SEVERE ASTHMA

Yıl 2018, Cilt: 19 Sayı: 4, 157 - 163, 26.10.2018

Seda Beyhan Sağmen Berrin Ceyhan

https://doi.org/10.18229/kocatepetip.475027

Öz

Asthma is a common inflammatory disease that has wide

clinical characteristics of the airway of the lungs. Asthma

symptoms can be prevented by avoiding triggers like

allergens and by the effective inhaled treatment. The

majority of asthma patients can be treated effectively

by current medications. Difficult asthma is a distinct

entity of asthma, comprising approximately %5-10 of

asthmatic patients. Despite the high effective treatment,

the patients with asthma have disease that is poorly

controlled. Severe asthmatics account for up to half of

the cost for asthma. It will include asthma uncontrolled

by new standard therapy, steroid dependent, steroid

resistant asthma patients. Asthma related deaths

are seen especially in severe asthma group. Asthma

is a heterogeneous disease, consisting of different

phenotypes. It requires multidisciplinary approach for

treatment management. Severe asthma may suddenly

develop in early time in disease or overtime. There was an

evidence that severe asthma related to genetic factors,

environmental factors, age, inflammation, duration of

disease The genetic and environmental factors may

play a role in severe asthma management. Phenotypetargeted

therapy has an important role in severe asthma,

but it is associated with high treatment costs. At first

diagnosis of asthma must be confirmed COPD and vocal

cord dysfunction is needed to be particular interest in

differential diagnosis. Triggering factors such as smoking,

atopy, work place condition and aspirin hypersensitivity

should be evaluated. Comorbidities that may affect

asthma should be considered. This review examines

the definition of asthma, its differential diagnosis,

phenotypes and available treatment options.

Anahtar Kelimeler

Asthma phenotypes, asthma control, corticosteroid

ZOR ASTIM

Öz

Astım havayolu inflamasyonu ile seyreden çeşitli klinik

özelliklere sahip bir hastalıktır. Dünyada yaklaşık 300

milyon insanı etkileyen bir inflamatuvar hastalıktır. Astım

semptomları alerjenler gibi risk faktörlerinden kaçınarak

ve etkili inhaler tedavi ile kontrol altına alınmaktadır.

Astımlı hastaların büyük bir çoğunluğu uygun tedavi

ile kontrol altına alınmaktadır. Astımlı hastaların %

5-10’unu oluşturan zor astım klinisyenler için tanımı

ve tedavisi hala zor bir grubu oluşturmaktadır. İş gücü

kaybı ve ekonomik maliyet açısından yüksektir. Uygun

tedaviye rağmen bazı olguların kontrolü zorlaşmaktadır.

Standart tedavi ile kontrol edilemeyen, steroide bağımlı

veya dirençli astım olgularını içermektedir. Astıma bağlı

ölümlerin çoğu ağır olan veya stabil olmayan grupta

görülmektedir. Heterojen bir hastalık olan astımda farklı

fenotipler vardır ve net olarak anlaşılmamıştır. Tedavi

yönetimi için multidisipliner yaklaşım gerekmektedir. Ağır

astım hastalığın ilk yıllarında veya yıllar sonra gelişebilir.

Ağır astımda fenotipe özgü tedaviler günümüzde önem

kazanmıştır ve tedavi maliyeti yüksektir. Genetik, çevresel

faktörler, yaş ve hastalık süresinin ağır astımda rolü

olduğuna dair kanıtlar vardır. Özellikle genetik ve çevresel

faktörler ağır astımda önemli rol oynamaktadır. Ağır astım

olduğu düşünülen hastalar dikkatle değerlendirilmelidir.

Birçok hastalık astımı taklit edebilir. Bu hastalarda

öncelikle astım tanısı doğrulanmalıdır. KOAH ve vokal

kord disfonksiyonu ayırıcı tanıda özellikle dikkat edilmesi

gerekli hastalıklardır. İkinci olarak hastanın tedaviye

uyumu gözden geçirilmelidir. Ardından sigara içimi,

atopik durum, çalışma ortamı ve aspirin aşırı duyarlılığı

gibi faktörler araştırılmalıdır. Aynı zamanda ek hastalıklar

gibi astım kontrolünü etkileyebilen durumlar gözden

geçirilmelidir. Astımı zorlaştıran durumlar tek tek

araştırılmalıdır. Bu derlemede ağır astım tanımı, ayırıcı

tanıların dışlanması, fenotipleri ve tedavi yaklaşımları ele alınmıştır.

Anahtar Kelimeler

Astım fenotipleri, astım kontrolü, kortikosteroid

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