Bosi Annamaria, Lombardi Carlo, Caruso Cristiano, Cottini Marcello, Baglivo Ilaria, Colantuono Stefania, Menzella Francesco
Pulmonology Unit, S. Valentino Hospital, Montebelluna (TV), AULSS2 Marca Trevigiana, Italy.
Departmental Unit of Allergology, Clinical Immunology & Pneumology, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy.
Drugs Context. 2024 Sep 23;13. doi: 10.7573/dic.2024-7-2. eCollection 2024.
Over the last two decades, we have witnessed great advancements in our understanding of the immunological pathways of asthma, leading to the development of targeted therapies, such as biologic drugs, that have radically and definitively changed the clinical outcomes of severe asthma. Despite the numerous therapeutic options available, ~4-10% of all people with asthma have severe or uncontrolled asthma, associated with an increased risk of developing chronic oral corticosteroid use, fixed airflow limitation, exacerbations, hospitalization and, finally, increased healthcare costs. The new concept of disease modification in asthma comes from the evolution of asthma management, which encompasses phenotyping patients with different inflammatory endotypes characterizing the disease, followed by the advent of more effective therapies capable of targeting the proximal factors of airway inflammation. This treat-to-target approach aims to achieve remission of the disease. Because the novel treatment paradigm for severe asthma with the advent of biologic therapies is no longer clinical control but rather clinical remission - a step closer to the concept of cure - a deeper and more accurate understanding of the critical causal mechanisms and endotypes of asthma is necessary to achieve the goal of clinical remission, which has the potential to generate real life-changing benefits for patients. This review aims to frame the evolution of the debated concept of clinical remission and provide clinicians with insights that may be helpful in achieving remission in the greatest number of patients.
在过去二十年中，我们见证了对哮喘免疫途径的理解取得了巨大进展，这促使了靶向治疗的发展，例如生物药物，这些药物从根本上彻底改变了重度哮喘的临床结局。尽管有众多可用的治疗选择，但所有哮喘患者中仍有4%-10%患有重度或未得到控制的哮喘，这与长期使用口服糖皮质激素、固定性气流受限、病情加重、住院治疗风险增加相关，最终导致医疗费用增加。哮喘疾病修正的新概念源于哮喘管理的演变，包括对具有不同炎症内型特征的患者进行表型分析，随后出现了能够针对气道炎症近端因素的更有效疗法。这种以目标为导向的治疗方法旨在实现疾病缓解。由于生物疗法出现后重度哮喘的新型治疗模式不再是临床控制而是临床缓解——更接近治愈的概念——因此有必要更深入、更准确地了解哮喘的关键因果机制和内型，以实现临床缓解的目标，这有可能为患者带来改变生活的实际益处。本综述旨在阐述备受争议的临床缓解概念的演变，并为临床医生提供有助于使尽可能多的患者实现缓解的见解。
