实现严重哮喘的缓解

Sarita Thawanaphong , Santi Nolasco , Parameswaran Nair
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引用次数: 0

摘要

严重哮喘影响全世界哮喘患者的5 - 10% ,由于死亡风险增加、生活质量受损和巨大的经济成本,造成了重大负担。生物疗法的最新进展通过针对特定的炎症途径,特别是2型炎症,改变了哮喘的治疗。生物治疗如omalizumab, mepolizumab, reslizumab, benralizumab和dupilumab已被证明在减少急性发作,改善肺功能和实现临床缓解的一部分患者中有效。本文综述了用于哮喘治疗的生物制剂的作用机制、适应症和治疗效果。我们还探讨了哮喘缓解的概念,以及通过生物疗法和补充策略(包括优化吸入器使用、大环内酯类药物和支气管热成形术)实现哮喘缓解的潜力。此外,我们还讨论了如何明智地选择这些治疗方法,并检查了每种生物治疗的局限性。尽管取得了这些进展,但临床缓解率仍然不高,这强调了对患者进行精细选择的必要性。新兴工具,如气道生物标志物、蛋白质组学和先进的成像技术,为改善诊断和个性化治疗方法提供了有希望的途径。未来的研究重点是使先进的生物标志物更容易获得和可行,以提高治疗精度。下一步将是将多组学方法整合到严重疾病的个性化哮喘管理中,进一步改善哮喘控制,实现持续缓解,并最终减轻严重哮喘的负担。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Achieving remission in severe asthma
Severe asthma affects 5–10 % of asthma patients worldwide, imposing a significant burden due to an increased risk of mortality, impaired quality of life, and substantial economic costs. Recent advancements in biologic therapies have transformed asthma management by targeting specific inflammatory pathways, particularly type 2 inflammation. Biologic treatments such as omalizumab, mepolizumab, reslizumab, benralizumab, and dupilumab have demonstrated efficacy in reducing exacerbations, improving lung function, and achieving clinical remission in a subset of patients. This review provides an overview of the mechanisms of action, indications, and treatment efficacy of biologics used in asthma management. We also explore the concept of asthma remission and the potential for achieving it through biologic therapies and complementary strategies, including optimized inhaler use, macrolides, and bronchial thermoplasty. In addition, we discuss how to choose among these treatments wisely and examine the limitations of each biologic therapy. Despite these advancements, clinical remission rates remain modest, underscoring the need for refined patient selection. Emerging tools such as airway biomarkers, proteomics, and advanced imaging techniques offer promising avenues to improve diagnosis and personalize treatment approaches. Future research focused on making advanced biomarkers more accessible and feasible for point-of-care testing will enhance treatment precision. The next step will be integrating a multiomics approach into personalized asthma management for severe disease, further improving asthma control, achieving sustained remission, and ultimately reducing the burden of severe asthma.
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来源期刊
Chinese medical journal pulmonary and critical care medicine
Chinese medical journal pulmonary and critical care medicine Critical Care and Intensive Care Medicine, Infectious Diseases, Pulmonary and Respiratory Medicine
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