Director, Imperial Centre for Paediatrics and Child Health, Professor of Paediatrics and Paediatric Respirology, National Heart and Lung Institute, Imperial College, Consultant Paediatric Chest Physician, Royal Brompton Hospital, London, United Kingdom.
Department of Pediatrics, Emory University, Atlanta, Ga; Children's Healthcare of Atlanta, Atlanta, Ga.
J Allergy Clin Immunol Pract. 2022 Feb;10(2):359-375. doi: 10.1016/j.jaip.2021.11.010. Epub 2021 Nov 25.
The World Health Organization divides severe asthma into three categories: untreated severe asthma; difficult-to-treat severe asthma; and severe, therapy-resistant asthma. The apparent frequency of severe asthma in the general population of asthmatic children is probably around 5%. Upon referral of these children, it is important to evaluate the diagnosis of asthma carefully before modifying management and applying a long-term monitoring plan. Identification of pathophysiologic phenotypes using objective biomarkers is essential in our routine assessments of severe asthma. Although conventional pharmacologic approaches should be attempted first, there is growing recognition that children with difficult-to-treat asthma may have unique clinical phenotypes that may necessitate alternative treatment approaches including asthma biologics. These new medications, especially those with effects on multiple pathologic features of asthma, raise the hope that new treatment strategies could induce remission. Besides introducing new medications, the opportunity for closer monitoring is feasible with advances in digital health. Therefore, we have the opportunity to improve response to medications, individualize treatment, and monitor response along with potential steps to prevent severe asthma.
未治疗的重症哮喘；治疗困难的重症哮喘；以及严重、治疗抵抗的哮喘。在哮喘儿童的普通人群中，重症哮喘的明显频率可能约为 5%。在转介这些儿童时，在修改管理并应用长期监测计划之前，仔细评估哮喘的诊断非常重要。使用客观生物标志物识别病理生理表型对于我们对重症哮喘的常规评估至关重要。虽然首先应该尝试常规药物治疗方法，但人们越来越认识到，治疗困难的哮喘儿童可能具有独特的临床表型，可能需要替代治疗方法，包括哮喘生物制剂。这些新的药物，尤其是那些对哮喘多种病理特征都有作用的药物，为新的治疗策略可以诱导缓解带来了希望。除了引入新的药物外，随着数字健康的进步，更密切监测的机会也是可行的。因此，我们有机会改善对药物的反应，个体化治疗，并监测反应以及预防重症哮喘的潜在步骤。
