Institute for Lung Health, NIHR Biomedical Research Centre, University of Leicester, Leicester, UK.
Respirology. 2023 Aug;28(8):709-721. doi: 10.1111/resp.14520. Epub 2023 May 24.
Asthma is a common chronic inflammatory condition of the airways that affects about 350 million people globally. In 5%-10% of individuals, it is severe, with considerable morbidity and high health care utilization. The goal of asthma management is disease control by reducing symptoms and exacerbations and reducing corticosteroid-related morbidity. The era of biologics has revolutionized the management of severe asthma. Biologics have changed our expectations for severe asthma, especially in those people with type-2 mediated immunity. We can now explore the potential for changing disease trajectory and inducing remission. However, biologics are not a panacea for all severe asthma sufferers and despite their success there remains substantial unmet clinical need. We review the pathogenesis of asthma, phenotyping the heterogeneity of asthma, currently licensed and future biologic agents, how to choose the initial biologic, assessing the response, remission and switching of biologic therapies.
哮喘是一种常见的气道慢性炎症性疾病,影响着全球约 3.5 亿人。在 5%-10%的人群中,哮喘病情较为严重,发病率较高,医疗保健利用率也较高。哮喘管理的目标是通过减少症状和加重来控制疾病,并减少与皮质类固醇相关的发病率。生物制剂的时代彻底改变了严重哮喘的治疗方法。生物制剂改变了我们对严重哮喘的期望,尤其是在那些具有 2 型介导免疫的人群中。我们现在可以探索改变疾病轨迹和诱导缓解的可能性。然而,生物制剂并不是所有严重哮喘患者的万灵药,尽管它们取得了成功,但仍有大量未满足的临床需求。我们回顾了哮喘的发病机制,表型分析了哮喘的异质性,目前已获得许可和未来的生物制剂,如何选择初始生物制剂,评估生物治疗的反应、缓解和转换。
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