Xin Lang Cai Jing·2025-12-20 09:50Core Insights - The article discusses a recent study identifying three distinct disease trajectories in severe asthma patients prior to biologic treatment, highlighting the heterogeneity of the disease and its implications for personalized intervention strategies [1][14]. Group 1: Disease Trajectories - The study included 755 severe asthma patients from Denmark, analyzing data from 1995 to 2022, and identified three main disease progression paths: "Chronic Severe Type" (26%), "Gradual Onset Type" (35%), and "Recent Onset Type" (39%) [2][3]. - "Chronic Severe Type" patients have the longest median disease duration of 35 years, the most severe lung function impairment (median FEV1%pred of 64%), and the highest rates of comorbidities related to corticosteroid exposure [2]. - "Gradual Onset Type" patients show a stepwise worsening pattern with a median disease duration of 26 years and a median FEV1%pred of 67%, indicating a progression from mild to severe asthma [3]. - "Recent Onset Type" patients have the shortest median disease duration of 5 years, with a median FEV1%pred of 75%, and a significant proportion of patients (43%) having baseline FEV1%pred > 80% [3]. Group 2: Treatment Response and Prognosis - The study found a clear association between disease trajectories and treatment outcomes, with "Recent Onset Type" patients showing the highest clinical response rate of 32%, compared to 29% for "Gradual Onset Type" and only 17% for "Chronic Severe Type" [4]. - A key barrier for "Chronic Severe Type" patients is the difficulty in restoring lung function, with only 32% achieving normal lung function post-treatment, compared to 56% in "Recent Onset Type" [4]. - The concept of "too late" asthma was introduced, indicating patients who do not achieve FEV1%pred > 80% after 12 months of biologic treatment, with a high occurrence in "Chronic Severe Type" (56%) [4][5]. Group 3: Implications for Early Intervention - The findings suggest that recognizing disease trajectories early can provide actionable intervention opportunities before reaching the "Chronic Severe" stage, potentially preventing irreversible lung damage [5][6]. - The study emphasizes the need to shift the treatment paradigm for severe asthma from a reactive approach to proactive early intervention with biologics, particularly for patients in the early stages of "Recent Onset Type" or "Gradual Onset Type" [6][7]. - Evidence from simulations indicates that initiating biologic treatment 5 years earlier could significantly reduce corticosteroid use, prevent deaths, and lower healthcare costs, highlighting the value of early intervention [7].