新型冠状病毒肺炎时代哮喘管理和病毒传播的考虑
2022/01/28
摘要
背景：随着全球新型冠状病毒肺炎大流行的展开，围绕着哮喘患者的最佳管理，他们有新型冠状病毒的风险或感染，哮喘和类固醇是否是严重新型冠状病毒肺炎的危险因素，以及病毒在儿童中的传播程度，已经有了很多争论。
目的：本研究的目的是为过敏症专家和其他临床医生提供有关新型冠状病毒肺炎大流行背景下哮喘患者管理的信息，并提供一些关于儿科人群传播风险的信息。
方法：以我们自己的一名哮喘患者新型冠状病毒肺炎发病为背景，我们回顾了最近的文献，讨论了哮喘患者新型冠状病毒肺炎的风险、大流行时期哮喘药物的管理以及病毒传播的风险。
结果：尽管最初的报告说，哮喘是发展为严重的新型冠状病毒肺炎的一个危险因素，随后的调查表明，这可能是不正确的。此外，使用全身性或吸入性糖皮质激素似乎不会增加严重新型冠状病毒肺炎的风险，但没有证据指导使用生物治疗。关于儿童传播病毒的能力有相互矛盾的证据。
结论：我们发现哮喘似乎与新型冠状病毒肺炎的风险增加无关，继续使用吸入性皮质类固醇似乎是安全的。虽然没有证据指导生物疗法的使用，但最近的一篇文献建议，除非患者合并新型冠状病毒肺炎，否则应继续使用生物疗法，直到临床康复。
Considerations for asthma management and viral transmission in the era of COVID-19
Mitchell M Pitlick, Avni Y Joshi
Abstract
Background：As the global COVID-19 pandemic has unfolded, there has been much debate surrounding the optimal management of patients with asthma who are at risk of or contract COVID-19, whether asthma and steroids are risk factors for severe COVID-19, and how transmissible the virus is among children.
Objective：The objective of this study is to provide allergists and other clinicians with pearls pertaining to the management of patients with asthma in the setting of the COVID-19 pandemic and to provide some information regarding the risk of transmission among the pediatric population.
Methods：Utilizing the case of one of our own patients with asthma who developed COVID-19 as context, we review the recent literature discussing the risk of COVID-19 in patients with asthma, the management of asthma medications in the time of the pandemic, and the risk of viral transmission.
Results：Despite initial reports that asthma was a risk factor for developing severe COVID-19, subsequent investigation has shown that this is likely not true. Additionally, the use of systemic or inhaled glucocorticoids does not appear to increase the risk of severe COVID-19, but there is no evidence guiding the use of biologic therapy. There is conflicting evidence regarding the ability of children to transmit the virus.
Conclusion；We provide pearls that asthma does not appear to be associated with an increased risk of COVID-19 and continued use of inhaled corticosteroids appears to be safe. While there is no evidence guiding the use of biologic therapies, a recent position paper suggests that they should be continued unless a patient contracts COVID-19, at which point they should be held until clinical recovery occurs.
背景：随着全球新型冠状病毒肺炎大流行的展开，围绕着哮喘患者的最佳管理，他们有新型冠状病毒的风险或感染，哮喘和类固醇是否是严重新型冠状病毒肺炎的危险因素，以及病毒在儿童中的传播程度，已经有了很多争论。
目的：本研究的目的是为过敏症专家和其他临床医生提供有关新型冠状病毒肺炎大流行背景下哮喘患者管理的信息，并提供一些关于儿科人群传播风险的信息。
方法：以我们自己的一名哮喘患者新型冠状病毒肺炎发病为背景，我们回顾了最近的文献，讨论了哮喘患者新型冠状病毒肺炎的风险、大流行时期哮喘药物的管理以及病毒传播的风险。
结果：尽管最初的报告说，哮喘是发展为严重的新型冠状病毒肺炎的一个危险因素，随后的调查表明，这可能是不正确的。此外，使用全身性或吸入性糖皮质激素似乎不会增加严重新型冠状病毒肺炎的风险，但没有证据指导使用生物治疗。关于儿童传播病毒的能力有相互矛盾的证据。
结论：我们发现哮喘似乎与新型冠状病毒肺炎的风险增加无关，继续使用吸入性皮质类固醇似乎是安全的。虽然没有证据指导生物疗法的使用，但最近的一篇文献建议，除非患者合并新型冠状病毒肺炎，否则应继续使用生物疗法，直到临床康复。
(中日友好医院呼吸与危重症医学科 张清 摘译 林江涛 审校 )
(Allergy Asthma Proc.2021 Jan 1;42(1):93-96.doi:10.2500/aap.2021.42.200111.Epub 2020 Dec 23.)
(Allergy Asthma Proc.2021 Jan 1;42(1):93-96.doi:10.2500/aap.2021.42.200111.Epub 2020 Dec 23.)
Considerations for asthma management and viral transmission in the era of COVID-19
Mitchell M Pitlick, Avni Y Joshi
Abstract
Background：As the global COVID-19 pandemic has unfolded, there has been much debate surrounding the optimal management of patients with asthma who are at risk of or contract COVID-19, whether asthma and steroids are risk factors for severe COVID-19, and how transmissible the virus is among children.
Objective：The objective of this study is to provide allergists and other clinicians with pearls pertaining to the management of patients with asthma in the setting of the COVID-19 pandemic and to provide some information regarding the risk of transmission among the pediatric population.
Methods：Utilizing the case of one of our own patients with asthma who developed COVID-19 as context, we review the recent literature discussing the risk of COVID-19 in patients with asthma, the management of asthma medications in the time of the pandemic, and the risk of viral transmission.
Results：Despite initial reports that asthma was a risk factor for developing severe COVID-19, subsequent investigation has shown that this is likely not true. Additionally, the use of systemic or inhaled glucocorticoids does not appear to increase the risk of severe COVID-19, but there is no evidence guiding the use of biologic therapy. There is conflicting evidence regarding the ability of children to transmit the virus.
Conclusion；We provide pearls that asthma does not appear to be associated with an increased risk of COVID-19 and continued use of inhaled corticosteroids appears to be safe. While there is no evidence guiding the use of biologic therapies, a recent position paper suggests that they should be continued unless a patient contracts COVID-19, at which point they should be held until clinical recovery occurs.
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高T型哮喘表型的全生命周期表现
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Astegolimab(抗ST2抗体)在重症哮喘成年患者中的有效性及安全性：一项随机临床试验
