth issues. Pediatrics 2002;109(2):373-80.
28. Tschanz SA, Haenni B, Burri PH. Glucocorticoid induced impairment of lung structure assessed digital image analysis by. Eur J Pediatr 2002;161(1):26-30.
29. Tal A, Golan H, Grauer N. Deposition pattern of radiolabeled salbutamol inhaled from a metered-dose inhaler by means of a spacer with mask in young children with airway obstruction. J Pediatr 1996;128(4):479-84.
30. Busse WW, Rosenwasser LJ. Mechanisms of asthma. J Allergy Clin Immunol 2003; 11(3):S799-804.
31. Roth M, Johnson PR, Borger P, Bihl MP, Rudiger JJ, King GG, Ge Q, Hostettler K, Burgess JK, Black JL, Tamm M. Dysfunctional interaction of C/EBPalpha and the glucocorticoid receptor in asthmatic bronchial smoothmuscle cells. N Engl J Med 2004;351(6):560- 74.
32. Reddel HK, Jenkins CR, Marks GB, Ware SI, Xuan W, Salome CM, Badcock CA, Woolcock AJ. Optimal asthma control, starting with high doses of inhaled budesonide. Eur Respir J 2000;16(2):226-35.
33. Knorr B, Matz J, Bernstein JA, Nguyen H, Seidenberg BC, Reiss TF, Becker A. Montelukast for chronic asthma in 6- to 14-year-old children: a randomized, double-blind trial. Pediatric Montelukast Study Group. JAMA 1998 5;279(15):1181-6.
34. Ducharme FM, Hicks GC. Anti-leukotriene agents compared to inhaled corticosteroids in the management of recurrent and/or chronic asthma in adults and children. Cochrane Database Syst Rev 2002(3):CD002314.
35. Vidal C, Fernandez-Ovide E, Pineiro J, Nunez R, Gonzalez-Quintela A. Comparison of montelukast versus budesonide in the treatment of exercise-induced bronchoconstriction. Ann Allergy Asthma Immunol 2001; 86(6):655-8.