Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland.
Christine Kühne-Center for Allergy Research and Education (CK-CARE), Davos, Switzerland.
Allergy. 2020 Dec;75(12):3124-3146. doi: 10.1111/all.14607. Epub 2020 Oct 16.
In this review, we discuss recent publications on asthma and review the studies that have reported on the different aspects of the prevalence, risk factors and prevention, mechanisms, diagnosis, and treatment of asthma. Many risk and protective factors and molecular mechanisms are involved in the development of asthma. Emerging concepts and challenges in implementing the exposome paradigm and its application in allergic diseases and asthma are reviewed, including genetic and epigenetic factors, microbial dysbiosis, and environmental exposure, particularly to indoor and outdoor substances. The most relevant experimental studies further advancing the understanding of molecular and immune mechanisms with potential new targets for the development of therapeutics are discussed. A reliable diagnosis of asthma, disease endotyping, and monitoring its severity are of great importance in the management of asthma. Correct evaluation and management of asthma comorbidity/multimorbidity, including interaction with asthma phenotypes and its value for the precision medicine approach and validation of predictive biomarkers, are further detailed. Novel approaches and strategies in asthma treatment linked to mechanisms and endotypes of asthma, particularly biologicals, are critically appraised. Finally, due to the recent pandemics and its impact on patient management, we discuss the challenges, relationships, and molecular mechanisms between asthma, allergies, SARS-CoV-2, and COVID-19.
在这篇综述中,我们讨论了最近关于哮喘的出版物,并回顾了报告哮喘患病率、危险因素和预防、机制、诊断和治疗的不同方面的研究。许多风险和保护因素以及分子机制参与了哮喘的发展。本文还回顾了实施暴露组学范例及其在过敏性疾病和哮喘中的应用所面临的新挑战和新兴概念,包括遗传和表观遗传因素、微生物失调以及环境暴露,特别是室内和室外物质。讨论了最相关的实验研究,这些研究进一步推进了对分子和免疫机制的理解,为治疗药物的开发提供了潜在的新靶点。在哮喘的管理中,对哮喘的可靠诊断、疾病表型分型和监测其严重程度非常重要。进一步详细阐述了哮喘合并症/多种疾病的正确评估和管理,包括与哮喘表型的相互作用及其对精准医学方法和预测生物标志物验证的价值。最后,由于最近的大流行及其对患者管理的影响,我们讨论了哮喘、过敏、SARS-CoV-2 和 COVID-19 之间的挑战、关系和分子机制。