Lang David M
Respiratory Institute, Department of Allergy and Clinical Immunology, Cleveland Clinic, Cleveland, Ohio, USA.
Allergy Asthma Proc. 2015 Nov-Dec;36(6):418-24. doi: 10.2500/aap.2015.36.3908.
Patients with severe persistent asthma comprise only 5-10 % of the total asthma population, but account for a large proportion of asthma morbidity and health care expenditures. Among patients with severe asthma, higher costs can be expected in association with not well or poorly controlled asthma.
To summarize the evidence concerning the epidemiology, burden, and heterogeneity of severe asthma.
A literature search was performed to identify citations using the terms "severe asthma" and "epidemiology", "asthma control", "asthma" and "heterogeneity".
Successful management of patients with severe asthma continues to be a major unmet need. One of the barriers to successful management is the heterogeneity of asthma. Asthma is not one disease; it is a disorder that can be subdivided into a number of different phenotypes and endotypes. A revised paradigm for asthma management, that entails categorization of asthma patients via use of "biomarkers", and prescribing targeted therapy, will supplant what has been a "one size fits all" approach to asthma management.
The novel approach to asthma management, in which therapy will be more mechanism-specific based on phenotype/endotype, offers the potential for improved asthma care outcomes - particularly for patients with severe persistent asthma who are not well or poorly controlled.
重度持续性哮喘患者仅占哮喘总人群的5%-10%，但却占哮喘发病率和医疗保健支出的很大比例。在重度哮喘患者中，哮喘控制不佳或较差时预计费用会更高。
总结有关重度哮喘的流行病学、负担和异质性的证据。
进行文献检索，使用“重度哮喘”和“流行病学”、“哮喘控制”、“哮喘”以及“异质性”等术语来识别文献引用。
重度哮喘患者的成功管理仍然是一项尚未满足的主要需求。成功管理的障碍之一是哮喘的异质性。哮喘并非一种单一疾病；它是一种可细分为多种不同表型和内型的病症。一种修订后的哮喘管理模式，即通过使用“生物标志物”对哮喘患者进行分类并开具靶向治疗药物，将取代以往“一刀切”的哮喘管理方法。
基于表型/内型使治疗更具机制特异性的新型哮喘管理方法，有望改善哮喘治疗效果——尤其是对于重度持续性哮喘且控制不佳或较差的患者。
