成人重度难治性哮喘
2018/01/05
摘要
重症哮喘患者占成人哮喘患者比例约为3%-10%，但医疗花费超过60%，其中主要指的是药物费用。重症哮喘患者治疗成本高于II型糖尿病，中风，或慢性阻塞性肺病（COPD）。重症哮喘患者还面临症状不稳定，病情反复加重以及药物副作用等，而这些因素与患者精神和情绪状态，社会关系和职业前景相关。
在过去五年中，重症哮喘临床诊治取得重大进步，主要包括明确标准化定义以及制订以循证医学为基础的治疗指南，表型和标志物研究循证依据收集，以及即将批准应用于临床的新型靶向药物。
在这篇关注重度难治性成人哮喘综述中，作者首先将现有评估和诊治方法进行梳理。从而明确重症哮喘患者应该如何充分接受现有治疗，而不是仅仅依靠了单克隆抗体治疗。同时作者也就重症哮喘气道的基础病理生化特征进行小结，同时例举出对因的靶向治疗措施。
Severe and Difficult-to-Treat Asthma in Adults.
N Engl J Med 2017;377:965-76. DOI: 10.1056/NEJMra1608969.
Elliot Israel, M.D., and Helen K. Reddel, M.B., B.S., Ph.D.
Abstract
Patients with severe asthma make up only 3% to 10% of adults with asthma, but their care is estimated to account for more than 60% of the costs associated with asthma, which are primarily for medications. Health care costs per patient for severe asthma are higher than those for type 2 diabetes, stroke, or chronic obstructive pulmonary disease (COPD). Severe asthma also imposes a substantial burden owing to symptoms, exacerbations, and medication side effects, which have profound consequences for mental and emotional health, relationships, and careers.
Considerable progress in understanding and treating severe asthma has been made in the past 5 years. Advances include formulation of a standardized definition and evidence-based treatment guidelines, compilation of substantial evidence about phenotypic patterns and biomarkers, and the availability or near-approval of novel targeted treatments.
In this review, we focus on severe and difficult-to-treat asthma in adults. We first outline an integrated approach to assessment and management, to ensure that the patient has severe asthma and, if so, to determine whether the care takes full advantage of currently available treatments that are not based on monoclonal antibody techniques. We also outline the underlying pathobiologic features of the airway in severe asthma and describe new therapeutic agents that have been developed to target this condition.
重症哮喘患者占成人哮喘患者比例约为3%-10%，但医疗花费超过60%，其中主要指的是药物费用。重症哮喘患者治疗成本高于II型糖尿病，中风，或慢性阻塞性肺病（COPD）。重症哮喘患者还面临症状不稳定，病情反复加重以及药物副作用等，而这些因素与患者精神和情绪状态，社会关系和职业前景相关。
在过去五年中，重症哮喘临床诊治取得重大进步，主要包括明确标准化定义以及制订以循证医学为基础的治疗指南，表型和标志物研究循证依据收集，以及即将批准应用于临床的新型靶向药物。
在这篇关注重度难治性成人哮喘综述中，作者首先将现有评估和诊治方法进行梳理。从而明确重症哮喘患者应该如何充分接受现有治疗，而不是仅仅依靠了单克隆抗体治疗。同时作者也就重症哮喘气道的基础病理生化特征进行小结，同时例举出对因的靶向治疗措施。
（上海交通大学医学院附属瑞金医院呼吸与危重症医学科 周剑平 万欢英 摘译）
（N Engl J Med 2017;377:965-76. DOI: 10.1056/NEJMra1608969.）
（N Engl J Med 2017;377:965-76. DOI: 10.1056/NEJMra1608969.）
Severe and Difficult-to-Treat Asthma in Adults.
N Engl J Med 2017;377:965-76. DOI: 10.1056/NEJMra1608969.
Elliot Israel, M.D., and Helen K. Reddel, M.B., B.S., Ph.D.
Abstract
Patients with severe asthma make up only 3% to 10% of adults with asthma, but their care is estimated to account for more than 60% of the costs associated with asthma, which are primarily for medications. Health care costs per patient for severe asthma are higher than those for type 2 diabetes, stroke, or chronic obstructive pulmonary disease (COPD). Severe asthma also imposes a substantial burden owing to symptoms, exacerbations, and medication side effects, which have profound consequences for mental and emotional health, relationships, and careers.
Considerable progress in understanding and treating severe asthma has been made in the past 5 years. Advances include formulation of a standardized definition and evidence-based treatment guidelines, compilation of substantial evidence about phenotypic patterns and biomarkers, and the availability or near-approval of novel targeted treatments.
In this review, we focus on severe and difficult-to-treat asthma in adults. We first outline an integrated approach to assessment and management, to ensure that the patient has severe asthma and, if so, to determine whether the care takes full advantage of currently available treatments that are not based on monoclonal antibody techniques. We also outline the underlying pathobiologic features of the airway in severe asthma and describe new therapeutic agents that have been developed to target this condition.
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