What is Severe Asthma?
研究人员已经学会了that 5-10 percent of asthmatics do not respond well to traditional asthma medications, making their asthma difficult to control. In order to better help these asthmatics, researchers now categorize them under a specialasthma subtypecalled severe asthma, also known as耐药性哮喘or哮喘COPD Overlap Syndrome。所以，什么是严重的哮喘，如果有的话是什么意思？
Defining severe asthma
Sally Wenzel, professor of medicine at the University of Pittsburgh, defines severe asthma as “patients who require high dose inhaled glucocorticoid (GC), or continuous or near continuous oral GC treatment to maintain asthma control or who never achieve control despite that treatment.”Different methodologieshave been used to identify subtypes of asthma, including severe asthma.
Conditions commonly mistaken for severe asthma
严重的哮喘不得与其他“难以治疗哮喘”的原因混淆，包括：
哮喘exacerbated by uncontrolled asthma triggers (i.e.过敏性哮喘由霉菌暴露引起）
由于不遵守而无法控制的哮喘（即不服用处方药）
模仿哮喘的疾病（即窦感染）
哮喘因合并症而加剧（即asthma and allergies， 或者哮喘和GERD;当控制一个条件会影响另一个条件的控制时）
What does a diagnosis of severe asthma mean?
A diagnosis of severe asthma, when confirmed, will include:
慢性气道炎症：这使气道对哮喘触发者高度敏感，从而导致周围的平滑肌痉挛。这会缩小或阻碍气道。第二个反应是增加痰液产生，进一步阻塞气道。这会导致间歇性哮喘症状，例如喘息和呼吸急促。这种反应是完全可逆的，可以通过典型的哮喘药物来预防和治疗。这在所有哮喘患者中都可以看出。
Airway Remodelling:这也称为气道疤痕。它与墙壁衬里的永久增厚有关，尤其是较小的气道。这使得它们长期狭窄或长期阻塞。原因仍然是一个谜，尽管有些人推测它与哮喘有关，剩下的长期未治疗或太多严重的哮喘发作。另一个常见原因是慢性吸入化学物质，例如烟草和木烟中的化学物质。它会导致持续的症状；即使在良好的哮喘日期，它也会让您感到呼吸。这种反应是不可逆转的，目前没有治疗。这类似于COPD中发生的情况，仅存在于严重的哮喘患者中。
这两个组件在一起充当“双打”，使哮喘难以控制。这可能意味着您也有：
Air trapping:空气可以越过长期狭窄的气道，但很难恢复。这会导致空气被困在肺部。
Airflow limitation:长期到期最好地观察到这一点。有时，似乎您可以永远呼气，永远不要全力以赴。您无法产生足够的流程来吹蜡烛。
Fewer treatment options:没有药物治疗气道重塑。你回应传统哮喘药物不佳，就像吸入的皮质类固醇一样。[支气管热成形术]can be effective in some individuals with severe asthma.
More frequent and severe asthma attacks:Their airways are increasingly brittle and narrow making them increasingly prone to more severe attacks compared to those with typical asthma.
许多医生的约会：They'll need to see doctors who specialize in this type of asthma. They are also prone to more frequent and unscheduled doctor visits compared to those with typical asthma.
很多费用：尽管它们仅由5-10％的哮喘患者组成，但在美国和欧洲，它们的哮喘成本最多只有一半。
Unanswered questions:So, why is it that only 5-10 percent of asthmatics develop severe asthma? Researchers are working overtime to answer this question and to create special guidelines and medicinal options to help them achieve optimal control of their disease.
我们目前对严重哮喘有什么了解？
研究人员认为，在严重哮喘患者中发生的免疫反应与传统哮喘患者中发生的免疫反应不同。例如，免疫细胞（称为CD4-TH2细胞）分泌与传统哮喘患者相同细胞不同的炎症蛋白。这使他们的气道高敏，以至于对皮质类固醇的反应不足。
Since patients with severe asthma experience most of the deaths associated with asthma and have more hospitalizations, it’s important识别有风险的人。识别某些人容易发生严重（抗性）哮喘的表型可以使医生可以为这些人量身定制治疗。最终结果应减轻症状，疾病进展减少和降低健康成本。
重要的是要注意，当前设定的组织之间存在一些分歧严重哮喘分类指南。When it is diagnosed, patients need to be educated so that they understand when it is not safe to remain at home because high grade treatment like intravenous magnesium sulfate, assistance in ventilation or possible short-term intubation may be necessary.
众所周知，严重的哮喘占哮喘的大部分医疗费用。The true impact of severe asthma on people's lives在2015年9月发布的一项调查中得到了揭示。在接受调查的850例严重哮喘患者中，每天报告了每周症状，每周报告71％的症状。同样，有32％的人表示影响了他们的社交生活，有23％的人表示影响了他们的工作生活，有18％的人表示影响了他们的家庭生活，而17％的人表示影响了他们的性生活。
In conclusion, a proper diagnosisan should lead your doctor to the best treatment options to help you obtain ideal control of your disease, reducing hospitalizations and complications. Ongoing research should equal better breathing in the near future for all asthmatics.
