Cardiothoracic Department, Pulmonary Unit, University Hospital of Pisa, Italy.
Expert Rev Respir Med. 2012 Feb;6(1):117-27. doi: 10.1586/ers.12.2.
Asthma and chronic obstructive pulmonary disease (COPD) represent the leading chronic respiratory diseases of interest in the word, owing to their high prevalence and burden on the health system. Care of these patients, undergoing frequent exacerbations, is a heavy burden on healthcare systems. In the last few years, large improvements in the management of asthma and COPD have been made, owing to new drugs and management strategies, and to the improvement of the nonpharmacologic treatment of COPD. There are still many unmet needs in the treatment of these diseases. In asthma, strategies to improve control should be implemented. There is a need to use more biomarkers to tailor treatment, in the assessment and choice of appropriate therapy, especially in severe patients. In COPD, there is growing evidence of individual differences in lung function decline rate and associated differences in appropriate management strategies. Early effective and prolonged bronchodilation can slow disease progression and reduce the frequency of exacerbations. New perspectives include the use of biologic drugs (anticytokine monoclonal antibodies) in selected categories of severe asthmatics, potential new inhibitors of chemokines and cytokines involved in the pathobiology of asthma and COPD, and a further improvement of current drugs and better implementation of management strategies, particularly in COPD patients.
哮喘和慢性阻塞性肺疾病（COPD）是世界上主要的慢性呼吸系统疾病，由于其高患病率和对医疗系统的负担，引起了广泛关注。这些经常发生恶化的患者的护理给医疗保健系统带来了沉重的负担。由于新的药物和管理策略，以及 COPD 的非药物治疗的改善，近年来哮喘和 COPD 的管理有了很大的改进。这些疾病的治疗仍有许多未满足的需求。在哮喘中，应实施改善控制的策略。需要使用更多的生物标志物来针对治疗进行调整，特别是在严重患者的评估和选择适当的治疗方法中。在 COPD 中，越来越多的证据表明肺功能下降率存在个体差异，并且与适当的管理策略存在差异。早期有效的、持久的支气管扩张可以减缓疾病进展并减少恶化的频率。新的观点包括在特定类别的严重哮喘患者中使用生物药物（抗细胞因子单克隆抗体）、潜在的新型趋化因子和细胞因子抑制剂，这些抑制剂涉及哮喘和 COPD 的病理生理学，以及进一步改善现有药物和更好地实施管理策略，特别是在 COPD 患者中。
