Rolfes Mary Claire, Juhn Young Jun, Wi Chung-Il, Sheen Youn Ho
Mayo Medical School, Rochester, MN, USA.
Department of Pediatric and Adolescent Medicine/Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Tuberc Respir Dis (Seoul). 2017 Apr;80(2):113-135. doi: 10.4046/trd.2017.80.2.113. Epub 2017 Mar 31.
Asthma is traditionally regarded as a chronic airway disease, and recent literature proves its heterogeneity, based on distinctive clusters or phenotypes of asthma. In defining such asthma clusters, the nature of comorbidity among patients with asthma is poorly understood, by assuming no causal relationship between asthma and other comorbid conditions, including both communicable and noncommunicable diseases. However, emerging evidence suggests that the status of asthma significantly affects the increased susceptibility of the patient to both communicable and noncommunicable diseases. Specifically, the impact of asthma on susceptibility to noncommunicable diseases such as chronic systemic inflammatory diseases (e.g., rheumatoid arthritis), may provide an important insight into asthma as a disease with systemic inflammatory features, a conceptual understanding between asthma and asthma-related comorbidity, and the potential implications on the therapeutic and preventive interventions for patients with asthma. This review discusses the currently under-recognized clinical and immunological phenotypes of asthma; specifically, a higher risk of developing a systemic inflammatory disease such as rheumatoid arthritis and their implications, on the conceptual understanding and management of asthma. Our discussion is divided into three parts: literature summary on the relationship between asthma and the risk of rheumatoid arthritis; potential mechanisms underlying the association; and implications on asthma management and research.
传统上，哮喘被视为一种慢性气道疾病，而最近的文献证实了其异质性，这基于哮喘独特的集群或表型。在定义此类哮喘集群时，由于假定哮喘与其他合并症（包括传染病和非传染病）之间不存在因果关系，哮喘患者中合并症的本质尚未得到充分理解。然而，新出现的证据表明，哮喘状态会显著影响患者对传染病和非传染病易感性的增加。具体而言，哮喘对慢性全身性炎症性疾病（如类风湿性关节炎）等非传染病易感性的影响，可能为将哮喘视为具有全身性炎症特征的疾病、对哮喘与哮喘相关合并症的概念理解以及对哮喘患者治疗和预防干预的潜在影响提供重要见解。本综述讨论了目前未被充分认识的哮喘临床和免疫表型；具体而言，患类风湿性关节炎等全身性炎症性疾病的较高风险及其对哮喘概念理解和管理的影响。我们的讨论分为三个部分：关于哮喘与类风湿性关节炎风险关系的文献综述；两者关联的潜在机制；以及对哮喘管理和研究的影响。
