Up to Date of Adult Bronchial Asthma

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  • 成人気管支喘息 up to date
  • セイジン キカンシ ゼンソク up to date

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Prevalence of asthma is increasing each year, but asthma deaths are declining. A peak in the number of asthma deaths is observed in people over 70 years of age, with a small number of deaths among younger people. Highlighted pathogenesis of asthma is mediated by interleukin（IL）-33, IL-25, and thymic stromal lymphopoietin（TSLP）, which are released from the epithelium after airway epithelial injury, acting on Th2 cells, group 2 innate lymphoid cells（ILC2）and dendritic cells（DCs）, bridging the crosstalk between innate and acquired immunity and promoting inflammation. Recent advances in the analysis of airway epithelium have suggested that tuft cells are IL-25 producing cells. In the treatment of asthma, inhaled corticosteroids（ICS）, long-acting beta-agonists（LABA）, and longacting muscarinic（long-acting muscarinic antagonist, LAMA）in a single inhaler triple therapy（SITT）, which is a once-daily inhaler in a single inhaler container, is expected to provide better asthma control through synergistic effects of the drugs and improved patient adherence. Patients with severe asthma that is not controlled by inhaled or oral corticosteroid therapy are considered steroid-resistant and are treated with biologics. Patients with type 2 inflammation with high blood eosinophil counts and fraction of exhaled nitric oxide（FeNO）levels are good candidates for biologics. With advances in asthma treatment, clinical remission, i.e., no symptoms, no exacerbations, no oral corticosteroid therapy, and stabilization of lung function, can be achieved in about 20〜30% of patients. The challenge for the future is to develop biomarkers and drugs for more precise treatment selection, since many patients still do not achieve clinical remission.

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