Severe asthma and asthma-chronic obstructive pulmonary disease syndrome
Severe asthma and asthma-chronic obstructive pulmonary disease syndrome
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DOI：
10.1016/s0140-6736(16)32425-4
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发表时间：
2016-12
期刊：
影响因子：
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通讯作者：
Yang Xia;C. Cao;Wen Li;Huahao Shen
中科院分区：
文献类型：
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作者：
Yang Xia;C. Cao;Wen Li;Huahao Shen
Dupilumab（一种人抗白细胞介素 4 受体 α 单克隆抗体）治疗可提高 1 秒用力呼气量 (FEV1)，改善哮喘症状控制，并降低未受控制的持续性哮喘患者的年恶化率。严重哮喘仍然是患者和临床医生面临的挑战，全球范围内仍有大量未满足的临床需求。本研究确立了抗白细胞介素4通路在难治性哮喘靶向治疗中的作用。严重哮喘的定义是需要大剂量吸入皮质类固醇和第二个控制器（或全身皮质类固醇）以防止哮喘失控，或者尽管按照欧洲呼吸学会/美国胸科学会（ERS/ATS）指南进行治疗，但疾病仍未得到控制。 2指南进一步明确了哮喘未受控制的情况，包括症状控制不佳、频繁严重发作、严重发作和气流受限。参与该研究的 755 名患者中，有 384 名患者接受了大剂量吸入皮质类固醇加长效 β2 激动剂治疗，总体平均 FEV1 为 60·77。1 这些数据表明，许多患者患有以持续气流受限为特征的难治性哮喘，这是一个令人担忧的问题，因为 ERS/ATS 指南中对该亚组患者的定义与哮喘慢性阻塞性肺病 (COPD) 综合征重叠。后一种疾病的定义是持续气流受限，具有全球哮喘倡议报告中哮喘和慢性阻塞性肺病的一些共同特征。 3 在这种情况下，符合这项严重哮喘研究资格的部分参与者可能是哮喘-慢性阻塞性肺病综合征患者，因此需要进行亚组分析。针对哮喘-慢性阻塞性肺病综合征的严重哮喘的具体治疗方法的证据仍然很少，包括
Treatment with dupilumab, a human anti-interleukin-4 receptor α monoclonal antibody, resulted in elevated forced expiratory volume in 1 s (FEV1), improved asthma symptom control, and reduced annual rates of exacerbation in patients with uncontrolled persistent asthma. Severe asthma remains a challenge for patients and clinicians, with substantial unmet clinical need worldwide. This study established the role of anti-interleukin-4 pathway in the targeted therapy of difficultto-control asthma. Severe asthma is defined by the requirement of high-dose inhaled corticosteroids and a second controller (or systemic corticosteroids) to prevent asthma from becoming uncontrolled, or the disease remains uncontrolled despite therapy in European Respiratory Society/American Thoracic Society (ERS/ATS) guidelines. 2 The guidelines further clarified the conditions attributed to uncontrolled asthma, including poor symptom control, frequent severe exacerbation, serious exacerbation, and airflow limitation. 384 of 755 patients enrolled in the study received high-dose inhaled corticosteroids plus long-acting β₂ agonist with the overall mean FEV1 of 60· 77. 1 These data suggested that many patients had treatmentresistant asthma characterised by persistent airflow limitation, which was a concern as the definition of this subgroup of patients in the ERS/ATS guidelines overlaps with asthmachronic obstructive pulmonary disease (COPD) syndrome. The latter disorder is defined by persistent airflow limitation with several features shared with both asthma and COPD in the Global Initiative for Asthma report. 3 In this case, a portion of participants eligible for this severe asthma study might be asthma-COPD syndrome patients and hence, subgroup analysis is required. Evidence of specific therapeutic approaches for severe asthma on asthma-COPD syndrome is still scarce, including