什么是严重的哮喘？
Researchers have learned5-10％的哮喘学对传统哮喘药物没有良好反应，使其哮喘难以控制。为了更好地帮助这些哮喘学，研究人员现在将它们归类为特殊的哮喘亚型被称为严重的哮喘，也称为Therapy-Resistant Asthma要么哮喘copd重叠综合征。So, what issevere asthma, and what does it mean if you have it?
定义严重的哮喘
莎莉温塞尔是，匹兹堡大学医学教授，将严重的哮喘定义为“需要高剂量吸入糖皮质激素（GC）的患者，或连续或接近连续口服GC处理，以维持哮喘控制或尽管治疗尽管从未实现控制。”不同的方法已被用于鉴定哮喘的亚型，包括严重哮喘。
条件通常误认为严重哮喘
Severe asthma must not be confused with other causes of "difficult to treat asthma", including:
由于不受控制的哮喘触发器而加剧了哮喘（即allergic asthmacaused by exposure to molds)
Asthma that is poorly controlled due to nonadherence (i.e.not taking medicines as prescribed)
Disorders that mimic asthma (i.e.sinus infections)
Asthma exacerbated by comorbid conditions (i.e.哮喘和过敏症, orasthma and GERD; when control of one condition affects control of the other)
什么是严重哮喘的诊断意味着什么？
确认时，严重哮喘的诊断将包括：
Chronic Airway Inflammation:This makes airways hypersensitive to asthma triggers, causing the smooth muscles surrounding them to spasm. This narrows or obstructs the airways. A second response is increased sputum production, further obstructing airways. This causes intermittent asthma symptoms like wheezing and shortness of breath. This response is completely reversible, and can be prevented and treated with typical asthma medications. This is seen in all asthmatics.
气道改造：This is also referred to as airway scarring. It’s associated with a permanent thickening of the walls lining airways, particularly smaller airways. This makes them chronically narrowed or chronically obstructed. The cause of this remains a mystery, although some speculate it has to do with asthma left untreated long-term, or too many severe asthma attacks. Another common cause is chronic inhalation of chemicals, such as those in tobacco and wood smoke. It causes persistent symptoms; it makes you feel short of breath even on a good asthma day. This response is irreversible, and there is at present no treatment. This is similar to what happens in COPD, and is only present in severe asthmatics.
These two components together act as a"double whammy", making asthma difficult to control. This probably means you also have:
空气陷阱：Air can get past chronically narrowed airways but has a hard time getting back out. This causes air to become trapped inside your lungs.
气流限制：This is best observed by a prolonged expiration. Sometimes it may seem you can exhale forever and never get all the air out. You can't generate enough flow to blow out a candle.
减少治疗选择：没有药物治疗气道重塑。你的反应poorly to traditional asthma medications, like inhaled corticosteroids.[Bronchial thermoplasty]可以在一些具有严重哮喘的个体中有效。
更频繁和严重的哮喘攻击：他们的气道越来越脆弱，与典型哮喘的人相比，它们越来越容易出现更严重的攻击。
Lots of doctor appointments:他们需要看专门从事这种哮喘的医生。与具有典型哮喘的人相比，它们也容易发生更频繁和更常见的医生访问。
Lots of fees:While they consist of only 5-10 percent of asthmatics, they consume up to half the cost of asthma in both the U.S. and Europe.
未答复的问题：那么，为什么只有5-10％的哮喘产生严重的哮喘？研究人员正在加班回答这个问题，并创建特殊指导方针和药用选择，以帮助他们实现对疾病的最佳控制。
What do we currently know about severe asthma?
Researchers believe the immune response that occurs in severe asthmatics is different than what occurs in traditional asthmatics. For instance, immune cells (called CD4-TH2 cells) secrete different inflammatory proteins than the same cells in traditional asthmatics. This makes their airways hypersensitive in such a way that does not respond sufficiently and effectively to corticosteroids.
由于患有严重哮喘的患者体验了与哮喘相关的大部分死亡，并且有更多的住院治疗，这很重要to identify individuals with risk。Identifying the phenotypes in certain individuals prone to develop severe (resistant) asthma can allow physicians to tailor treatment to these individuals. The net result should be reduced symptoms, less progression of disease and lower health costs.
It’s important to note that there is some disagreement among the organizations that currently set theguidelines for classification of severe asthma。当诊断出来时，患者需要受过教育，以便他们了解在家里不安全时，因为静脉内硫酸镁等高级治疗，可能需要在通风或可能的短期插管中进行辅助。
It is well established that severe asthma accounts for a majority of healthcare costs for asthma.严重哮喘对人们生活的真正影响was revealed in a survey released in September, 2015. Of 850 severe asthmatics surveyed, 25 percent reported daily symptoms, and 71 percent reported weekly symptoms. Likewise, 32 percent said it affected their social life, 23 percent said it affected their working life, 18 percent said it affected their family life, and 17 percent said it affected their sex life.
总之，适当的诊断，将医生引导您的医生以帮助您获得对疾病的理想控制，减少住院治疗和并发症。持续的研究应该在不久的将来等于所有哮喘的呼吸。
