重温轻度哮喘：当前知识和未来需求
2021/10/20
摘要
哮喘是一种常见的慢性呼吸道疾病，对患者、护理者和医疗系统都有重大影响。虽然大多数研究和新的干预措施主要集中在未控制的重症哮喘患者身上，但大多数哮喘患者病情是较轻的。流行病学研究表明，许多患轻度哮喘患者都报道了频繁的急性发作和未控制的症状。然而，尽管轻度哮喘有一定影响，但对其既没有统一的定义，也没有对其临床和病理生理进展达成共识。最近，治疗轻度哮喘患者的方法发生了重大变化，主要是基于新出现的证据，即气道炎症在该人群中很重要。据此也开展了许多关于探索按需吸入糖皮质激素的疗效以及传统上作为主要治疗手段的急救药物的临床研究。尽管近年来该领域取得了一些进展，但仍存在许多争议和不足。在这篇综述中，我们阐明了目前对轻度哮喘的病理生理学和治疗的理解。此外，我们还概述了未来研究的需求。我们得出结论，轻度哮喘对哮喘的发病率和死亡率有显著影响，应该成为未来研究的重点。
Revisiting Mild Asthma: Current Knowledge and Future Needs
Arjun Mohan, Amy Ludwig, Caryn Brehm, Njira Lugogo, Kaharu Sumino, Nicola A Hanania
Abstract
Asthma is a common chronic airway disease with significant impact on patients, caregivers, and the healthcare system. While most research and novel interventions have mainly focused on patients with uncontrolled severe asthma, the majority of patients with asthma have mild disease. Epidemiologic studies suggest that many patients with mild asthma report frequent exacerbations of their disease and uncontrolled symptoms. However, despite its impact, there is neither a uniformly agreed upon definition for mild asthma, nor a consensus on its clinical and pathophysiologic progression. More recently, the approach to treatment of patients with mild asthma has undergone significant changes primarily based on emerging evidence that airway inflammation in this population is important. This led to clinical research studies that explored the efficacy of as-needed inhaled corticosteroids along with the rescue medications which have traditionally been the mainstay of treatment. Despite some advancement in the field in recent years, many controversies and unmet needs remain. In this review, we shed light on current understanding of the pathophysiology and management of mild asthma. In addition, we outline unmet needs for future research. We conclude that mild asthma contributes significantly to the morbidity and mortality of asthma and should be the focus of future research.
哮喘是一种常见的慢性呼吸道疾病，对患者、护理者和医疗系统都有重大影响。虽然大多数研究和新的干预措施主要集中在未控制的重症哮喘患者身上，但大多数哮喘患者病情是较轻的。流行病学研究表明，许多患轻度哮喘患者都报道了频繁的急性发作和未控制的症状。然而，尽管轻度哮喘有一定影响，但对其既没有统一的定义，也没有对其临床和病理生理进展达成共识。最近，治疗轻度哮喘患者的方法发生了重大变化，主要是基于新出现的证据，即气道炎症在该人群中很重要。据此也开展了许多关于探索按需吸入糖皮质激素的疗效以及传统上作为主要治疗手段的急救药物的临床研究。尽管近年来该领域取得了一些进展，但仍存在许多争议和不足。在这篇综述中，我们阐明了目前对轻度哮喘的病理生理学和治疗的理解。此外，我们还概述了未来研究的需求。我们得出结论，轻度哮喘对哮喘的发病率和死亡率有显著影响，应该成为未来研究的重点。
(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)
(Chest. 2021 Sep 17;S0012-3692(21)03862-9. doi: 10.1016/j.chest.2021.09.004.)
(Chest. 2021 Sep 17;S0012-3692(21)03862-9. doi: 10.1016/j.chest.2021.09.004.)
Revisiting Mild Asthma: Current Knowledge and Future Needs
Arjun Mohan, Amy Ludwig, Caryn Brehm, Njira Lugogo, Kaharu Sumino, Nicola A Hanania
Abstract
Asthma is a common chronic airway disease with significant impact on patients, caregivers, and the healthcare system. While most research and novel interventions have mainly focused on patients with uncontrolled severe asthma, the majority of patients with asthma have mild disease. Epidemiologic studies suggest that many patients with mild asthma report frequent exacerbations of their disease and uncontrolled symptoms. However, despite its impact, there is neither a uniformly agreed upon definition for mild asthma, nor a consensus on its clinical and pathophysiologic progression. More recently, the approach to treatment of patients with mild asthma has undergone significant changes primarily based on emerging evidence that airway inflammation in this population is important. This led to clinical research studies that explored the efficacy of as-needed inhaled corticosteroids along with the rescue medications which have traditionally been the mainstay of treatment. Despite some advancement in the field in recent years, many controversies and unmet needs remain. In this review, we shed light on current understanding of the pathophysiology and management of mild asthma. In addition, we outline unmet needs for future research. We conclude that mild asthma contributes significantly to the morbidity and mortality of asthma and should be the focus of future research.
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NCR(+)ILC3s 与哮喘严重程度相关的气道微生物组之间的相互作用
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microRNA-155对异氰酸酯诱发的哮喘中固有淋巴细胞的作用
