经鼻高流量治疗严重哮喘加重：目前的证据和临床观点
2025/12/29
摘要
哮喘急性发作的治疗方法，包括吸入短效β2激动剂、全身皮质类固醇治疗和补充氧气。对药物和氧气治疗无反应的严重哮喘加重（SAE）可能需要通过气管内插管（ETI）进行机械通气、评估以及入住重症监护病房（ICU）。然而，高达35%的插管和通气患者死于常规机械通气（CMV）相关的危及生命的并发症（即气压损伤、循环衰竭、心律失常、急性冠状动脉综合征、肺不张和肺炎）。在无创呼吸治疗中，无创通气（NIV）在SAE早期预防临床恶化和CMV的有效性仍存在争议。对机械通气的耐受性有限是影响治疗成功的一个缺点。经鼻高流量（HFNC）是一种广泛应用的呼吸支持工具，可用于治疗多种类型的急性呼吸衰竭，患者接受度是其应用的关键。尽管有潜在的病理生理原理，但缺乏HFNC在SAE中的可行性和有效性的临床数据。我们进行了这一简明的叙述性回顾，以总结与传统氧疗（COT）相比，HFNC在成人SAE患者中的生理和临床益处，重点关注呼吸困难、舒适度、肺气体交换、吸入治疗的促进、住院、ETI和ICU住院等结果。根据现有资料，在SAE中，没有证据表明HFNC与COT孰优孰劣。需要进一步更大规模的随机对照试验来确定HFNC在哮喘发作中的作用。
High-flow nasal cannula in severe asthma exacerbations: current evidence and clinical perspectives
Lorenzo Carriera, Simone Ielo, Roberto Barone, Roberto Lipsi, Angelo Coppola, Andrea Smargiassi, Riccardo Inchingolo, Luca Richeldi, Raffaele Scala
Abstract
The management of asthma exacerbations is well established, including inhaled short-acting β2-agonist administration, systemic corticosteroid therapy and supplemental oxygen. Severe asthma exacerbations (SAEs) nonresponsive to medical and O2 therapy may require mechanical ventilation via endotracheal intubation (ETI), evaluation and admission to the intensive care unit (ICU). However, up to 35% of intubated and ventilated patients die due to conventional mechanical ventilation (CMV)-related life-threatening complications (i.e. barotrauma, circulatory collapse, cardiac arrhythmias, acute coronary syndrome, atelectasis and pneumonia). Among noninvasive respiratory therapies, the effectiveness of noninvasive ventilation (NIV) in preventing clinical deterioration and CMV in the earlier phases of SAE remains controversial. Limited tolerance to mechanical ventilation represents a drawback that can compromise treatment success. The high-flow nasal cannula (HFNC) is a widely applied respiratory supportive tool for the management of several patterns and types of acute respiratory failure, with patient acceptance being a key point favouring its application. Despite a potential pathophysiological rationale, clinical data on the feasibility and effectiveness of HFNC in SAEs are lacking. We conducted this concise narrative review to summarise the physiological and clinical benefits of HFNC compared to conventional oxygen therapy (COT) in adult patients with SAEs, focusing on outcomes such as dyspnoea, comfort, lung gas exchange, facilitation of inhaled therapy, hospitalisations, ETI and ICU admission. According to available data, there is no evidence of either superiority or inferiority of HFNC versus COT in SAEs. Further larger randomised control trials are required to define the role of HFNC in asthmatic attacks.
哮喘急性发作的治疗方法，包括吸入短效β2激动剂、全身皮质类固醇治疗和补充氧气。对药物和氧气治疗无反应的严重哮喘加重（SAE）可能需要通过气管内插管（ETI）进行机械通气、评估以及入住重症监护病房（ICU）。然而，高达35%的插管和通气患者死于常规机械通气（CMV）相关的危及生命的并发症（即气压损伤、循环衰竭、心律失常、急性冠状动脉综合征、肺不张和肺炎）。在无创呼吸治疗中，无创通气（NIV）在SAE早期预防临床恶化和CMV的有效性仍存在争议。对机械通气的耐受性有限是影响治疗成功的一个缺点。经鼻高流量（HFNC）是一种广泛应用的呼吸支持工具，可用于治疗多种类型的急性呼吸衰竭，患者接受度是其应用的关键。尽管有潜在的病理生理原理，但缺乏HFNC在SAE中的可行性和有效性的临床数据。我们进行了这一简明的叙述性回顾，以总结与传统氧疗（COT）相比，HFNC在成人SAE患者中的生理和临床益处，重点关注呼吸困难、舒适度、肺气体交换、吸入治疗的促进、住院、ETI和ICU住院等结果。根据现有资料，在SAE中，没有证据表明HFNC与COT孰优孰劣。需要进一步更大规模的随机对照试验来确定HFNC在哮喘发作中的作用。
（北京朝阳医院呼吸与危重症医学科 顾宪民 摘译 中日友好医院呼吸与危重症医学科 林江涛 审校）
（Eur Respir Rev. 2025 Dec 17;34(178):250109. doi: 10.1183/16000617.0109-2025. Print 2025 Oct.）
（Eur Respir Rev. 2025 Dec 17;34(178):250109. doi: 10.1183/16000617.0109-2025. Print 2025 Oct.）
High-flow nasal cannula in severe asthma exacerbations: current evidence and clinical perspectives
Lorenzo Carriera, Simone Ielo, Roberto Barone, Roberto Lipsi, Angelo Coppola, Andrea Smargiassi, Riccardo Inchingolo, Luca Richeldi, Raffaele Scala
Abstract
The management of asthma exacerbations is well established, including inhaled short-acting β2-agonist administration, systemic corticosteroid therapy and supplemental oxygen. Severe asthma exacerbations (SAEs) nonresponsive to medical and O2 therapy may require mechanical ventilation via endotracheal intubation (ETI), evaluation and admission to the intensive care unit (ICU). However, up to 35% of intubated and ventilated patients die due to conventional mechanical ventilation (CMV)-related life-threatening complications (i.e. barotrauma, circulatory collapse, cardiac arrhythmias, acute coronary syndrome, atelectasis and pneumonia). Among noninvasive respiratory therapies, the effectiveness of noninvasive ventilation (NIV) in preventing clinical deterioration and CMV in the earlier phases of SAE remains controversial. Limited tolerance to mechanical ventilation represents a drawback that can compromise treatment success. The high-flow nasal cannula (HFNC) is a widely applied respiratory supportive tool for the management of several patterns and types of acute respiratory failure, with patient acceptance being a key point favouring its application. Despite a potential pathophysiological rationale, clinical data on the feasibility and effectiveness of HFNC in SAEs are lacking. We conducted this concise narrative review to summarise the physiological and clinical benefits of HFNC compared to conventional oxygen therapy (COT) in adult patients with SAEs, focusing on outcomes such as dyspnoea, comfort, lung gas exchange, facilitation of inhaled therapy, hospitalisations, ETI and ICU admission. According to available data, there is no evidence of either superiority or inferiority of HFNC versus COT in SAEs. Further larger randomised control trials are required to define the role of HFNC in asthmatic attacks.
上一篇：
慢性鼻-鼻窦炎伴鼻息肉及共存哮喘患者中度普利尤单抗与奥马珠单抗的对比研究（EVEREST）：一项多中心、随机、双盲、头对
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