중증 천식의 임상적, 병태생리적 특징
Clinical and Pathophysiological Characteristics of Severe Asthma
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초록
중증 천식은 매우 다양한 표현형을 나타내며, 임상적 측면 뿐 아니라, 기도염증, 면역반응에 따라 다양한 양상을 보이는 이질적인 양상을 보인다. Th2 염증의 항진, IL-17의 증가를 포함한 비 Th2 염증의 작용, 기도개형, 스테로이드 저항성 등이 중증 천식의 주요한 기전으로 제시되고 있다. 최근에는 천식의 여러 표현형을 아우르는 군집분석, endotype 분석 등을 통하여 중증 천식의 다중적이고 복합적인 측면들이 보다 입체적으로 제시되고 있다. SARP, U-BIOPRED 등 외국의 중증 천식 그룹에서 보고하는 결과는 중증 천식의 이해를 넓히는데 크게 기여를 할 것으로 보이지만, 한국인에서의 중증 천식에 대한 연구를 위해서는 우리 나라의 다기관 연구가 보다 체계적으로 전개되어야 할 것이다. 이를 통하여 중증 천식의 기전을 보다 명확히 규명할 수 있고, 새로운 치료적 접근 방향을 제시할 것으로 기대한다.
Abstract
Severe asthma is characterized by poor asthma control and frequent exacerbation despite high degree of medication. Severe asthma leads to not only increased morbidity and mortality but high socioeconomic burden. To date, several research networks have been organized to understand the clinical and pathophysiological characteristics of severe asthma. These groups organized multicenter registries and collected both clinical and biological information. The results of these groups revealed that severe asthma is a very heterogeneous entity, which could not be defined based on a single feature. Various phenotypes of asthma has been identified based on clinical, inflammatory and immune responses. To understand severe asthma more drastically in consideration of many phenotypes, cluster analysis and endotyping severe asthma have been tried. Although uncontrolled inflammation and airway remodeling underlies the development of severe asthma, much is not known about its pathomechanisms. This review discusses the current understanding of the clinical and pathogenic mechanisms of severe asthma based on the recent publications. (Korean J Med 2012;83:424-429)
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