易于发作型哮喘
2020/10/14
摘要
在易于发作的哮喘患者因误工、误学、急症就诊和住院等方面耗费了巨额成本。发作主要是由环境暴露引起的，包括污染物、应激、病毒和细菌病原体等。这些暴露最有可能在高危患者中诱发急性严重的“哮喘发作”。哮喘发作的这些个人危险因素随哮喘表型和患者年龄的不同而不同。对儿童来说，变应性致敏是一个很强的危险因素，特别是对于那些在幼年就发生过敏的儿童。气道炎症是一个重要的危险因素，生物标记物在检测嗜酸性和2型炎症以及中性粒细胞炎症（反复发作的风险预测因子）中是被低估的。由于对炎症机制的深入研究，出现了使用靶向特定2型通路的生物制剂预防发作的新方法。在建立一个证据基础来支持这些有效而昂贵的精准干预治疗方法，以及确定这些治疗方法对幼儿是否安全有效方面，仍然存在挑战。遗憾的是，目前急性加重的治疗进展较少。希望随着对呼吸道病毒、细菌、粘蛋白产生和中性粒细胞炎症反应相关的机制更深入的了解，能够为遭受急性发作的患者提供额外的治疗选择。
Exacerbation-Prone Asthma.
Loren C Denlinger ,Peter Heymann ,Rene Lutter ,James E Gern.
Abstract
Patients who are prone to exacerbations of asthma experience significant costs in terms of missed work and school, acute care visits, and hospitalizations. Exacerbations are largely driven by environmental exposures including pollutants, stress, and viral and bacterial pathogens. These exposures are most likely to induce acute severe "asthma attacks" in high-risk patients. These personal risk factors for exacerbations can vary with the phenotype of asthma and age of the patient. In children, allergic sensitization is a strong risk factor, especially for those children who develop sensitization early in life. Airway inflammation is an important risk factor, and biomarkers are under evaluation for utility in detecting eosinophilic and type 2 inflammation and neutrophilic inflammation as indicators of risk for recurrent exacerbations. Insights into inflammatory mechanisms have led to new approaches to prevent exacerbations using mAb-based biologics that target specific type 2 pathways. Challenges remain in developing an evidence base to support precision interventions with these effective yet expensive therapies, and in determining whether these treatments will be safe and effective in young children. Unfortunately, there has been less progress in developing treatments for acute exacerbations. Hopefully, greater understanding of mechanisms relating airway viruses, bacteria, mucin production, and neutrophilic inflammatory responses will lead to additional treatment options for patients experiencing acute exacerbations.
在易于发作的哮喘患者因误工、误学、急症就诊和住院等方面耗费了巨额成本。发作主要是由环境暴露引起的，包括污染物、应激、病毒和细菌病原体等。这些暴露最有可能在高危患者中诱发急性严重的“哮喘发作”。哮喘发作的这些个人危险因素随哮喘表型和患者年龄的不同而不同。对儿童来说，变应性致敏是一个很强的危险因素，特别是对于那些在幼年就发生过敏的儿童。气道炎症是一个重要的危险因素，生物标记物在检测嗜酸性和2型炎症以及中性粒细胞炎症（反复发作的风险预测因子）中是被低估的。由于对炎症机制的深入研究，出现了使用靶向特定2型通路的生物制剂预防发作的新方法。在建立一个证据基础来支持这些有效而昂贵的精准干预治疗方法，以及确定这些治疗方法对幼儿是否安全有效方面，仍然存在挑战。遗憾的是，目前急性加重的治疗进展较少。希望随着对呼吸道病毒、细菌、粘蛋白产生和中性粒细胞炎症反应相关的机制更深入的了解，能够为遭受急性发作的患者提供额外的治疗选择。
(中日友好医院呼吸与危重症医学科 顾宪民 摘译 林江涛 审校)
(J Allergy Clin Immunol Pract,2020 Feb;8(2):474-482. doi: 10.1016/j.jaip.2019.11.009. Epub 2019 Nov 22.)
(J Allergy Clin Immunol Pract,2020 Feb;8(2):474-482. doi: 10.1016/j.jaip.2019.11.009. Epub 2019 Nov 22.)
Exacerbation-Prone Asthma.
Loren C Denlinger ,Peter Heymann ,Rene Lutter ,James E Gern.
Abstract
Patients who are prone to exacerbations of asthma experience significant costs in terms of missed work and school, acute care visits, and hospitalizations. Exacerbations are largely driven by environmental exposures including pollutants, stress, and viral and bacterial pathogens. These exposures are most likely to induce acute severe "asthma attacks" in high-risk patients. These personal risk factors for exacerbations can vary with the phenotype of asthma and age of the patient. In children, allergic sensitization is a strong risk factor, especially for those children who develop sensitization early in life. Airway inflammation is an important risk factor, and biomarkers are under evaluation for utility in detecting eosinophilic and type 2 inflammation and neutrophilic inflammation as indicators of risk for recurrent exacerbations. Insights into inflammatory mechanisms have led to new approaches to prevent exacerbations using mAb-based biologics that target specific type 2 pathways. Challenges remain in developing an evidence base to support precision interventions with these effective yet expensive therapies, and in determining whether these treatments will be safe and effective in young children. Unfortunately, there has been less progress in developing treatments for acute exacerbations. Hopefully, greater understanding of mechanisms relating airway viruses, bacteria, mucin production, and neutrophilic inflammatory responses will lead to additional treatment options for patients experiencing acute exacerbations.
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Dupilumab在不可控制的中度至重度过敏性哮喘患者的疗效研究
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Benralizumab治疗严重嗜酸性哮喘的真实世界有效性
