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2013年哮喘呼吸综述

Respiratory reviews in asthma 2013.

作者信息

Kim Tae-Hyung

机构信息

Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Seoul, Korea.

出版信息

Tuberc Respir Dis (Seoul). 2014 Mar;76(3):105-13. doi: 10.4046/trd.2014.76.3.105. Epub 2014 Mar 29.

Abstract

From January 2012 up until March 2013, many articles with huge clinical importance in asthma were published based on large numbered clinical trials or meta-analysis. The main subjects of these studies were the new therapeutic plan based on the asthma phenotype or efficacy along with the safety issues regarding the current treatment guidelines. For efficacy and safety issues, inhaled corticosteroid tapering strategy or continued long-acting beta agonists use was the major concern. As new therapeutic trials, monoclonal antibodies or macrolide antibiotics based on inflammatory phenotypes have been under investigation, with promising preliminary results. There were other issues on the disease susceptibility or genetic background of asthma, particularly for the "severe asthma" phenotype. In the era of genome and pharmacogenetics, there have been extensive studies to identify susceptible candidate genes based on the results of genome wide association studies (GWAS). However, for severe asthma, which is where most of the mortality or medical costs develop, it is very unclear. Moreover, there have been some efforts to find important genetic information in order to predict the possible disease progression, but with few significant results up until now. In conclusion, there are new on-going aspects in the phenotypic classification of asthma and therapeutic strategy according to the phenotypic variations. With more pharmacogenomic information and clear identification of the "severe asthma" group even before disease progression from GWAS data, more adequate and individualized therapeutic strategy could be realized in the future.

摘要

从2012年1月到2013年3月,基于大量临床试验或荟萃分析,发表了许多对哮喘具有重大临床意义的文章。这些研究的主要主题是基于哮喘表型或疗效的新治疗方案以及当前治疗指南的安全性问题。对于疗效和安全性问题,吸入性糖皮质激素减量策略或长效β受体激动剂的持续使用是主要关注点。作为新的治疗试验,基于炎症表型的单克隆抗体或大环内酯类抗生素一直在研究中,初步结果令人鼓舞。哮喘的疾病易感性或遗传背景也存在其他问题,特别是对于“重度哮喘”表型。在基因组学和药物遗传学时代,基于全基因组关联研究(GWAS)的结果,已经进行了广泛的研究以确定易感候选基因。然而,对于大多数死亡或医疗费用产生的重度哮喘,情况仍非常不明朗。此外,已经做出了一些努力来寻找重要的遗传信息以预测可能的疾病进展,但到目前为止取得的显著成果很少。总之,哮喘的表型分类和根据表型变异的治疗策略有新的进展。随着更多的药物基因组学信息以及在疾病从GWAS数据进展之前对“重度哮喘”组的明确识别,未来可能会实现更充分和个性化的治疗策略。

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