Asthma

被引:458
作者
Holgate, Stephen T. [1 ]
Wenzel, Sally [2 ]
Postma, Dirkje S. [3 ]
Weiss, Scott T. [4 ]
Renz, Harald [5 ]
Sly, Peter D. [6 ,7 ]
机构
[1] Southampton Gen Hosp, Clin & Expt Sci, Mail Point 810,Level F,Sir Henry Wellcome Bldg, Southampton SO16 6YD, Hants, England
[2] Univ Pittsburgh, UPMC UPSOM, Asthma Inst, Allergy Pulm Allergy & Crit Care Med, Pittsburgh, PA USA
[3] Univ Groningen, Univ Med Ctr Groningen, Dept Pulmonol, Groningen, Netherlands
[4] Harvard Med Sch, Brigham & Womens Hosp, Dept Med, Channing Div Network Med, Boston, MA USA
[5] Univ Marburg, Univ Hosp Giessen & Marburg GmbH, Inst Lab Med & Pathobiochem, Mol Diagnost, Marburg, Germany
[6] Univ Queensland, Queensland Childrens Med Res Inst, Brisbane, Qld, Australia
[7] Univ Queensland, Ctr Child Hlth Res, Brisbane, Qld, Australia
来源
NATURE REVIEWS DISEASE PRIMERS | 2015年 / 1卷
基金
英国医学研究理事会;
关键词
AIRWAY SMOOTH-MUSCLE; WHEEZING RHINOVIRUS ILLNESSES; LUNG-FUNCTION; BRONCHIAL THERMOPLASTY; PRIMARY PREVENTION; CHILDHOOD ASTHMA; DOUBLE-BLIND; VITAMIN-D; PRESCHOOL-CHILDREN; EPITHELIAL-CELLS;
D O I
10.1038/nrdp.2015.25
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Asthma is the most common inflammatory disease of the lungs. The prevalence of asthma is increasing in many parts of the world that have adopted aspects of the Western lifestyle, and the disease poses a substantial global health and economic burden. Asthma involves both the large-conducting and the small-conducting airways, and is characterized by a combination of inflammation and structural remodelling that might begin in utero. Disease progression occurs in the context of a developmental background in which the postnatal acquisition of asthma is strongly linked with allergic sensitization. Most asthma cases follow a variable course, involving viral-induced wheezing and allergen sensitization, that is associated with various underlying mechanisms (or endotypes) that can differ between individuals. Each set of endotypes, in turn, produces specific asthma characteristics that evolve across the lifecourse of the patient. Strong genetic and environmental drivers of asthma interconnect through novel epigenetic mechanisms that operate prenatally and throughout childhood. Asthma can spontaneously remit or begin de novo in adulthood, and the factors that lead to the emergence and regression of asthma, irrespective of age, are poorly understood. Nonetheless, there is mounting evidence that supports a primary role for structural changes in the airways with asthma acquisition, on which altered innate immune mechanisms and microbiota interactions are superimposed. On the basis of the identification of new causative pathways, the subphenotyping of asthma across the lifecourse of patients is paving the way for more-personalized and precise pathway-specific approaches for the prevention and treatment of asthma, creating the real possibility of total prevention and cure for this chronic inflammatory disease.
引用
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页数:22
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