Department of Pulmonary, Critical Care, Allergy, and Immunologic Diseases, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA.
Curr Allergy Asthma Rep. 2017 Feb;17(2):10. doi: 10.1007/s11882-017-0678-1.
Inhaled corticosteroids are the mainstay of asthma treatment using a step-up approach with incremental dosing and additional controller medications in order to achieve symptom control and prevent exacerbations. While most patients respond well to this treatment approach, some patients remain refractory despite high doses of inhaled corticosteroids and a long-acting β-agonist. The problem lies in the heterogeneity of severe asthma, which is further supported by the emergence of severe asthma phenotypes. This heterogeneity contributes to the variability in treatment response. Randomized controlled trials involving add-on therapies in poorly controlled asthma have challenged the idea of a "one size fits all" approach targeting specific phenotypes in their subject selection. This review discusses severe asthma phenotypes from unbiased clustering approaches and the most recent scientific evidence on novel treatments to provide a guide in personalizing severe asthma treatment.
吸入性皮质类固醇是哮喘治疗的主要方法，采用逐步递增剂量的方法，并使用额外的控制器药物，以实现症状控制和预防恶化。虽然大多数患者对这种治疗方法反应良好，但有些患者尽管使用了高剂量的吸入性皮质类固醇和长效β-激动剂仍无法控制病情。问题在于严重哮喘的异质性，这进一步得到了严重哮喘表型的出现的支持。这种异质性导致了治疗反应的可变性。涉及添加治疗药物的对控制不佳的哮喘的随机对照试验挑战了针对特定表型的“一刀切”方法的理念。这篇综述从无偏聚类方法讨论了严重哮喘表型，并讨论了最新的关于新型治疗方法的科学证据，以在个性化严重哮喘治疗方面提供指导。
