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Präzisionsmedizin in der Diagnostik und Therapie von Asthma

Precision medicine in the diagnosis and treatment of asthma

  • Schwerpunkt: Präzisionsmedizin
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Zusammenfassung

Durch die Verfügbarkeit von „disease-modifying anti-asthmatic drugs“ (DMAAD), insbesondere von inhalativen Steroiden (allein oder in Kombination mit langwirksamen Bronchodilatatoren), Biologika und modernen Allergenimmuntherapien, hat sich die Asthmatherapie grundsätzlich gewandelt. Ziele einer modernen Asthmapräzisionsmedizin sind die Symptomprävention und das Erreichen einer Asthmaremission (langfristige Symptomfreiheit, Exazerbationsfreiheit und stabile Lungenfunktion ohne Einsatz systemischer Steroide). Es wird, wie bei anderen chronisch-entzündlichen Erkrankungen der Inneren Medizin, ein Treat-to-target-Ansatz verfolgt: Ziel ist das Erreichen einer Remission durch eine individuell maßgeschneiderte Therapie mit DMAADs. Voraussetzung für die moderne Asthmapräzisionsmedizin ist jedoch die genaue Phänotypisierung der Patienten, inklusive sorgfältiger Anamneseerhebung, Lungenfunktionsprüfung, allergologischer Diagnostik und Bestimmung von Typ-2-Markern (Bluteosinophile und, falls verfügbar, Fraktion des exhalierten Stickstoffmonoxids [FeNO]).

Abstract

Due to the availability of disease-modifying anti-asthmatic drugs (DMAADs), especially inhaled steroids (alone or in combination with long-acting bronchodilators), biologics and modern allergen immunotherapy, the treatment of asthma has fundamentally changed. The aims of modern asthma precision medicine are prevention of symptoms and the induction and maintenance of asthma remission (long-term asthma control, freedom from exacerbations and stable lung function without the use of systemic steroids). A treat to target approach is used as for other chronic inflammatory diseases in internal medicine: the aim is to achieve remission by an individually tailored treatment with DMAADs; however, the prerequisite for modern asthma precision medicine is asthma phenotyping, including a detailed medical history, lung function testing, allergological diagnostics and measurement of type 2 markers (blood eosinophils and, if available, exhaled nitric oxide, FeNO).

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Authors and Affiliations

  1. Abteilung für Pneumologie, Zentrum für Innere Medizin, Universitätsmedizin Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Deutschland

    Marek Lommatzsch

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Correspondence to Marek Lommatzsch.

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Interessenkonflikt

M. Lommatzsch: Forschungsunterstützung von: DFG, GSK, AstraZeneca. Honorare für Vortrags- und Beratertätigkeiten von: ALK, Allergopharma, AstraZeneca, Bencard, Berlin-Chemie, Boehringer Ingelheim, Bosch, Chiesi, Circassia, GSK, HAL Allergy, Janssen-Cilag, Leti, MSD, Mundipharma, Novartis, Nycomed/Takeda, Sanofi, Stallergenes, TEVA, UCB.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Lommatzsch, M. Präzisionsmedizin in der Diagnostik und Therapie von Asthma. Innere Medizin 65, 229–238 (2024). https://doi.org/10.1007/s00108-024-01666-7

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