Should lung biopsies be performed in patients with severe asthma?
Should lung biopsies be performed in patients with severe asthma?
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DOI：
10.1183/16000617.0045-2015
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发表时间：
2015-09
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哮喘，特别是严重哮喘，越来越多地被认为是一种异质性疾病。识别这些不同的哮喘表型并为患者分配表型特异性治疗是呼吸内科目前的难题之一。严重哮喘（或任何疾病）的任何诊断程序都应该有两个目标：1）更好地理解或识别诊断，2）提供有关哮喘表型异质性的信息，以指导治疗，改善结局。肺活检可以靶向大、小气道以及肺实质。在严重哮喘中，所有隔室都受到影响;然而，对远端肺的了解有限。在这一点上，它仍然不确定是否肺标本常规添加诊断信息，是无法获得，否则。事实上，肺活检是否适用于严重哮喘患者的检查仍然是一个个体决定。希望这项综述能够支持合理的决策，并提供诊断为严重哮喘的患者活检中观察到的各种组织病理学特征的详细概要。由于关于这一主题的数据有限，本综述主要基于作者个人经验的意见和建议。在严重哮喘的诊断检查中优化肺活检的使用需要多学科方法http://ow.ly/PdLW2
Asthma, and severe asthma, in particular, is increasingly recognised as a heterogeneous disease. Identifying these different phenotypes of asthma and assigning patients to phenotype-specific treatments is one of the current conundrums in respiratory medicine. Any diagnostic procedure in severe asthma (or any disease) should have two aims: 1) better understanding or identifying the diagnosis, and 2) providing information on the heterogeneity of asthma phenotypes to guide therapy with the objective of improving outcomes. Lung biopsies can target the large and small airways as well as the lung parenchyma. All compartments are affected in severe asthma; however, knowledge on the distal lung is limited. At this point, it remains uncertain whether lung specimens routinely add diagnostic information that is unable to be obtained otherwise. Indeed, whether a lung biopsy is indicated in the workup of a patient with severe asthma remains an individual decision. It is hoped this review will support rational decision-making and provide a detailed synopsis of the varied histopathological features seen in biopsies of patients with a diagnosis of severe asthma. Due to limited data on this topic this review is primarily based on opinion with recommendations arising primarily from the personal experience of the authors. Optimising use of lung biopsies in a diagnostic workup of severe asthma requires a multidisciplinary approach http://ow.ly/PdLW2