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Asthma bronchiale

Update 2006

Bronchial asthma. Update 2006

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Zusammenfassung

Asthma bronchiale bleibt mit einer Prävalenz von 5% für Erwachsene und 10% für Kinder in Deutschland eine häufige Erkrankung. Neuere zellbiologische Daten zeigen eine getrennte Steuerung der Allergie (Interleukin-4- (IL-4-) Pfad) und der eosinophilen Asthma-Entzündung (IL-5-Pfad). Beides muss therapeutisch angegangen werden. Um ein irreversibles bronchiales Remodeling zu verhindern, ist eine frühzeitige Diagnose und konsequente Therapie entscheidend. Ein Asthma bronchiale gilt als gesichert, wenn der anfallsweise Krankheitscharakter nachgewiesen wird und sich eine zumindest intermittierende obstruktive Ventilationsstörung zeigt, die gut auf kurzwirksame β2-Adrenergika anspricht. Die heutige Asthmatherapie ist in vielen Studien gesichert (Evidenzlevel A) und beruht auf einem Stufenplan, der die therapeutischen Maßnahmen nach 4 Schweregraden gliedert. Darunter sind die meisten Patienten weitgehend beschwerdefrei, nächtliche Attacken sind heute eine Seltenheit. Neue Medikamente sollen verbliebene therapeutische Schwachstellen schließen. Antileukotriene und Anti-IgE-Antikörper können zur Reduktion der notwendigen Kortikosteroide beitragen. Pharmaka, die in die IL-4- oder IL-5-Steuerung eingreifen oder das Remodeling verhindern helfen, sind in Entwicklung.

Abstract

Bronchial asthma, with a prevalence in Germany of 5% among adults and 10% among children, remains a frequent disease. Newer cell biological data show a separate regulation of the allergy (interleukin 4, IL-4, pathway) and of the eosinophilic inflammation in asthma (IL-5 pathway). Both conditions require a therapeutic approach. To prevent irreversible bronchial remodeling, early diagnosis and targeted therapy are decisive. Bronchial asthma is regarded as evident when the paroxysmal character of the disease is confirmed and an—at least intermittent—obstructive ventilation disorder is apparent which responds well to short-acting β2-adrenergic agents. Current asthma treatment has been assured in many studies (evidence level A) and is based on therapy in stages which classifies therapeutic measures depending on four grades of severity. Accordingly, most patients are largely without complaints, and nocturnal attacks are now rare. New medications are intended to overcome any remaining therapeutic weak points. Antileukotrienes and anti-IgE antibodies can contribute to reducing the necessary corticosteroids. Pharmaceutical agents that intervene in the IL-4 or IL-5 regulation or prevent remodeling are being developed.

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  1. Schwerpunkt Pneumologie, Medizinische Klinik und Poliklinik I, Klinikum der JMU, Josef-Schneider-Straße 2, 97080, Würzburg

    M. Schmidt

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Schmidt, M. Asthma bronchiale. Internist 47, 835–852 (2006). https://doi.org/10.1007/s00108-006-1671-2

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