Différences entre versions de « Asthme »
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** <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>:(1) symptoms inadequately controlled with inhaled glucocorticoids, (2) evidence of allergies to perennial aeroallergens, and (3) serum IgE levels between 30 and 700 U/mL (30-700 kU/L) (normal range, 0-90 U/mL [0-90 kU/L]). Omalizumab has been shown to reduce exacerbations and emergency department visits; | ** <u>Indications à l'omalizumab</u>:(1) symptoms inadequately controlled with inhaled glucocorticoids, (2) evidence of allergies to perennial aeroallergens, and (3) serum IgE levels between 30 and 700 U/mL (30-700 kU/L) (normal range, 0-90 U/mL [0-90 kU/L]). Omalizumab has been shown to reduce exacerbations and emergency department visits; | ||
| + | |||
| + | == 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. | ||
== Références == | == Références == | ||
[[Category:Pneumologie]] | [[Category:Pneumologie]] | ||
[[Category:Médecine d'urgence]] | [[Category:Médecine d'urgence]] | ||
Version du 26 mars 2020 à 00:48
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
Fichier:Mk18 b pm f03.83285833bbe6483760a4bc185374460b.svg
Source: MKSAP 2018
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 pour abaisser le titre d'IgE (omalizumab, Xolair) ou d'éosinophiles (mépolizumab, Nucala)
- Indication: eligible patients with severe persistent allergic asthma despite standard therapy reduces symptoms, need for oral glucocorticoids, and exacerbations.
- Indications à l'omalizumab:(1) symptoms inadequately controlled with inhaled glucocorticoids, (2) evidence of allergies to perennial aeroallergens, and (3) serum IgE levels between 30 and 700 U/mL (30-700 kU/L) (normal range, 0-90 U/mL [0-90 kU/L]). Omalizumab has been shown to reduce exacerbations and emergency department visits;
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.
