Zhang Qing, Wu Wen Wen, Li Lei, McDonald Vanessa M, Chen Yu Cheng, Wang Gang, Gibson Peter G
Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, China.
Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, Sichuan University, Chengdu 610041, Sichuan, China.
Precis Clin Med. 2023 Feb 24;6(1):pbad003. doi: 10.1093/pcmedi/pbad003. eCollection 2023 Mar.
Traditional stepwise approach usually adjusts the treatment regimen based on changes in asthma symptoms and severity to achieve good asthma control. However, due to the generalized heterogeneity and complexity of asthma, its therapeutic efficacy in difficult-to-treat asthma is limited. Recently, a precision medicine approach based on the identification and intervention of treatable traits of chronic airway disease has been proposed and appears to be of greater benefit to asthmatics. We reported a 71-year-old male with uncontrolled asthma and multiple exacerbations over the past year. He complained of persistent dyspnea despite high-dose of inhaled corticosteroids plus other controllers. Does this patient have some potential treatable traits contributing to difficult-to-treat asthma? Through a multidimensional assessment of three domains including pulmonary, extrapulmonary, and behavioral/risk factors, 15 treatable traits were identified in the patient, mainly including airflow limitation, eosinophilic airway inflammation, small airway dysfunction, exacerbation prone, dilated cardiomyopathy, diabetes mellitus, inhaler device polypharmacy, smoking, and the absence of an asthma action plan. After targeted treatment for these treatable traits, the patient experienced significant improvement in dyspnea and he could maintain good asthma control with low-dose inhaled corticosteroids and long-acting β-agonist. This study shows that, in response to the limitation of a stepwise approach to therapy, treatable traits is a new strategy where patients are individually assessed for a specified set of treatable problems, and an individualized treatment program is developed and implemented based on this multidimensional assessment, especially for difficult-to-treat asthma.
传统的逐步治疗方法通常根据哮喘症状和严重程度的变化来调整治疗方案，以实现良好的哮喘控制。然而，由于哮喘具有广泛的异质性和复杂性，其在难治性哮喘中的治疗效果有限。最近，一种基于识别和干预慢性气道疾病可治疗特征的精准医学方法被提出，似乎对哮喘患者更有益。我们报告了一名71岁男性，他的哮喘在过去一年中未得到控制且多次发作。尽管使用了高剂量吸入性糖皮质激素加其他控制药物，他仍主诉持续呼吸困难。该患者是否存在一些导致难治性哮喘的潜在可治疗特征？通过对包括肺部、肺外和行为/风险因素三个领域的多维评估，在该患者中识别出15个可治疗特征，主要包括气流受限、嗜酸性气道炎症、小气道功能障碍、易发作、扩张型心肌病、糖尿病、吸入装置联合用药、吸烟以及缺乏哮喘行动计划。针对这些可治疗特征进行靶向治疗后，患者的呼吸困难有了显著改善，并且他可以通过低剂量吸入性糖皮质激素和长效β受体激动剂维持良好的哮喘控制。这项研究表明，针对逐步治疗方法的局限性，可治疗特征是一种新策略，即对患者进行特定一组可治疗问题的个体化评估，并基于这种多维评估制定和实施个体化治疗方案，尤其适用于难治性哮喘。
