Zhang Jintao, Dong Liang
Department of Respiratory and Critical Care Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
J Thorac Dis. 2020 Oct;12(10):6090-6101. doi: 10.21037/jtd-20-1024.
Airway remodeling, as a major characteristic of bronchial asthma, is critical to the progression of this disease, whereas it is of less importance in clinical management. Complying with the current stepwise treatment standard for asthma, the choice of intervention on the clinical status is primarily determined by the patient's treatment response to airway inflammation. However, a considerable number of asthmatic patients, especially severe asthmatic subjects, remain uncontrolled though they have undergone fortified anti-inflammation treatment. In the past few years, a growing number of biologics specific to asthma phenotypes have emerged, bringing new hope for patients with refractory asthma and severe asthma. While at the same time, the effect of airway remodeling on asthma treatment has become progressively prominent. In the era of personalized treatment, it has become one of the development directions for asthma treatment to find reliable airway remodeling biomarkers to assist in asthma phenotypes classification, and to further combine multiple phenotypes to accurately treat patients. In the present study, the research status of airway remodeling in asthma is reviewed to show the basis for classifying and treating such disease. Besides, several selected airway remodeling biomarkers and possibility to use them in individual treatment are discussed as well. This study considers that continuously optimized mechanisms and emerging biomarkers for airway remodeling in the future may further support individual therapy for asthma patients.
气道重塑作为支气管哮喘的主要特征,对该疾病的进展至关重要,然而在临床管理中其重要性较低。遵循当前哮喘的阶梯式治疗标准,临床状态干预措施的选择主要取决于患者对气道炎症的治疗反应。然而,相当一部分哮喘患者,尤其是重度哮喘患者,尽管接受了强化抗炎治疗,病情仍未得到控制。在过去几年中,越来越多针对哮喘表型的生物制剂出现,为难治性哮喘和重度哮喘患者带来了新希望。与此同时,气道重塑对哮喘治疗的影响也日益凸显。在个性化治疗时代,寻找可靠的气道重塑生物标志物以辅助哮喘表型分类,并进一步结合多种表型精准治疗患者,已成为哮喘治疗的发展方向之一。在本研究中,对哮喘气道重塑的研究现状进行综述,以展示该疾病分类和治疗的依据。此外,还讨论了几种选定的气道重塑生物标志物及其在个体化治疗中的应用可能性。本研究认为,未来持续优化的气道重塑机制和新兴生物标志物可能会进一步支持哮喘患者的个体化治疗。