Différences entre versions de « Asthme »
De médecine.top
Ligne 25 : | Ligne 25 : | ||
** En ajout à un CSI + LABA si mauvais contrôle de l'asthme | ** En ajout à un CSI + LABA si mauvais contrôle de l'asthme | ||
** For patients with excessive side effects from LABAs, a LAMA can reasonably be substituted. However, there is not substantial evidence that LAMAs should be the first choice for long-acting airway dilation instead of LABAs. | ** For patients with excessive side effects from LABAs, a LAMA can reasonably be substituted. However, there is not substantial evidence that LAMAs should be the first choice for long-acting airway dilation instead of LABAs. | ||
− | * '''Nouveaux biologiques''' | + | * '''Nouveaux biologiques''' |
** <u>Indication</u>: eligible patients with severe persistent allergic asthma despite standard therapy reduces symptoms, need for oral glucocorticoids, and exacerbations. | ** <u>Indication</u>: eligible patients with severe persistent allergic asthma despite standard therapy reduces symptoms, need for oral glucocorticoids, and exacerbations. | ||
− | ** <u>Indications à l'omalizumab</u>: Omalizumab has been shown to reduce exacerbations and emergency department visits | + | ** <u>Indications à l'omalizumab</u>: ↓ titre d'IgE ([https://compendium.ch/fr/product/1050220-xolair-subst-seche-150-mg-c-solv Xolair]. Omalizumab has been shown to reduce exacerbations and emergency department visits |
**# symptoms inadequately controlled with inhaled glucocorticoids, | **# symptoms inadequately controlled with inhaled glucocorticoids, | ||
**# evidence of allergies to perennial aeroallergens, and | **# evidence of allergies to perennial aeroallergens, and | ||
**# serum IgE levels between 30 and 700 U/mL (30-700 kU/L) (normal range, 0-90 U/mL [0-90 kU/L]). | **# serum IgE levels between 30 and 700 U/mL (30-700 kU/L) (normal range, 0-90 U/mL [0-90 kU/L]). | ||
+ | ** <u>Indications au mépolizumab</u>: anti-IL-5, ↓ symptomes, exacerbations, besoins en glucocorticoïdes oraux ([https://compendium.ch/fr/product/1319261-nucala-subst-seche-100-mg-ml Nucala]) | ||
+ | **# Compte des éosinophiles absolus > 150 cellules/mcl | ||
+ | **# Asthme sévère non contrôlé par la thérapie standard | ||
== Overlap syndrome avec la BPCO == | == Overlap syndrome avec la BPCO == |
Version du 20 juin 2020 à 16:32
Crise d'asthme aiguë
Comorbidités
Leur gestion adéquate permet de diminuer les symptômes ou potentiellement améliorer le contrôle de l'asthme
- Reflux gastro-oesophagien
- IVRS (rhinite, sinusite)
- Syndrome d'apnées du sommeil
- Dysfonction des cordes vocales
- Obésité
Stratégie
Traitements
- Corticostéroïdes inhalés (CSI)
- LABA (β2-agonistes à longue durée d'action)
- Améliore le contrôle de l'asthme et diminue le risque d'exacerbation
- Single-agent use of long-acting β2-agonists is not recommended because of the demonstrated increased risk of asthma-related death when used without another controller medication.[1]
- Anti-leucotriènes
- Effet bronchodilatateur modeste
- A envisager lors de rhinite allergique et d'asthme induit par l'aspirine ou les AINS.
- Corticostéroïdes systémiques
- Pas de place dans le traitement de fond
- LAMA (antagonistes des récepteurs muscariniques à longue durée d'action)
- En ajout à un CSI + LABA si mauvais contrôle de l'asthme
- For patients with excessive side effects from LABAs, a LAMA can reasonably be substituted. However, there is not substantial evidence that LAMAs should be the first choice for long-acting airway dilation instead of LABAs.
- Nouveaux biologiques
- Indication: eligible patients with severe persistent allergic asthma despite standard therapy reduces symptoms, need for oral glucocorticoids, and exacerbations.
- Indications à l'omalizumab: ↓ titre d'IgE (Xolair. Omalizumab has been shown to reduce exacerbations and emergency department visits
- symptoms inadequately controlled with inhaled glucocorticoids,
- evidence of allergies to perennial aeroallergens, and
- serum IgE levels between 30 and 700 U/mL (30-700 kU/L) (normal range, 0-90 U/mL [0-90 kU/L]).
- Indications au mépolizumab: anti-IL-5, ↓ symptomes, exacerbations, besoins en glucocorticoïdes oraux (Nucala)
- Compte des éosinophiles absolus > 150 cellules/mcl
- Asthme sévère non contrôlé par la thérapie standard
Overlap syndrome avec la BPCO
- Traitement: Experts recommend that patients who have an asthma-COPD overlap syndrome who are receiving a long-acting bronchodilator should ideally also be prescribed an inhaled glucocorticoid. Combination therapy seems to mitigate the excess risk of mortality observed in patients with asthma treated with long-acting β2-agonist monotherapy.