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Schwieriges Asthma

Differenzialdiagnosen und therapeutische Optionen

Severe bronchial asthma

Differential diagnosis and therapeutic options

  • Leitthema
  • Published:
Der Pneumologe Aims and scope

Zusammenfassung

Ein leitlinienkonformer Einsatz der heute verfügbaren Asthmamedikamente führt bei den meisten Asthmapatienten zu einer guten oder zumindest befriedigenden Krankheitskontrolle. Bei ca. 2–5% der Betroffenen liegt jedoch ein schwieriges, kaum zu behandelndes Asthma bronchiale vor, das trotz korrekter, leitlinienkonformer Therapie inklusive niedriger Dosen oraler Glukokortikoide in der Langzeittherapie nicht ausreichend zu stabilisieren ist [1]. Diese geringe Anzahl an Patienten stellt nicht nur für den Asthmaspezialisten, sondern auch für das Gesundheitssystem eine enorme Herausforderung dar, verschlingt sie doch bis zu 50% der direkten und indirekten asthmabezogenen Kosten [2]. Der Leidensdruck dieser Patienten ist erheblich, und ihre Lebensqualität ist nachhaltig beeinträchtigt. Die zum Teil exzessiv hoch dosierten Steroide führen auf Dauer zu einem enormen Maß an Komorbidität, bedingt durch Nebenwirkungen. Von daher ist es notwendig, bei einem nicht stabilisierbaren Asthma bronchiale alle verfügbaren diagnostisch-therapeutischen Optionen zum Einsatz zu bringen. Dabei kommt der subtilen Betrachtung des Leitsymptoms Atemnot ebenso wie der Reevaluation der Diagnose durch einen Asthmaspezialisten unter Berücksichtigung differenzialdiagnostischer Überlegungen größte Bedeutung zu.

Abstract

Drug therapy for bronchial asthma according to current guidelines leads to complete or at least sufficient disease control in most of the patients. About 2–5% show a difficult-to-treat asthma course despite adequate medical therapy including long-term oral corticosteroids [1]. These few patients represent a great challenge for the asthma specialist as well as for health systems because they require about half of the financial resources needed for asthma [2]. Quality of life and activities of daily living (ADL) are remarkably reduced in those patients due to disease severity. The use of high-dose corticosteroids may induce relevant side effects leading to additional comorbidity. Thus all available diagnostic and therapeutic options have to be considered in those cases. Careful observation of dyspnoea as the main symptom as well as the precise re-evaluation of the diagnosis by an asthma specialist is important.

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Abb. 1

Abbreviations

ABPA:

Allergische bronchopulmonale Aspergillose

BAL:

Bronchoalveoläre Lavage

BGA:

Blutgasanalyse

BHR:

Bronchiale Hyperreagibilität

CF:

Zystische Fibrose

CSS:

Churg-Strauss-Syndrom

GERD:

„Gastro-esophageal reflux disease“

GKP:

Ganzkörperplethysmographie

HRCT:

High-Resolution-Computertomographie

LE:

Lungenembolie

MEF50 :

Maximaler exspiratorischer Fluss bei 50% der Vitalkapazität

MIF50 :

Maximaler inspiratorischer Fluss bei 50% der Vitalkapazität

NSAR:

Nichtsteroidale Antirheumatika

PEF:

„Peak-expiratory-flow“

PND:

„Post nasal drip“

VCD:

„Vocal cord dysfunction“

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  1. Abteilung Pneumologie, Klinikum Berchtesgadener Land, Malterhöh 1, 83471, Schönau a. Königssee, Deutschland

    K. Kenn

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Kenn, K. Schwieriges Asthma. Pneumologe 5, 32–39 (2008). https://doi.org/10.1007/s10405-007-0184-6

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  • DOI: https://doi.org/10.1007/s10405-007-0184-6

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