刘明明 张秀琴

[关键词] 重度哮喘;疾病负担;表型;靶向治疗

[中图分类号] R562          [文献标识码] A          [文章編号] 1673-9701（2021）29-0188-05

Recent advances of disease burden and targeted therapy in severe bronchial asthma

LIU Mingming   ZHANG Xiuqin

Department of Respiration， the First Affiliated Hospital of Soochow University， Suzhou   215000， China

[Abstract] Bronchial asthma（asthma） is a very common chronic respiratory disease， and its prevalence is increasing year by year around the world. Although severe asthma accounts for only 5%-10% of all asthma， the large population base of patients with severe asthma in China is huge， and the proportion and cannot be underestimated. The serious impacts of severe asthma on the health status of patients and the resulting heavy disease burden should arouse the attention of clinicians and decision makers. In recent years， individualized targeted therapy based on biologics has developed extremely rapidly， and biologically targeted therapy has improved the quality of life of patients and brought new benefits to patients with severe asthma. Through retrospecting the latest guidelines and research progress at home and abroad in recent years， this paper reviews the severe asthma in terms of epidemiology， disease burden， clinical characteristics and current status of targeted therapy in China， with an aim to providing reference for the diagnosis and treatment of severe asthma and the formulation of public health policies.

[Key words] Severe asthma; Disease burden; Phenotype; Targeted therapy

支气管哮喘（哮喘）是一种严重威胁公共健康的慢性气道炎症性疾病，其临床表现为反复发作的呼吸急促、喘息、咳嗽和（或）胸闷，同时伴有不同程度气流受限和气道高反应性，气道结构随时间推移而改变[1]。过去二十年间，哮喘领域发生了无数变革，重度哮喘的评估和诊治经历着一场场重大演变。全球哮喘防治创议（Global Initiative for Asthma，GINA）[2]将重度哮喘定义为即使接受最佳治疗方案仍无法控制的哮喘，或是在高剂量治疗减量后病情出现恶化的哮喘。与轻度哮喘相比，重度哮喘所占比例不高，但它造成了沉重的疾病负担和急性加重频率的增加[3]，这引起了医患双方对疾病的广泛重视，促进相关诊疗策略不断改善。因此强调重度哮喘的流调与疾病监测，全面评估其疾病负担，有效采取预防措施，充分掌握临床现状及最新诊疗指南对我国重度哮喘控制水平的提升和相关研究进展的推动意义重大。

1 重度哮喘的流行病学与疾病负担

1.1 哮喘的流行病学

全球哮喘患者达3.58亿，患病率在25年间（1990—2015年）增长12.6%，是全球范围内最常见的慢性疾病之一[4]。研究表明，我国20岁及以上人群的哮喘患病率为4.2%，气流受限存在于26.2%的哮喘患者中，并且我国哮喘的未控制率高达55.1%[5]，病死率为36.7人/万人[6]，远远超过世界平均水平。

重度哮喘占全球哮喘人口的5%～10%，虽然规范接受吸入性糖皮质激素等最佳治疗，但仍有约3.6%的患者哮喘控制不佳[7]。……