Park So-Young, Kang Sung-Yoon, Song Woo-Jung, Kim Joo-Hee
Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
Division of Pulmonary, Allergy and Critical Care Medicine, Chung-Ang University Gwangmyeong Medical Center, Gwangmyeong, Korea.
Allergy Asthma Immunol Res. 2022 Sep;14(5):447-464. doi: 10.4168/aair.2022.14.5.447.
In recent decades, the concept of severe asthma has evolved from an umbrella term encompassing patients with high-intensity treatment needs to a clinical syndrome with heterogeneous, albeit distinct, pathophysiological processes. Biased and unbiased cluster approaches have been used to identify several clinical phenotypes. In parallel, cellular and molecular approaches allow for the development of biological therapies, especially targeting type 2 (T2) cytokine pathways. Although T2-biologics have significantly improved clinical outcomes for patients with severe asthma in real-world practice, questions on the proper use of biologics remain open. Furthermore, a subset of severe asthma patients remains poorly controlled. The unmet needs require a new approach. The "treatable traits" concept has been suggested to address a diversity of pathophysiological factors in severe asthma and overcome the limitations of existing treatment strategies. With a tailored therapy that targets the treatable traits in individual patients, better personalized medical care and outcomes should be achieved.
近几十年来，重度哮喘的概念已从一个涵盖有高强度治疗需求患者的笼统术语，演变为一种具有异质性但又各不相同的病理生理过程的临床综合征。有偏和无偏聚类方法已被用于识别几种临床表型。与此同时，细胞和分子方法有助于生物疗法的开发，尤其是针对2型（T2）细胞因子途径的疗法。尽管T2生物制剂在实际临床中显著改善了重度哮喘患者的治疗效果，但关于生物制剂的合理使用问题仍未解决。此外，一部分重度哮喘患者的病情仍然控制不佳。这些未满足的需求需要一种新方法。“可治疗特征”的概念已被提出，以解决重度哮喘中多种病理生理因素，并克服现有治疗策略的局限性。通过针对个体患者可治疗特征的定制疗法，应能实现更好的个性化医疗和治疗效果。
