Fusion Media Reporter Huang Lingling
As we all know, most asthma can be controlled with reasonable treatment, but there is a part of asthma that is difficult to achieve good control, which is severe asthma. According to the Global Initiative for Asthma (GINA) definition, severe asthma requires treatment with GINA-recommended level 4 or 5 asthma medications in the past year to maintain control or persists despite such treatment. Uncontrolled” asthma. Among the 45.7 million asthma patients in my country, about 7% are severe asthma patients. The population with severe asthma is huge and the disease burden is very serious. According to the National Asthma Research Collaborative Group, the direct cost (per person per time) of hospitalization for acute attack of asthma from 2013 to 2014 was RMB 11,603.
analyzes the pathogenesis of severe asthma and explores the latest treatment options for severe asthma. On June 17, the second live broadcast of "Doctors First Decode New Concepts in Asthma Diagnosis and Treatment" sponsored by The Doctor's News was held online at the Doctor's News Live Center, Sina News Client and other platforms, attracting a large number of viewers, with more than 32 viewers Ten thousand.
Click on the QR code in the poster to view the live replay
C-BIOPRED research brings Chinese data
Chairman of the conference and Professor Zhang Qingling of the First Affiliated Hospital of Guangzhou Medical UniversityProfessor Zhang Qingling introduced that for severe asthma, there have been a number of multi-center registration studies abroad. However, there has been little research and data on severe asthma in China. Recently, China's first multi-center adult severe asthma cohort was jointly launched by 33 hospitals across the country, led by the National Center for Respiratory Medicine, the National Clinical Research Center for Respiratory Diseases, Guangzhou Institute of Respiratory Health, and the First Affiliated Hospital of Guangzhou Medical University. The relevant results of the study "C-BIOPRED study, biomarker used to predict the prognosis of respiratory diseases in the Chinese population" were published in "Clinical and Translational Medicine". As the first author of the study, Professor Zhang Qingling believes that this study not only allows us to have a deeper understanding of the clinical characteristics of severe asthma in China and guide disease management, but also provides powerful insights into the precise treatment of severe asthma of different phenotypes and the study of molecular mechanisms. Learn from. "At that time, little was known about the epidemiology of severe asthma in adults and the characteristics of the disease. There was a very urgent need to develop new drugs for severe asthma due to the diverse pathogenesis of asthma, so we conducted this study. .”
As one of the participating families in this study, Professor Cai Shaoxi from Nanfang Hospital of Southern Medical University gave a detailed explanation of the C-BIOPRED research. The study was led by Academician Zhong Nanshan and recruited patients with severe asthma who met the definition of ERS/ATS standards from 33 hospitals in 15 provinces across the country from 2015 to 2018. Patients with mild/moderate asthma and healthy control volunteers were also included. The study included 645 subjects. The study results show that although Chinese adults with severe asthma receive higher-level asthma treatment, acute exacerbation of symptoms, reduced quality of life, and airflow limitation are still more significant than those with mild/moderate asthma. Taking the proportion of induced sputum eosinophils as a type 2 inflammatory marker, the proportion of eosinophils phenotype [(induced sputum eosinophil proportion ≥ 2.5%)] in the C-BIOPRED cohort was 76.8%, which is higher than that in foreign countries. The study cohort was higher. On this basis, this study will provide an important reference for the future application of biologically targeted therapy in people with severe asthma with type 2 inflammatory phenotype. "As for the identification of the inflammatory phenotype of severe asthma, in addition to using clinical diagnosis and treatment strategies to evaluate, it should also be judged based on blood eosinophils, induced sputum eosinophils, neutrophils , etc. as much as possible. It is better "
Eosinophils are an important detection indicator for asthma
Professor Feng Mengjie of Shenzhen People's Hospital said that the C-BIOPRED study allows us to know which biomarkers can help judge. The severe asthma phenotype is of great significance to clinicians. At work, she often encounters some very troublesome cases of severe asthma.For example, some patients still have little effect despite standardized diagnosis and treatment of asthma, and even develop comorbidities. Once the hormones are reduced, the patients will have recurring asthma attacks. "What is the basis for hormone reduction? For example, biomarkers can help us make decisions? When should we consider biologically targeted treatment?" She raised her confusion. In response to this problem, Professor Zhang Qingling pointed out that standardized management and treatment are important methods to prevent the further development of severe asthma. Therefore, early braking and reasonable management strategies, including biologically targeted treatments other than glucocorticoids , should be paid attention to. These may prevent further progression of the disease. How to choose the right medicine? Professor Cai Shaoxi believes that it should also be based on the patient's symptoms, comorbidities, and the status of eosinophils in induced sputum. Individual differences, such as the sensitivity of individual genes, should also be considered.
Eosinophilic asthma is a very important phenotype in severe asthma. What role does eosinophils play in phenotypic differentiation of severe asthma? The "Chinese Expert Consensus on the Diagnosis and Treatment of Eosinophilia-Related Lung Disease" brings us the answer. Professor Chen Ruchong from the First Affiliated Hospital of Guangzhou Medical University introduced that the consensus pointed out that asthma has a variety of clinical and inflammatory phenotypes, and eosinophilic asthma (EA) is the most common asthma phenotype. EOS in its induced sputum increases. EOS infiltration can be seen in bronchial mucosa, submucosal and lung tissue. Severe EA is a common form of the severe asthma type 2 inflammatory phenotype. Many EPDs initially present as EA, which requires careful identification. The treatment of EA is based on the 2021 Global Initiative for Asthma (GINA) stepped treatment plan. Severe EA can benefit from biologically targeted therapies targeting the type 2 inflammatory pathway, such as anti-IL‑5/5R drugs and anti-IL‑4R/13 drugs. Why might biologic antibodies targeting the IL-5 pathway play a role in severe eosinophilic asthma? Because IL‑5 is crucial for promoting the maturation of eosinophils, biologically targeted drugs that specifically reduce IL‑5 can significantly reduce eosinophils and thus play a therapeutic role.
In addition, the clinical features of eosinophilic asthma include increased blood/sputum eosinophils, frequent acute exacerbations, dependence on oral corticosteroids (OCS), and comorbidities (such as chronic sinusitis with nasal Polyps ), poor lung function, adult onset, etc. The eosinophil count in blood routine is a very important detection indicator for asthma patients. It can not only be used to determine the clinical phenotype of asthma, but also to evaluate whether anti-inflammatory treatment is effective. Professor Feng Mengjie added that this consensus is very practical. "It provides doctors with a very good clinical idea, looking at the problem more comprehensively, without missing anything, but also grasping the key points, and giving patients the most appropriate diagnosis as much as possible."
Precision targeted biological therapy is the future of severe asthma Important Research Directions
Professor Zhang Min from Shenzhen Second People's Hospital said that asthma patients with elevated eosinophils are often severe and do need to be paid attention to clinically. Not long ago, he received a 39-year-old asthma patient who was transferred from a primary medical institution and almost died of an acute asthma attack. This patient has the characteristics of increased eosinophils, but the grassroots may lack awareness of this and not realize its seriousness. "We used biological treatment in time after the rescue was successful, and achieved very good results." There is also a patient with COPD and combined with asthma. The proportion of eosinophils in induced sputum has been between 20% and 40% for a long time. He used biological therapy. After treatment with the drug, the value dropped to 0 the next day. After treatment, the patient's symptoms and lung function improved, with almost no side effects. Targeted therapy for asthma patients with elevated IgE is even more popular and has been widely carried out across the country for more than 4 years. At present, severe asthma has entered the era of targeted biological treatment, and precision treatment may be a very promising research direction for severe asthma in the future.
"Practice is the only criterion for testing truth. In the future, we will need more clinical research and multi-center exploration to further answer questions related to the diagnosis and treatment of severe asthma." Professor Zhang Qingling concluded.
