University Children's Hospital Munich, Department of Allergy and Pulmonary, Ludwig-Maximilians University of Munich, Munich, Germany; German Centre for Lung Research, Comprehensive Pneumology Centre, Munich, Germany.
University Children's Hospital Munich, Department of Allergy and Pulmonary, Ludwig-Maximilians University of Munich, Munich, Germany; German Centre for Lung Research, Comprehensive Pneumology Centre, Munich, Germany.
Lancet Respir Med. 2014 Aug;2(8):647-56. doi: 10.1016/S2213-2600(14)70129-8. Epub 2014 Jul 6.
Early life influences are crucial for the development of distinct childhood asthma phenotypes, which are currently included under the term asthma syndrome. Improved characterisation of different childhood asthma phenotypes will help to elucidate specific underlying immune mechanisms--namely, endotypes. Besides genetics, epigenetics and environmental factors have an effect on innate and adaptive immune regulatory networks. Crucial determining factors for complex immune regulation and barrier function include family history of atopy, respiratory infections, microbiome, and nutrition. Recent diagnostic approaches, including biomarkers, might offer a unique opportunity to improve definitions of asthma sub-phenotypes, prediction of outcome, and treatment options, by referring to the underlying pathophysiology. For prevention and patient-individualised medicine, a multifactorial approach incorporating deep phenotyping and mathematical models for analysis to extend our present knowledge is needed.
早期生活的影响对不同的儿童哮喘表型的发展至关重要，目前这些表型被归入哮喘综合征这一术语下。对不同儿童哮喘表型的更好描述将有助于阐明特定的潜在免疫机制，即表型。除了遗传因素，表观遗传和环境因素也会影响先天和适应性免疫调节网络。复杂免疫调节和屏障功能的关键决定因素包括特应性家族史、呼吸道感染、微生物组和营养。最近的诊断方法，包括生物标志物，可能通过参考潜在的病理生理学，为改善哮喘亚表型的定义、预测结果和治疗选择提供独特的机会。为了进行预防和个体化医疗，需要采用多因素方法，将深入的表型分析和数学模型分析结合起来，以扩展我们现有的知识。
