Ray Anuradha, Raundhal Mahesh, Oriss Timothy B, Ray Prabir, Wenzel Sally E
J Clin Invest. 2016 Jul 1;126(7):2394-403. doi: 10.1172/JCI84144.
The term asthma encompasses a disease spectrum with mild to very severe disease phenotypes whose traditional common characteristic is reversible airflow limitation. Unlike milder disease, severe asthma is poorly controlled by the current standard of care. Ongoing studies using advanced molecular and immunological tools along with improved clinical classification show that severe asthma does not identify a specific patient phenotype, but rather includes patients with constant medical needs, whose pathobiologic and clinical characteristics vary widely. Accordingly, in recent clinical trials, therapies guided by specific patient characteristics have had better outcomes than previous therapies directed to any subject with a diagnosis of severe asthma. However, there are still significant gaps in our understanding of the full scope of this disease that hinder the development of effective treatments for all severe asthmatics. In this Review, we discuss our current state of knowledge regarding severe asthma, highlighting different molecular and immunological pathways that can be targeted for future therapeutic development.
哮喘这一术语涵盖了从轻度到非常严重的一系列疾病表型，其传统的共同特征是气流受限可逆。与较轻的疾病不同，重度哮喘难以通过当前的护理标准得到有效控制。目前正在进行的研究使用先进的分子和免疫学工具以及改进的临床分类方法，结果表明重度哮喘并非指特定的患者表型，而是包括那些医疗需求持续存在、病理生物学和临床特征差异很大的患者。因此，在最近的临床试验中，根据特定患者特征进行指导的治疗比以往针对任何诊断为重度哮喘的患者的治疗取得了更好的效果。然而，我们对这种疾病全貌的理解仍存在重大差距，这阻碍了针对所有重度哮喘患者开发有效治疗方法。在本综述中，我们讨论了目前关于重度哮喘的知识状况，重点介绍了未来治疗开发中可作为靶点的不同分子和免疫途径。
