Hilft die Phänotypisierung des Asthmas bei der Differentialtherapie?

Zusammenfassung

Asthmas ist ein Syndrom charakterisiert durch entzündliche Schleimhautveränderungen in den Atemwegen, Atemwegsüberempfindlichkeit (AHR) und Atemwegsobstruktion. Dabei ist unter der Diagnose Asthma in der Summe ein heterogenes Patientenkollektiv zu finden. In den letzten Jahren sind vermehrt Anstrengungen unternommen worden, das heterogene Krankheitsbild Asthma genauer zu klassifizieren und die Patienten verschiedenen klinisch relevanten Phänotypen zuzuteilen. Diese Phänotypen können aufgrund des klinischen Bildes, nach ätiologischen bzw. auslösenden Faktoren oder nach Art der bronchialen Entzündungsreaktion charakterisiert sein. Allerdings sind die beschriebenen Einteilungen und Ansätze noch sehr unübersichtlich und häufig ist eine klare Abgrenzung von unterschiedlichen Phänotypen nicht möglich. Einige der Phänotypen resultieren aus unterschiedlichen pathophysiologischen Mechanismen und können sich im Krankheitsverlauf erheblich unterscheiden. Auch kann die korrekte Phänotypisierung eines Patienten einen direkten Einfluss auf therapeutische Entscheidungen haben. Eine genauere Definition klinischer Asthma-Phänotypen ist daher in pathogenetischer, diagnostischer, therapeutischer und prognostischer Hinsicht dringlich.

Abstract

Asthma is a syndrome characterized by airway inflammation, airway hyperresponsiveness (AHR) and airway obstruction. The diagnosis asthma comprises a very heterogeneous patient population. In recent years different strategies have been developed to classify the patients into different phenotypes. The phenotypes can be based on clinical findings, etiology and triggers or be defined by the type of airway inflammation. These classifications are still very crude and confusing and often a clear-cut differentiation between different described phenotypes is not possible. Still some phenotypes depend on different pathophysiological mechanisms and can differ profoundly in their clinical course. Also for some of these phenotypes specifical treatpeuthic options are available. Therefore a good definition and classification of asthma phenotypes is important in regard of diagnosis, prognosis and therapy of these patients.

Schlüsselwörter

Asthma - Therapie - Entzündung - Phänotypen

Keywords

asthma - inflammation - therapy - phenotypes

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