哮喘联盟

   摘要
   所有年龄段的重度哮喘都具有异质性，儿童和成人在重度哮喘的表型上存在差异。然而，成人和儿童的重度哮喘也有许多相似之处，如它们都不能长时间地处于稳定状态。
   成人和儿童的重度哮喘都存在嗜酸粒细胞性气道炎症和气道重构。在成人中，通过抗IL-5抗体针对嗜酸性粒细胞治疗取得了非常大的成功，因此推荐用痰液中嗜酸性粒细胞来指导治疗。相反，在儿童中并没有关于抑制IL-5治疗效果的数据。然而，它的效果并不明确，因为很多重度哮喘患儿的血嗜酸性粒细胞正常，且Th2-介导的炎症的地位存在争议。揭示了基因标记和生物标记（如骨膜蛋白，与成人疾病特异相关）的方法，现在也需要应用于儿童，以发现有效的儿童治疗方法并减少向儿童推广成人治疗方法。

 

（杨冬 审校）
Expert Rev Respir Med. 2015 Jul 15:1-10. [Epub ahead of print]

 

The need to differentiate between adults and children when treating severe asthma.
 

Fainardi V1, Saglani S.
 

Abstract
Severe asthma at all ages is heterogeneous incorporating several phenotypes that are distinct in children and adults, however, there are also numerous similar features including the limitation that they may not remain stable longitudinally.
Severe asthma in both children and adults is characterized by eosinophilic airway inflammation and evidence of airway remodeling. In adults, targeting eosinophilia with anti-IL-5 antibody therapy is very successful, resulting in the recommendation that sputum eosinophils should be used to guide treatment. In contrast, data for the efficacy of blocking IL-5 remain unavailable in children. However, its effectiveness is uncertain since many children with severe asthma have normal blood eosinophils and the dominance of Th2-mediated inflammation is controversial. Approaches that have；revealed gene signatures and biomarkers such as periostin that are specific to adult disease now need to be adopted in children to identify effective pediatric specific therapeutics and minimize the extrapolation of adult therapeutics to children.
 

Expert Rev Respir Med. 2015 Jul 15:1-10. [Epub ahead of print]