ABSTRACT
Le dépistage annuel du cancer du poumon (lung cancer screening, LCS) par CT-scan à faible dose (LDCT) chez les adultes éligibles augmente la détection précoce de cancer pulmonaire dans la pratique communautaire et réduit la mortalité dans des études cliniques randomisées. Cependant, le LCS peut aussi présenter des inconvénients tels que des résultats faussement positifs, des imageries avec irradiation, la nécessité de procédures diagnostiques invasives et le risque de complications. Par conséquent, comprendre l'équilibre entre les avantages et les risques liés au LCS dans la pratique clinique est primordial afin d'optimiser les directives et les critères de qualité pour améliorer l'efficacité du dépistage à travers l'ensemble des systèmes de santé et des populations.
Subject(s)
Early Detection of Cancer , Lung Neoplasms , Tomography, X-Ray Computed , Humans , Lung Neoplasms/diagnosis , Lung Neoplasms/diagnostic imaging , Early Detection of Cancer/methods , Early Detection of Cancer/standards , Tomography, X-Ray Computed/methods , Mass Screening/methods , Mass Screening/standards , Adult , Practice Guidelines as TopicABSTRACT
Severe asthma is associated with increased morbidity, mortality, healthcare costs and impaired quality of life. Asthma is no longer considered as a single entity but as a heterogeneous disease with different clinical presentations (phenotypes) and variable underlying mechanistic biological pathways (endotypes). Two different endotypes are based on the inflammatory Type 2 T-helper response: T2-high and T2-low. The understanding of these endotypes has revolutionised the management of severe asthma. Recent guidelines from the 2019 European Respiratory Society/American Thoracic Society (ERS/ATS) and Global Initiative for Asthma (GINA) 2021 specifically address the diagnosis and the management of severe asthma in adults, but less evidence exists for the paediatric population. Presently, five biologics for the treatment of severe asthma are approved, i.e., omalizumab (anti-IgE antibody), mepolizumab and reslizumab (anti-IL-5 antibody), benralizumab (anti-IL-5 receptor antibody) and dupilumab (anti-IL-4 receptor alpha antibody). This article reviews the pathological mechanisms of severe asthma, clinical biomarkers related to the T2-high endotype, and their use for the prediction of the severity of the disease and response to biological therapy. Furthermore, future developments of biologics for severe asthma are presented.
