Centre of Excellence in Treatable Traits, College of Health, Medicine and Wellbeing, University of Newcastle, Hunter Medical Research Institute Asthma and Breathing Program, Newcastle, New South Wales, Australia.
Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia.
Respirology. 2023 Sep;28(9):828-840. doi: 10.1111/resp.14556. Epub 2023 Jul 30.
The landscape of asthma has considerably changed in the last decade. Effective medications and inhaler devices have been developed and integrated into the asthma pharmacopoeia, but unfortunately, the proportion of uncontrolled patients remains unacceptably high. This is now recognized to be mainly due to the inappropriate use of medications or inhaler devices, heterogeneity of the disease or other factors contributing to the disease. Currently, inhaled corticosteroids (ICS), with or without long-acting beta agonists (LABA), are the cornerstone of asthma management, and recently international guidelines recognized the importance of combination inhaler therapy (ICS/LABA) even in mild asthma. In future, ultra-long-acting personalized medications and smart inhalers will complement combination inhaler therapy in order to effectively addresses issues such as adherence, inhaler technique and polypharmacy (both of drugs and devices). Asthma is now acknowledged as a multifaceted cluster of disorders and the treatment model has evolved from one-size-fits-all to precision medicine approaches such as treatable traits (TTs, defined as measurable and treatable clinically important factors) which encourages the quality use of medications and identification and management of all underlying behavioural and biological treatable risk factors. TT requires research and validation in a clinical context and the implementation strategies and efficacy in various settings (primary/secondary/tertiary care, low-middle income countries) and populations (mild/moderate/severe asthma) are currently evolving. Combination inhaler therapy and the TTs approach are complementary treatment approaches. This review examines the current status of personalized medicine and combination inhaler therapy, and describes futuristic views for these two strategies.
在过去的十年中，哮喘的治疗领域发生了重大变化。有效的药物和吸入器设备已经开发出来并纳入了哮喘药物学，但不幸的是，未得到控制的患者比例仍然高得令人无法接受。这主要是由于药物或吸入器设备使用不当、疾病异质性或其他导致疾病的因素造成的。目前，吸入性皮质类固醇（ICS），联合或不联合长效β激动剂（LABA），是哮喘管理的基石，最近国际指南认识到联合吸入治疗（ICS/LABA）的重要性，即使在轻度哮喘中也是如此。未来，超长效个体化药物和智能吸入器将与联合吸入治疗相辅相成，以有效解决依从性、吸入技术和多药治疗（药物和设备）等问题。哮喘现在被认为是一种多方面的疾病群，治疗模式已经从一刀切转变为精准医学方法，如可治疗特征（TTs），定义为可测量和临床重要的可治疗因素，这鼓励合理使用药物，并识别和管理所有潜在的行为和生物学可治疗的风险因素。TT 需要在临床环境中进行研究和验证，并且在各种环境（初级/二级/三级保健、中低收入国家）和人群（轻度/中度/重度哮喘）中的实施策略和疗效正在不断发展。联合吸入治疗和 TTs 方法是互补的治疗方法。本文综述了个性化医学和联合吸入治疗的现状，并描述了这两种策略的未来展望。
