支气管热成形术治疗重症支气管哮喘的时机选择

Timing of bronchial thermoplasty for severe bronchial asthma

支气管哮喘(哮喘)的患病率逐年上升,重症哮喘的医疗负担巨大,目前不断开发新的治疗方法或药物应用于重症哮喘的临床。支气管热成形术(BT)是一种经支气管镜治疗重症哮喘的非药物方法,用于经过最佳的药物治疗但仍有症状的哮喘患者,2010年批准应用于临床。临床试验结果表明,BT在减少哮喘严重急性发作、改善生活质量和减少急诊就医等方面是安全有效的。但是,如何选择适宜的患者以及选择BT的时机一直困扰着临床医师。目前,大量的生物靶向药物(抗IgE单抗、抗IL-5/IL-5R和IL-4R单抗)应用于临床,它们都有相对明确的对应表型。而BT的局限性就是难以预测临床反应者,临床上不能判定哪些患者对BT可以更好地获益。因此,还需要更进一步的研究来证明BT长期的安全性和有效性,以及哪种表型更加适合BT,哪些生物标志物可以提示患者对BT能够临床获益。

The prevalence of bronchial asthma(asthma)is increasing year by year and the medical burden of severe asthma is huge.Currently,new treatments or drugs are continuously being developed for the clinical application of severe asthma.Bronchial themoplasty(BT)is a non-pharmacological treatment of severe asthma via bronchoscope.It is used for asthma patients who have the best medical treatment but still have symptoms.It was approved for clinical use in 2010.Clinical trial results show that BT is safe and effective in reducing severe acute attacks of asthma and improving quality of life and reducing emergency medical treatment.However,how to choose the right patients and when to choose BT has always puzzled clinicians.At present,a large number of bio-targeted drugs(anti-IgEmAb,anti-IL-5/IL-5R and IL-4R mAb)are applied in the clinic and they all have relatively clear corresponding phenotypes.The limitation of BT is that it is difficult to predict clinical responders and it is impossible to determine which patients can better benefit from BT clinically.Therefore,further research is needed to prove the long-term safety and effectiveness of BT and which phenotype is more suitable for BT and which biomarkers can prompt patients to clinically benefit from BT.