Xinhuanet, Beijing, May 6 (Wu Qilong) Today is the 27th World Asthma Day. This year's theme focuses on "let inhalation treatment benefit all patients with asthma", calling on all sectors of society to pay attention to the key role of inhalation treatment in asthma management and promote the standardized use and popularization of inhalation drugs.

Recently, Zhang Min, member of the Global Asthma Prevention and Control Scientific Committee (GINA), deputy head of the Asthma Group of the Respiratory Branch of the Chinese Medical Association, and director of the Department of Respiratory and Critical Care Medicine of the First People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, said in an interview that inhalation treatment is the cornerstone of asthma management. Its direct effect on the airway administration method can achieve efficient anti-inflammatory in smaller doses and reduce systemic side effects, and is an effective means to achieve long-term asthma control.

In order to help patients better regulate inflammation and effectively control asthma, the "Confident breathing without delaying inflammation" charity action participated by world champion Fu Yuanhui of swimming and supported by the Public Welfare Times was launched. Through catchy mnemonics, patients can establish correct treatment concepts, adhere to the inhalation anti-inflammatory treatment of "full amount, full course of treatment, and the entire course of the disease", and stay away from repeated asthma attacks.

At the same time, facing the challenges and unmet treatment needs in the daily management of severe asthma patients, many experts in the field of respiratory dysfunction call for accelerated clinical access to innovative biological agents, bringing more treatment options to patients to improve long-term prognosis and improve quality of life.

More than 40 million patients are trapped in asthma, and the current control situation needs to be improved

At present, asthma has become the second largest respiratory disease in my country. The prevalence rate of people aged 20 and above reaches 4.2%, with about 45.7 million asthma patients, and is showing an upward trend year by year. However, the current asthma control rate is not ideal. Data shows that about 50% of asthma patients have poor control, especially severe asthma often occurs repeatedly.

It is understood that typical symptoms of asthma include repeated attacks of wheezing, cough, shortness of breath or chest tightness, which often worsen at night and early morning, and the attack is random; during acute attacks, patients may experience dyspnea, airway spasm, and may even endanger life in a short period of time.

At the same time, there are also some occult asthma clinically, such as the main symptom of patients with "cough variant asthma" is persistent cough. Because there are no typical symptoms such as wheezing, it is easy to be misdiagnosed as bronchitis or repeated upper respiratory tract infections in clinical practice, thereby delaying diagnosis.

"Asthma symptoms are highly heterogeneous. In addition to typical wheezing and shortness of breath, atypical symptoms such as chest tightness and long-term cough cannot be ignored." Zhang Min said that some patients have chest tightness as the main symptoms, and are even misdiagnosed as heart disease or psychological disease, delaying treatment for several years. For example, a 16-year-old boy was misdiagnosed as a mental illness due to chest tightness, his weight dropped sharply to more than 50 kilograms, and he was eventually diagnosed with asthma. He was able to recover his health after standardized treatment.

In fact, frequent asthma attacks not only affect patients' physical health, but also have long-term impacts on quality of life. Especially for childhood patients, recurrent asthma attacks may not only cause pain and stress, but may also interfere with learning, exercise and sleep, and in severe cases, even affect growth and development indicators such as height and weight.

Zhang Min reminds that if asthma is not controlled for a long time, mild and moderate asthma may also evolve into severe asthma, increasing the risk of disability and death, which will lead to airway remodeling, resulting in long-term airflow restriction (PAO), and even developing into irreversible damage to lung function, and even evolve into chronic obstructive pulmonary disease (COPD).

She said that when many patients with COPD trace their medical history, they often find undiagnosed symptoms of asthma in their early years; if chronic inflammation of asthma is not intervened in time, it will gradually lead to changes in the airway structure and eventually develop into irreversible airflow limitation.

Adhere to the full amount, full course of treatment, and the entire course of disease to achieve free breathing

Asthma is essentially chronic airway inflammation, where eosinophils (EOS) are the key effector cells that drive this type of inflammatory response. Research data shows that the higher the EOS level in the airway, the more difficult it is to control asthma. Therefore, reducing EOS levels and controlling airway inflammation have become one of the main goals of asthma treatment.

Zhang Min further explained that the combination of inhaled glucocorticoids (ICS) and long-acting β₂ receptor agonist (LABA) can effectively inhibit EOS-mediated inflammatory response and alleviate airway hyperresponsiveness. It is a golden combination in anti-inflammatory treatment of asthma.

"ICS reduces airway inflammation by inhibiting the production of inflammatory factors, while LABA activates specific receptors to diastolic bronchial smooth muscle; the combination of the two can synergistically synergistically, especially for long-term treatment in patients with moderate and severe asthma, and has now been widely recommended by global guidelines," she said.

It is worth noting that airway inflammation in asthma often worsens before the symptoms appear. Even if the clinical symptoms disappear, the inflammation will continue, laying a hidden danger for the next attack.

Zhang Min reminds that the treatment of asthma should not only focus on the relief of acute symptoms, but also continuously control airway inflammation during asymptomatic periods. Adhering to anti-inflammatory treatment of "full amount, full course of treatment, and full course of disease" is the key to achieving long-term control and preventing recurring attacks.

"The advantage of inhalation treatment is that it acts directly on the airway, takes effect quickly and has few systemic adverse reactions." She introduced that through local administration, the dose of inhalation treatment is only 1/10 to 1/20 of oral preparations, which can significantly reduce the risk of systemic side effects.

Improve the accessibility of innovative biological agents and help "clinical cure" of severe asthma

According to Zhang Min, although most asthma patients can achieve good control after long-term standardized use of inhaled sex hormone therapy, there are still about 3 million severe eosinophilic asthma patients in my country, and severe asthma is misdiagnosed and undertreated.

"Due to frequent acute attacks, severe lung function limitations and decreased quality of life, patients face a heavy burden of disease. Not only that, these patients are also at a higher risk of death, and the associated risk of hospitalization is twice that of patients with persistent asthma." Zhang Min said that the medical expenses of patients with severe asthma account for about 50% of the total medical cost of all patients with asthma, which brings a huge economic burden to society.

She said the application of innovative biologics provides a new option for severe asthma treatment. These biological agents can accurately target key inflammatory effector cells in the onset of asthma, effectively inhibit related inflammatory factors, reduce acute attacks of severe asthma, improve lung function, and reduce hormone dosage.

The recently released "Guidelines for the Prevention and Treatment of Bronchial Asthma (2024 Edition)" proposed for the first time the concept of asthma can be "clinical cured", which means that patients with severe asthma are expected to achieve stable symptoms and maintain normal activity levels through standardized management, and significantly reduce the risks of acute attacks, persistent airflow restrictions, adverse drug reactions and asthma-related deaths.

As an expert involved in the formulation of the new version of the guideline, Zhang Min explained that the criteria for "clinical cure" include no acute attacks in one year, no need for oral hormones, and basically normal lung function. The realization of this goal depends on the application of innovative therapies such as biologics.

"The update of the new version of the asthma treatment guide is exciting. It not only makes the treatment goals of asthma clearer, strengthens our confidence in achieving asthma's controllable, curable and healable, but also ignites the hope of returning to a healthy life for more severe asthma patients." She said that she hopes that domestic scholars can have more research on improving their diagnosis and treatment capabilities, and at the same time, she hopes that more innovative biological agents can be included in the national medical insurance catalog, so as to achieve universal access and access on the clinical side, bring benefits to patients with severe asthma and reduce the burden on families and society.

Experts call for: Standardized diagnosis and treatment and innovative treatment are needed to treat asthma

In the interview, Zhang Min further emphasized the importance of standardized diagnosis and treatment. She said that the diagnosis rate of asthma is less than 30%, and some grassroots hospitals still have missed diagnosis and misdiagnosis due to equipment restrictions. The new version of the guide recommends improving the diagnostic rate through lung function detection, exhaled nitric oxide (FeNO), and other means, and diagnostic treatment can be used if necessary.

Regarding the choice of inhalation treatment devices, Zhang Min introduced that dry powder inhalers (DPI) do not require hand-oral coordination and are suitable for most patients; pressure quantitative inhalers (pMDI) need to pay attention to hand-oral synchronization; soft mist inhalers (SMI) are suitable for patients with lower inhalation flow rates. “Patients should choose the device that suits them best under the guidance of a professional doctor and regularly evaluate the use method,” she added.

For pediatric patients, she specifically reminded that parents' concerns about ICS may stem from misunderstandings about hormone side effects. Studies have shown that standardized use of low-dose ICS will not only not affect children's growth and development, but will also reduce the use of systemic hormones during acute attacks. For example, ICS-enhanced β2 agonists (such as formoterol) have a significant effect on reducing acute asthma attacks in children.

"By the combination of standardized treatment, innovative therapies and public education, we are expected to enable more asthma patients to achieve 'clinical cure' and regain free breathing," said Zhang Min.

[Editor in charge: Sun Hui]