Mailhot-Larouche Samuel, Celis-Preciado Carlos, Heaney Liam G, Couillard Simon
Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Québec, Canada.
Centre for Experimental Medicine, Queen's University Belfast School of Medicine, Dentistry and Biomedical Sciences, Belfast, United Kingdom.
Ann Allergy Asthma Immunol. 2025 Jan;134(1):31-45. doi: 10.1016/j.anai.2024.09.023. Epub 2024 Oct 9.
Asthma is a chronic respiratory disease marked by heterogeneity and variable clinical outcomes. Recent therapeutic advances have highlighted patients achieving optimal outcomes, termed "remission" or "super-response." This review evaluates the various definitions of these terms and explores how disease burden impedes the attainment of remission. We assessed multiple studies, including a recent systematic review and meta-analysis, on biologic treatments for asthma remission. Our review highlights that type 2 inflammation may be the strongest predictor of biologic response. Key comorbidities (eg, obesity and mood disorders) and behavioral factors (eg, poor adherence, improper inhalation technique, and smoking) were identified as dominant traits limiting remission. In addition, asthma burden and longer disease duration significantly restrict the potential for remission in patients with severe asthma under the current treatment paradigm. We review the potential for a "predict-and-prevent" approach, which focuses on early identification of high-risk patients with type 2 inflammation and aggressive treatment to improve long-term asthma outcomes. In conclusion, this scoping review highlights the following unmet needs in asthma remission: (1) a harmonized global definition, with better defined lung function parameters; (2) integration of nonbiologic therapies into remission strategies; and (3) a clinical trial of early biologic intervention in patients with remission-prone, very type 2-high, moderately severe asthma with clinical remission as a predefined primary end point.
哮喘是一种慢性呼吸道疾病，具有异质性和多变的临床结局。最近的治疗进展突出了达到最佳结局的患者，即所谓的“缓解”或“超反应”。本综述评估了这些术语的各种定义，并探讨了疾病负担如何阻碍缓解的实现。我们评估了多项关于哮喘缓解生物治疗的研究，包括最近的一项系统评价和荟萃分析。我们的综述强调，2型炎症可能是生物反应的最强预测因素。关键合并症（如肥胖和情绪障碍）和行为因素（如依从性差、吸入技术不当和吸烟）被确定为限制缓解的主要特征。此外，在当前治疗模式下，哮喘负担和较长的病程显著限制了重度哮喘患者的缓解潜力。我们回顾了“预测并预防”方法的潜力，该方法侧重于早期识别2型炎症的高危患者并积极治疗，以改善哮喘的长期结局。总之，这项范围综述突出了哮喘缓解方面以下未满足的需求：（1）一个统一的全球定义，具有更明确的肺功能参数；（2）将非生物疗法纳入缓解策略；（3）对具有缓解倾向、2型炎症程度高、中度严重哮喘的患者进行早期生物干预的临床试验，将临床缓解作为预先定义的主要终点。
