Duke University Medical Center, Durham, NC, United States; GCS Medical College, Hospital, and Research Center, Ahmedabad, India.
Bhaskar Medical College, Telangana, India.
Dis Mon. 2023 Jul;69(7):101483. doi: 10.1016/j.disamonth.2022.101483. Epub 2022 Oct 13.
Asthma is a significant worldwide health issue affecting kids and adults. Asthma management is mainly straightforward, but considering the associated co-morbidities, it is essential to diagnose the disease accurately. Steroid resistance and dependence, along with inhaler abuse, are the other challenges in clinical practice. Despite being treated with the recommended guidelines, a good portion of the population has persistent symptoms. Emerging biological treatments can alter the global landscape of managing severe asthma. With these new therapeutic possibilities, phenotype- and endotype-specific therapies can be used to individualize treatment plans.
We searched Medline, Embase, Google Scholar, and PubMed until March 2022 for all types of literature. Medical Subject Heading (MeSH) terms such as "asthma," "pathogenesis," "diagnosis and classification," "comorbidities," "treatments," "inhaler abuse & corticosteroid resistance," and "biologics" were used in the searches. To better understand the disease, we analyzed the literature on asthma regarding pathophysiology, diagnostic criteria, endotypic and phenotypic classification, comorbidities, existing treatment guidelines, management challenges, and potential for biologics in uncontrolled cases.
After exploring the data, our review article aims to highlight current limitations in the clinical management of asthma and the advances in treating asthma.
Clinical practice should consider an integrative approach to the care and prevention of asthma. We advocate for a large-scale cohort of observation studies and RCTs that further look into the underlying immunological mechanisms, the function of hereditary and environmental variables, and the novel molecular targets of asthma in light of the rising incidence and prevalence of the disease. Even with rising steroid resistance and dependence, the standard therapy will be the mainstream of asthma management. Biologics have promiscuous results and the potential for changing the treatment of uncontrolled asthma. Optimizing the standard therapy with biologics is needed to decrease asthma-related morbidity.
哮喘是一个全球性的重大健康问题,影响着儿童和成年人。哮喘的管理主要是直接的,但考虑到相关的合并症,准确诊断疾病是至关重要的。类固醇耐药和依赖,以及吸入器滥用,是临床实践中的其他挑战。尽管按照建议的指南进行治疗,但很大一部分人群仍存在持续的症状。新兴的生物治疗可以改变管理严重哮喘的全球格局。随着这些新的治疗可能性,表型和内型特异性治疗可以用于个体化治疗计划。
我们搜索了 Medline、Embase、Google Scholar 和 PubMed 中的所有类型的文献,直到 2022 年 3 月。搜索中使用了医学主题词(MeSH)术语,如"哮喘"、"发病机制"、"诊断和分类"、"合并症"、"治疗"、"吸入器滥用和皮质类固醇耐药"和"生物制剂"。为了更好地了解疾病,我们分析了有关哮喘病理生理学、诊断标准、内型和表型分类、合并症、现有治疗指南、管理挑战以及在未控制病例中生物制剂的潜在作用的文献。
在探索了这些数据之后,我们的综述文章旨在强调哮喘临床管理中的当前局限性和治疗进展。
临床实践应考虑将综合方法应用于哮喘的护理和预防。我们主张进行大规模的观察研究和 RCT,进一步研究哮喘的潜在免疫学机制、遗传和环境变量的功能以及哮喘的新分子靶点,考虑到疾病发病率和流行率的上升。即使类固醇耐药和依赖上升,标准治疗仍将是哮喘管理的主流。生物制剂具有广谱的效果,有可能改变未经控制的哮喘的治疗方法。需要用生物制剂优化标准疗法,以降低哮喘相关发病率。