Busse William W, Castro Mario, Casale Thomas B
Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
Division of Pulmonary, Critical Care and Sleep Medicine, University of Kansas, Kansas City, Kan.
J Allergy Clin Immunol Pract. 2023 Jan;11(1):21-33. doi: 10.1016/j.jaip.2022.10.015. Epub 2022 Oct 22.
Management of asthma in adults has advanced in the past 10 years. Central to these advances has been further clarification of type (T) 2 mechanisms of airway inflammation and utilization of T2 biomarkers, that is, eosinophils and fractional exhaled nitric oxide. In addition, epithelial cells are emerging as significant contributors to inflammation through generation of alarmins to initiate local injury as well as downstream pathways. Five new biologics, mepolizumab, benralizumab, reslizumab, dupilumab, and tezepelumab, were approved to join omalizumab and revolutionize severe asthma treatment. These biologics significantly prevent exacerbations to spare systemic corticosteroids use and their side effects. Guidelines attest to the effectiveness of inhaled corticosteroids/long-acting β-agonists (formoterol) for both maintenance and rescue therapy. Focused updates to the Expert Panel Report addressed limited but specific questions relevant to asthma control. Future guidelines should include phenotype/endotype-directed therapeutics to gain more precision-directed treatment.
在过去10年中，成人哮喘的管理取得了进展。这些进展的核心是进一步明确了气道炎症的2型（T）机制以及T2生物标志物（即嗜酸性粒细胞和呼出气一氧化氮分数）的应用。此外，上皮细胞正通过产生警报素引发局部损伤以及下游通路，成为炎症的重要促成因素。五种新的生物制剂——美泊利单抗、贝那利珠单抗、瑞利珠单抗、度普利尤单抗和tezepelumab——获批加入奥马珠单抗，彻底改变了重度哮喘的治疗方式。这些生物制剂能显著预防病情加重，从而避免全身使用皮质类固醇及其副作用。指南证实吸入性皮质类固醇/长效β受体激动剂（福莫特罗）用于维持治疗和急救治疗均有效。专家小组报告的重点更新解决了与哮喘控制相关的有限但具体的问题。未来的指南应纳入基于表型/内型的治疗方法，以实现更精准的靶向治疗。
