Firestone Institute for Respiratory Health, St Joseph's Healthcare & Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Department of Respiratory Medicine, Lucus Augusti University Hospital, EOXI, Lugo Cervo, Monforte, Spain.
J Investig Allergol Clin Immunol. 2020;30(5):307-316. doi: 10.18176/jiaci.0628. Epub 2020 Jun 23.
Anti-interleukin 5 (IL-5) and anti-IL-5 receptor α monoclonal antibodies markedly decrease airway and peripheral blood eosinophil numbers and are thus highly effective in reducing asthma exacerbations. Nonetheless, these biologics do not completely resolve exacerbations. There is very little information on the cellular nature of exacerbations during treatment with biologics. Using illustrative clinical case scenarios, we highlight the importance of carefully characterizing asthmatics at the time of exacerbation and recognizing neutrophilic causes of exacerbations to ensure optimal management. While an eosinophilic exacerbation may improve with more corticosteroids or by switching to another anti-IL-5 monoclonal antibody, a noneosinophilic exacerbation will likely not. An infective exacerbation needs to be recognized, and the pathogen must be identified and treated with the appropriate antimicrobial agent.
抗白细胞介素 5（IL-5）和抗 IL-5 受体 α 单克隆抗体显著减少气道和外周血嗜酸性粒细胞数量，因此在减少哮喘加重方面非常有效。尽管如此，这些生物制剂并不能完全解决加重问题。关于在使用生物制剂治疗期间加重的细胞性质，信息非常有限。通过说明性的临床病例情况，我们强调了在加重时仔细描述哮喘患者特征以及识别加重的中性粒细胞原因的重要性，以确保进行最佳管理。虽然嗜酸性粒细胞加重可能会因更多皮质类固醇或改用另一种抗 IL-5 单克隆抗体而改善，但非嗜酸性粒细胞加重可能不会。必须认识到感染性加重，并且必须识别病原体并使用适当的抗菌药物进行治疗。
