Transylvania University, Faculty of Medicine, Brasov, Romania.
Semin Immunol. 2019 Dec;46:101301. doi: 10.1016/j.smim.2019.101301. Epub 2019 Aug 27.
Current management of severe asthma relying either on guidelines (bulk approach) or on disease phenotypes (stratified approach) did not improve the burden of the disease. Several severe phenotypes are described: clinical, functional, morphological, inflammatory, molecular and microbiome-related. However, phenotypes do not necessarily relate to or give insights into the underlying pathogenetic mechanisms which are described by the disease endotypes. Based on the major immune-inflammatory pathway involved type-2 high, type-2 low and mixed endotypes are described for severe asthma, with several shared pathogenetic pathways such as genetic and epigenetic, metabolic, neurogenic and remodelling subtypes. The concept of multidimensional endotyping as un unbiased approach to severe asthma is discussed, together with new tools and targets facilitating the shift from the stratified to the precision medicine approach.
目前，严重哮喘的管理要么依赖于指南（批量方法），要么依赖于疾病表型（分层方法），但都没有改善疾病负担。已经描述了几种严重表型：临床、功能、形态、炎症、分子和微生物组相关。然而，表型不一定与潜在的发病机制相关或提供深入了解，这些发病机制由疾病的内型来描述。根据涉及的主要免疫炎症途径，严重哮喘可分为 2 型高、2 型低和混合内型，还有几个共同的发病途径，如遗传和表观遗传、代谢、神经源性和重塑亚型。讨论了多维内型作为一种无偏方法来处理严重哮喘的概念，以及新的工具和靶点，这些工具和靶点有助于从分层医学方法向精准医学方法转变。
