Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
Department of Environmental and Occupational Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
Lancet. 2020 Feb 1;395(10221):371-383. doi: 10.1016/S0140-6736(19)33005-3.
Asthma is a disease of reversible airflow obstruction characterised clinically by wheezing, shortness of breath, and coughing. Increases in airway type 2 cytokine activity, including interleukin-4 (IL-4), IL-5, and IL-13, are now established biological mechanisms in asthma. Inhaled corticosteroids have been the foundation for asthma treatment, in a large part because they decrease airway type 2 inflammation. However, inhaled or systemic corticosteroids are ineffective treatments in many patients with asthma and few treatment options exist for patients with steroid resistant asthma. Although mechanisms for corticosteroid refractory asthma are likely to be numerous, the development of a new class of biologic agents that target airway type 2 inflammation has provided a new model for treating some patients with corticosteroid refractory asthma. The objective of this Therapeutic paper is to summarise the new type 2 therapeutics, with an emphasis on the biological rationale and clinical efficacy of this new class of asthma therapeutics.
哮喘是一种可逆转气流阻塞的疾病,临床上表现为喘息、呼吸急促和咳嗽。气道 2 型细胞因子活性的增加,包括白细胞介素-4(IL-4)、白细胞介素-5(IL-5)和白细胞介素-13(IL-13),现在已被确立为哮喘的生物学机制。吸入性皮质类固醇一直是哮喘治疗的基础,很大程度上是因为它们可以减少气道 2 型炎症。然而,在许多哮喘患者中,吸入或全身皮质类固醇治疗无效,并且对类固醇耐药性哮喘患者的治疗选择很少。尽管皮质类固醇难治性哮喘的机制可能很多,但靶向气道 2 型炎症的新型生物制剂的开发为治疗一些皮质类固醇难治性哮喘患者提供了新的模式。本文的目的是总结新型 2 型治疗方法,重点介绍这类新型哮喘治疗方法的生物学原理和临床疗效。