Der Internist

, Volume 49, Issue 11, pp 1311–1319

Leitliniengerechte Therapie des Asthma bronchiale

Schwerpunkt

Zusammenfassung

Asthma bronchiale ist ein komplexes Syndrom mit vielen klinischen Phänotypen. Weltweit ist eine steigende Prävalenz der Erkrankung nachzuweisen. Bemühungen um die Optimierung der Diagnose und Versorgung von Patienten mit Asthma haben zur Erstellung von nationalen und internationalen Leitlinien geführt. Neben präventiven und nichtmedikamentösen Maßnahmen wie Patientenschulung, und körperlichem Training wird in den Leitlinien insbesondere eine standardisierte medikamentöse Therapie empfohlen. Im vorliegenden Artikel fassen wir die Grundlagen der medikamentösen Behandlung nach Empfehlungen der Leitlinien von Patienten mit Asthma bronchiale zusammen.

Schlüsselwörter

Asthma bronchiale Leitlinien Medikamentöse Therapie Inhalative Kortikosteroide β2-Sympathomimetika 

Guideline-adherent treatment for asthma

Abstract

Asthma is a complex syndrome with numerous clinical phenotypes. An increase in prevalence is detectable worldwide. Efforts to optimize diagnosis and care of patients with asthma have led to the development of international and national guidelines. Besides preventive and non-pharmacological measures such as patient education and physical training, the guidelines particularly recommend standardized drug therapy. In the present article we summarize the recommended pharmacotherapy for patients with bronchial asthma.

Keywords

Asthma Guidelines Pharmacotherapy Inhaled corticosteroids β2-agonists 

Literatur

  1. 1.
    American Lung Association Asthma Clinical Research Centers (2007) Clinical trial of low-dose theophylline and montelukast in patients with poorly controlled asthma. Am J Respir Crit Care Med 175: 235–242CrossRefGoogle Scholar
  2. 2.
    American Thoracic Society (2000) Proceedings of the ATS workshop on refractory asthma: current understanding, recommendations, and unanswered questions. Am J Respir Crit Care Med: 2341–2351Google Scholar
  3. 3.
    Antonicelli L, Bucca C, Neri M et al. (2004) Asthma severity and medical resource utilisation. Eur Respir J 23: 723–729PubMedCrossRefGoogle Scholar
  4. 4.
    Bateman ED, Boushey HA, Bousquet J et al. (2004) Can guideline-defined asthma control be achieved? The gaining optimal asthma control study. Am J Respir Crit Care Med 170: 836–844PubMedCrossRefGoogle Scholar
  5. 5.
    Bateman ED, Hurd SS, Barnes PJ et al. (2008) Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J 31: 143–178PubMedCrossRefGoogle Scholar
  6. 6.
    Berry MA, Hargadon B, Shelley M et al. (2006) Evidence of a role of tumor necrosis factor alpha in refractory asthma. N Engl J Med 354: 697–708PubMedCrossRefGoogle Scholar
  7. 7.
    Buhl R, Berdel D, Criee CP et al. (2006) Leitlinie zur Diagnostik und Therapie von Patienten mit Asthma. Pneumologie 60: 139–177PubMedCrossRefGoogle Scholar
  8. 8.
    Buhl R, Soler M, Matz J et al. (2002) Omalizumab provides long-term control in patients with moderate-to-severe allergic asthma. Eur Respir J 20: 73–78PubMedCrossRefGoogle Scholar
  9. 9.
    Busse WW, Lemanske RF jr (2001) Asthma. N Engl J Med 344: 350–362PubMedCrossRefGoogle Scholar
  10. 10.
    Cookson W (1999) The alliance of genes and environment in asthma and allergy. Nature 402 (Suppl): B5–11PubMedCrossRefGoogle Scholar
  11. 11.
    Eder W, Ege MJ, von Mutius E (2006) The asthma epidemic. N Engl J Med 355(21): 2226–2235PubMedCrossRefGoogle Scholar
  12. 12.
    European Network for Understanding Mechanisms of Severe Asthma (2003) The ENFUMOSA cross-sectional European multicentre study of the clinical phenotype of chronic severe asthma. Eur Respir J 22: 470–477CrossRefGoogle Scholar
  13. 13.
    Evans DJ, Taylor DA, Zetterstrom O et al. (1997) A comparison of low-dose inhaled budesonide plus theophylline and high-dose inhaled budesonide for moderate asthma. N Engl J Med 337: 1412–1418PubMedCrossRefGoogle Scholar
  14. 14.
    Global Initiative for Asthma, GINA (2007) Global strategy for asthma management and prevention. http://www.ginasthma.org
  15. 15.
    Godfrey S, Bar-Yishay E (1993) Exercised-induced asthma revisited. Respir Med 87: 331–344PubMedCrossRefGoogle Scholar
  16. 16.
    Hanf G, Brachmann I, Kleine-Tebbe J et al. (2006) Omalizumab decreased IgE-release and induced changes in cellular immunity in patients with allergic asthma. Allergy 61: 1141–1144PubMedCrossRefGoogle Scholar
  17. 17.
    Mash B, Bheekie A, Jones PW (2000) Inhaled vs oral steroids for adults with chronic asthma. Cochrane Database Syst Rev CD002160Google Scholar
  18. 18.
    Morjaria JB, Chauhan AJ, Babu KS et al. (2008) The role of a soluble TNFalpha receptor fusion protein (etanercept) in corticosteroid refractory asthma: a double blind, randomised, placebo controlled trial. Thorax 63: 584–591PubMedCrossRefGoogle Scholar
  19. 19.
    Nelson HS, Busse WW, Kerwin E et al. (2000) Fluticasone propionate/salmeterol combination provides more effective asthma control than low-dose inhaled corticosteroid plus montelukast. J Allergy Clin Immunol 106: 1088–1095PubMedCrossRefGoogle Scholar
  20. 20.
    Nelson HS, Weiss ST, Bleecker ER et al. (2006) The salmeterol multicenter asthma research trial: a comparison of usual pharmacotherapy for asthma or usual pharmacotherapy plus salmeterol. Chest 129: 15–26PubMedCrossRefGoogle Scholar
  21. 21.
    O’Byrne PM, Barnes PJ, Rodriguez-Roisin R et al. (2001) Low dose inhaled budesonide and formoterol in mild persistent asthma: the OPTIMA randomized trial. Am J Respir Crit Care Med 164: 1392–1397Google Scholar
  22. 22.
    O’Byrne PM, Bisgaard H, Godard PP et al. (2005) Budesonide/formoterol combination therapy as both maintenance and reliever medication in asthma. Am J Respir Crit Care Med 171: 129–136Google Scholar
  23. 23.
    Palmqvist M, Persson G, Lazer L et al. (1997) Inhaled dry-powder formoterol and salmeterol in asthmatic patients: onset of action, duration of effect and potency. Eur Respir J 10: 2484–2489PubMedCrossRefGoogle Scholar
  24. 24.
    Pauwels RA, Lofdahl CG, Postma DS et al. (1997) Effect of inhaled formoterol and budesonide on exacerbations of asthma. Formoterol and Corticosteroids Establishing Therapy (FACET) International Study Group. N Engl J Med 337: 1405–1411PubMedCrossRefGoogle Scholar
  25. 25.
    Pauwels RA, Pedersen S, Busse WW et al. (2003) Early intervention with budesonide in mild persistent asthma: a randomised, double-blind trial. Lancet 361: 1071–1076PubMedCrossRefGoogle Scholar
  26. 26.
    Peters SP, Anthonisen N, Castro M et al. (2007) Randomized comparison of strategies for reducing treatment in mild persistent asthma. N Engl J Med 356: 2027–2039PubMedCrossRefGoogle Scholar
  27. 27.
    Powell H, Gibson PG (2003) Inhaled corticosteroid doses in asthma: an evidence-based approach. Med J Aust 178: 223–225PubMedGoogle Scholar
  28. 28.
    Rabe KF, Pizzichini E, Stallberg B et al. (2006) Budesonide/formoterol in a single inhaler for maintenance and relief in mild-to-moderate asthma: a randomized, double-blind trial. Chest 129: 246–256PubMedCrossRefGoogle Scholar
  29. 29.
    Sears MR, Taylor DR, Print CG et al. (1990) Regular inhaled beta-agonist treatment in bronchial asthma. Lancet 336: 1391–1396PubMedCrossRefGoogle Scholar
  30. 30.
    Sont JK, Willems LN, Bel EH et al. (1999) Clinical control and histopathologic outcome of asthma when using airway hyperresponsiveness as an additional guide to long-term treatment. The AMPUL Study Group. Am J Respir Crit Care Med 159: 1043–1051PubMedGoogle Scholar
  31. 31.
    Vogelmeier C, D’Urzo A, Pauwels R et al. (2005) Budesonide/formoterol maintenance and reliever therapy: an effective asthma treatment option? Eur Respir J 26: 819–828PubMedCrossRefGoogle Scholar
  32. 32.
    Woolcock A, Lundback B, Ringdal N et al. (1996) Comparison of addition of salmeterol to inhaled steroids with doubling of the dose of inhaled steroids. Am J Respir Crit Care Med 153: 1481–1488PubMedGoogle Scholar
  33. 33.
    Zeiger RS, Bird SR, Kaplan MS et al. (2005) Short-term and long-term asthma control in patients with mild persistent asthma receiving montelukast or fluticasone: a randomized controlled trial. Am J Med 118: 649–657PubMedCrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

  1. 1.III. Medizinische Klinik Schwerpunkt PneumologieKlinikum der Johannes Gutenberg-Universität, MainzMainzDeutschland

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