Jesenak Milos, Bobcakova Anna, Djukanovic Ratko, Gaga Mina, Hanania Nicola A, Heaney Liam G, Pavord Ian, Quirce Santiago, Ryan Dermot, Fokkens Wytske, Conti Diego, Hellings Peter W, Scadding Glenis, Van Staeyen Elizabeth, Bjermer Leif H, Diamant Zuzana
Department of Pediatrics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovakia; Department of Pulmonology and Phthisiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovakia; Institute of Clinical Immunology and Medical Genetics, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Teaching Hospital in Martin, Martin, Slovakia.
NIHR Southampton Biomedical Centre, Faculty of Medicine, University of Southampton, United Kingdom.
Chest. 2025 Apr;167(4):956-974. doi: 10.1016/j.chest.2024.11.035. Epub 2024 Dec 11.
Asthma is a common, multifaceted respiratory disease with a major impact on quality of life. Despite increased insights into mechanisms underlying various asthma phenotypes and endotypes and the availability of targeted biologic treatment options, the disease remains uncontrolled in a substantial proportion of patients with risk of exacerbations, requiring systemic corticosteroids, and with progressive disease. Current international guidelines advocate for a personalized management approach to patients with uncontrolled severe asthma. The European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) asthma expert panel was convened to discuss strategies to optimize asthma care and to prevent systemic corticosteroid overuse and disease progression. In this meeting report, we summarize current concepts and recommendations and provide a rationale to implement personalized asthma management at earlier stages of the disease. The ultimate goal is to move away from the current one-size-fits-most concept, which focuses on a symptom-driven treatment strategy, and shift toward a phenotype- and endotype-targeted approach aimed at curbing the disease course by improving clinical outcomes and preserving health-related quality of life. Herein, we provide a consensus view on asthma care that advocates a holistic approach and highlight some unmet needs to be addressed in future clinical trials and population studies.
哮喘是一种常见的、多方面的呼吸道疾病,对生活质量有重大影响。尽管对各种哮喘表型和内型的潜在机制有了更多了解,且有了靶向生物治疗选择,但在相当一部分有加重风险、需要全身使用皮质类固醇以及患有进展性疾病的患者中,该疾病仍未得到有效控制。当前的国际指南提倡对未控制的重度哮喘患者采用个性化管理方法。欧洲过敏与气道疾病研究与教育论坛(EUFOREA)哮喘专家小组召开会议,讨论优化哮喘治疗以及预防全身皮质类固醇过度使用和疾病进展的策略。在本会议报告中,我们总结了当前的概念和建议,并为在疾病早期实施个性化哮喘管理提供了理论依据。最终目标是摒弃当前的“一刀切”概念,即专注于症状驱动的治疗策略,转向以表型和内型为靶点的方法,旨在通过改善临床结局和维持健康相关生活质量来控制疾病进程。在此,我们提供了一种关于哮喘治疗的共识观点,倡导整体方法,并强调了未来临床试验和人群研究中需要解决的一些未满足需求。