《当代简明评论2025：哮喘》

摘要(中文译文)

2025年的哮喘研究进一步推进了对哮喘的多维度认识，整合了疾病轨迹、急性加重风险、气道结构改变、合并症和治疗反应性。在轻度哮喘方面，2025年发表的研究进一步强化了抗炎缓解策略优于单用短效β2受体激动剂（SABA）治疗的重要性，支持在症状加重时及时给予吸入性糖皮质激素以降低急性加重风险，这一点在成人和青少年中尤为突出，同时在儿童中提供了新兴但仍存在细微差别的证据。在重度哮喘方面，治疗重点已从减少急性加重扩展至疾病修饰，包括减少口服糖皮质激素用量、改善或恢复正常肺功能、减少黏液栓形成以及实现临床缓解。临床缓解的定义更加明确，并日益被定位为治疗目标和研究终点，这得到了新兴共识定义、真实世界数据以及生物制剂试验分析的支持。真实世界哮喘管理日益强调实施，包括基于可治疗特征的诊疗、基于生物标志物的分层、数字吸入器技术，以及应对持续存在的民族、社会和年龄相关结局差异的方法。病理生物学进展凸显了气道上皮、炎症细胞生态系统、微生物组相关内型、黏液栓生物学以及生命早期气道重塑起源在塑造哮喘异质性和进展中的核心作用。

Abstract

Asthma research in 2025 further advanced a multidimensional view of asthma, integrating disease trajectory, exacerbation risk, structural airway changes, comorbidities, and treatment responsiveness. In mild asthma, studies published in 2025 further reinforced the importance of anti-inflammatory reliever strategies over SABA-only treatment by supporting timely inhaled corticosteroid delivery at symptom worsening to reduce exacerbation risk, particularly in adults and adolescents, while providing emerging but still nuanced evidence in child. In severe asthma, the therapeutic focus expanded beyond exacerbation reduction towards disease modification, including oral corticosteroid sparing, improvement or normalisation of lung function, reduction of mucus plugging, and attainment of clinical remission. Clinical remission became more clearly defined and increasingly positioned as a treatment target and research endpoint, supported by emerging consensus definitions, real-world data, and analyses of biologic trials. Real-world asthma management increasingly emphasised implementation, including treatable-traits-based care, biomarker-informed stratification, digital inhaler technologies, and approaches to persistent ethnic, social, and age-related inequities in outcomes. Advances in pathobiology highlighted the central role of the airway epithelium, inflammatory cellular ecosystems, microbiome-associated endotypes, mucus-plug biology, and early-life origins of airway remodelling in shaping asthma heterogeneity and progression.

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