TOPIC IMPORTANCE Chronic obstructive pulmonary disease (COPD) is a complex, heterogeneous lung disease characterized by persistent airflow limitation secondary to airways and parenchymal abnormalities, and respiratory symptoms, including dyspnoea, fatigue, chronic cough, and sputum production. Cigarette smoke exposure is a major contributor to COPD although inhalation of toxic particles and other environmental and host factors can contribute to its genesis. Over time, the clinical course is frequently punctuated by exacerbations that further accelerate lung function decline and increase exacerbation risk. Despite current optimal therapy, many patients remain symptomatic, have exacerbations, and increased morbidity, mortality, and health-care costs. This review focuses on current knowledge of COPD pathophysiology, the role of inflammatory mechanisms, and the potential use of biologics to modulate these mechanisms. REVIEW FINDINGS The inflammatory response in COPD includes both type 1 and type 2 immune cells. Type 2 inflammation is suggested by eosinophilia in a significant proportion of COPD patients. Studies targeting IL-5 in patients with COPD have failed to demonstrate significant reductions in exacerbations, suggesting that eosinophil modulation alone may be insufficient to treat COPD. Based on a better understanding of the disease and role of alarmins, with a broader role in the inflammatory cascade, it is likely that some biologics may benefit certain COPD endotypes. Ongoing trials will provide information about which groups can benefit from the blocking of specific pathways, such as interleukin (IL)-5, IL-4/IL-13, IL-33 or thymic stromal lymphopoietin. SUMMARY Biologics targeting inflammatory pathways may be effective treatments for specific patients with COPD.

中文翻译：

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靶向 alarmin 的生物制剂在 COPD 患者治疗中的新兴作用。


主题 重要性 慢性阻塞性肺疾病 （COPD） 是一种复杂的异质性肺部疾病，其特征是继发于气道和实质异常的持续气流受限，以及呼吸系统症状，包括呼吸困难、疲劳、慢性咳嗽和咳痰。香烟烟雾暴露是 COPD 的主要因素，尽管吸入有毒颗粒和其他环境和宿主因素可导致其发生。随着时间的推移，临床病程经常被急性加重所打断，进一步加速肺功能下降并增加加重风险。尽管目前采取了最佳治疗，但许多患者仍然存在症状，病情加重，发病率、死亡率和医疗保健费用增加。本综述重点介绍了 COPD 病理生理学的当前知识、炎症机制的作用以及生物制剂调节这些机制的潜在用途。综述结果COPD 的炎症反应包括 1 型和 2 型免疫细胞。在很大一部分 COPD 患者中，嗜酸性粒细胞增多表明 2 型炎症。针对 COPD 患者 IL-5 的研究未能证明恶化显着减少，这表明单独的嗜酸性粒细胞调节可能不足以治疗 COPD。基于对疾病和警报蛋白作用的更好理解，在炎症级联反应中具有更广泛的作用，一些生物制剂可能有益于某些 COPD 内型。正在进行的试验将提供有关哪些群体可以从阻断特定途径中受益的信息，例如白细胞介素 （IL）-5、IL-4/IL-13、IL-33 或胸腺基质淋巴细胞生成素。摘要 针对炎症途径的生物制剂可能是特定 COPD 患者的有效治疗方法。