Royal Brompton Hospital, Respiratory Medicine, London, United Kingdom.
The Breathing Institute, Children's Hospital Colorado, Aurora, Colo; Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo.
J Allergy Clin Immunol Pract. 2021 Mar;9(3):1090-1098. doi: 10.1016/j.jaip.2020.10.035. Epub 2020 Oct 28.
Asthma treatments have evolved from bronchodilators to interventions directed toward the regulation of airway inflammation. From these advances has come greater disease control and reduced morbidity. The addition of biologics directed toward specific pathways of inflammation has advanced the efficacy of asthma control. With these treatment advances, a renewed interest in achieving a remission in asthma has arisen. Although asthma remission has been considered to reflect a "cure," new evaluations of this concept have proposed criteria for remission while on treatment. These criteria reflect a high level of disease control including absence of symptoms, optimization and stabilization of lung function, and absence of the use of systemic corticosteroids and have been proposed to indicate a remission of disease activity. Given the added efficacy found with biologics in asthma treatment for patients with moderate to severe disease, the question has arisen as to whether the use of biologics meets criteria for remission and may this change a component of underlying disease and risks. Biologics are highly effective in reducing exacerbations, diminishing symptoms, and improving lung function in well-defined asthma populations. At present, however, biologics achieve some, but in most cases not all criteria for a remission on treatment. However, the concept of promoting treatment efforts to achieve disease remission in asthma is important, potentially achievable, and merits consideration for future guideline-directed care approaches.
哮喘治疗已经从支气管扩张剂发展为针对气道炎症调节的干预措施。这些进展带来了更好的疾病控制和降低发病率。针对炎症特定途径的生物制剂的加入提高了哮喘控制的疗效。随着这些治疗进展，人们对实现哮喘缓解重新产生了兴趣。尽管哮喘缓解被认为反映了“治愈”，但对这一概念的新评估提出了治疗期间缓解的标准。这些标准反映了高度的疾病控制，包括无症状、肺功能的优化和稳定，以及不使用全身皮质类固醇，并被提议表明疾病活动的缓解。鉴于生物制剂在中重度疾病患者的哮喘治疗中发现的额外疗效，人们提出了这样一个问题，即生物制剂的使用是否符合缓解的标准，并且这是否可能改变潜在疾病和风险的一个组成部分。生物制剂在减少中重度哮喘患者的恶化、减轻症状和改善肺功能方面非常有效。然而，目前生物制剂在治疗期间仅满足缓解标准的部分而非全部标准。然而，促进治疗努力以实现哮喘疾病缓解的概念很重要，在未来的指南指导的护理方法中值得考虑。
