儿童哮喘状态的药物和最新专利。

IF 4.2 Q3 Pharmacology, Toxicology and Pharmaceutics
K. Hon, A. Leung
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引用次数: 8

摘要

背景哮喘持续状态是一种哮喘的急性加重,持续性和难治性,对支气管扩张剂和全身皮质类固醇的初始治疗仍然没有反应,这种情况可能导致低氧血症、高碳酸血症和继发性呼吸衰竭。目的综述哮喘持续状态的治疗方法和近期专利。METHODA PubMed搜索是在临床查询中使用关键术语“哮喘持续状态”完成的。检索包括荟萃分析、随机对照试验、临床试验、综述和相关参考文献。使用www.google.com/Patents、www.uspto.gov和www.freepatentsonline.com中的关键术语状态“哮喘持续”搜索专利。RESULTS应给予补充氧气,以保持室内空气中≥92%的氧饱和度。哮喘持续状态的主要药物治疗包括短效β2激动剂,如沙丁胺醇,通过带间隔物的计量吸入器给药,或者最好通过喷雾器和口服皮质类固醇给药。静脉注射皮质类固醇没有好处,除非孩子不能耐受口服皮质类固醇(例如,长期呕吐),或不能口服皮质类固醇。吸入异丙托溴铵和静脉注射硫酸镁治疗对常规治疗无效的严重哮喘加重儿童应予以考虑。对于空气进入不良、不配合雾化治疗或对雾化治疗反应不佳的严重哮喘恶化儿童,可考虑皮下和肌肉注射β2激动剂,如特布他林和肾上腺素。单克隆抗IgE抗体(omalizumab)和靶向白细胞介素途径的人源化单克隆抗体在严重难治性嗜酸性粒细胞哮喘中显示出巨大的前景。失败的治疗干预需要无创或有创通气支持。机械通气和插管的适应症包括严重衰竭、意识恶化、空气进入不良、低氧血症恶化、高碳酸血症和心肺骤停。对于哮喘的慢性治疗,吸入皮质类固醇、支气管扩张剂和口服孟鲁司特是主要药物。一些草药配方是有效的,但通常缺乏补充和替代药物的其他模式的证据。这篇综述还讨论了最近与哮喘管理相关的专利。这些最近的专利描述了一些可用于治疗慢性严重哮喘的免疫调节药物。最近还没有关于哮喘持续状态管理的专利。结论吸入性支气管扩张剂和系统性皮质类固醇是治疗严重和状态哮喘的主要药物。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Medications and Recent Patents for Status Asthmaticus in Children.
BACKGROUND Status asthmaticus is an acute exacerbation of asthma that is persistent and intractable and remains unresponsive to initial treatment with bronchodilators and systemic corticosteroids and that the condition can result in hypoxemia, hypercarbia, and secondary respiratory failure. OBJECTIVE To review treatment and recent patents on management of status asthmaticus. METHOD A PubMed search was completed in Clinical Queries using the key term "status asthmaticus". The search included meta-analyses, randomized controlled trials, clinical trials, reviews and pertinent references. Patents were searched using the key term status "asthmaticus" from www.google.com/patents, www.uspto.gov, and www.freepatentsonline.com. RESULTS Supplemental oxygen should be given to maintain an oxygen saturation of ≥ 92% in room air. Mainstay of pharmacologic treatment of status asthmaticus includes short-acting, β2 agonists such as salbutamol (albuterol) administered by metered-dose inhaler with spacer or, preferably, by nebulizer and oral corticosteroids. There is no advantage to intravenous corticosteroids unless the child cannot tolerate oral corticosteroids (e.g., protracted vomiting), or unable to take oral corticosteroid (e.g., intubated or unconscious). Inhaled ipratropium bromide and intravenous magnesium sulfate should be considered in children with severe asthma exacerbations not responsive to conventional therapy. Subcutaneous and intramuscular β2 agonists such as terbutaline and epinephrine may be considered for children with severe asthma exacerbation who have poor air entry, are uncooperative with nebulized therapy, or have poor response to nebulized therapy. Monoclonal anti-IgE antibody (omalizumab) and humanized monoclonal antibodies targeting interleukin pathway have shown great promise in severe refractory eosinophilic asthma. Failing therapeutic interventions necessitate non-invasive or invasive ventilation support. Severe exhaustion, deteriorating consciousness, poor air entry, worsening hypoxemia, hypercapnia, and cardiopulmonary arrest are indications for mechanical ventilation and intubation. For chronic treatment of asthma, inhaled corticosteroids, bronchodilator, and oral montelukasts are the mainstay. Some formulations of herbal medicine are efficacious but evidence of other modalities of complementary and alternative medicine are generally lacking. This review also discusses recent patents related to the management of asthma. These recent patents describe a few immunomodulating medications useful for the treatment of chronic severe asthma. There have been no recent patents for the management of status asthmaticus. CONCLUSION Inhaled bronchodilators and systematic corticosteroids are the mainstay of therapy in the management of severe and status asthmaticus.
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来源期刊
CiteScore
3.90
自引率
0.00%
发文量
0
期刊介绍: Recent Patents on Inflammation & Allergy Drug Discovery publishes review articles by experts on recent patents in the field of inflammation and allergy drug discovery e.g. on novel bioactive compounds, analogs and targets. A selection of important and recent patents in the field is also included in the journal. The journal is essential reading for all researchers involved in inflammation and allergy drug design and discovery.
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