重度哮喘胸部CT与支气管活检的多学科推荐：基于真实世界经验的专家共识
该专家共识由13家以三级医院为主的多学科专家在2025年11月西班牙Santander的AGHORA研讨会上制定，针对重度哮喘胸部CT和支气管活检的临床应用提出实用推荐和最低报告标准，旨在减少中心间差异并促进多中心研究。
要点
- CT最可能改变管理的决策点包括生物制剂启动前和生物制剂治疗反应不佳时。
- 临床怀疑气管支气管软化/中心气道塌陷时，呼气相成像是必需的。
- 支气管活检适用于疑似T2低哮喘、生物标志物不一致和生物制剂无应答等场景。
核心结论
- 该专家声明为重度哮喘的CT和支气管活检提供了实用的多学科推荐和最低报告标准。
- 实施这些推荐可能减少中心间差异、改善个体化临床决策并促进多中心研究和前瞻性验证。
研究设计与样本
- 多学科专家共识，制定于2025年11月21-22日在西班牙Santander举行的AGHORA研讨会。
- 参与专家来自13家以三级医院为主的机构，涵盖重度哮喘诊疗、支气管镜、胸部影像和肺病理领域。
- 推荐通过结构化全体会议和学科分组会议生成，经跨学科讨论后实时修订草案，并提交举手投票。
- 共识程度按高、中、低进行定性分类。
主要发现
- 专家组确定了CT最可能改变管理的关键决策点，尤其是生物制剂启动前和生物制剂治疗反应不佳时。
- 临床怀疑气管支气管软化/中心气道塌陷时，呼气相成像被认为是必需的。
- 提出了CT采集和结构化报告的最低数据集，强调系统评估（并在可行时量化）黏液栓、支气管壁增厚/支气管扩张分布和范围以及空气潴留/小气道疾病模式。
- 对于支气管活检，专家同意了组织评估增加价值的场景（如疑似T2低哮喘、生物标志物不一致和生物制剂无应答），并提出了最低技术和报告标准。
- 标准化组织病理学报告锚定于经验证的11项病理评分（PS评分），支持结构化的条目级报告和跨炎症及重塑领域的基准比较。
关键数值与推荐
- CT结构化报告应系统评估（并在可行时量化）黏液栓、支气管壁增厚/支气管扩张分布和范围以及空气潴留/小气道疾病模式。
- 支气管活检的标准化组织病理学报告应锚定于经验证的11项病理评分（PS评分）。
- 当临床怀疑气管支气管软化/中心气道塌陷时，呼气相成像被认为是必需的。
临床怎么用
- 在生物制剂启动前和生物制剂治疗反应不佳时，考虑使用胸部CT以辅助重度哮喘表型分型和管理决策。
- 临床怀疑气管支气管软化/中心气道塌陷时，应进行呼气相CT成像。
- 对疑似T2低哮喘、生物标志物不一致或生物制剂无应答的患者，可考虑支气管活检以获取组织学信息。
- 采用提出的CT最低数据集和结构化报告模板，以及基于11项PS评分的标准化组织病理学报告，以提高可比性。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
J Asthma Allergy. 2026 May 23;19:604260. doi: 10.2147/JAA.S604260. eCollection 2026. ABSTRACT BACKGROUND: Chest computed tomography (CT) and bronchial biopsy can refine severe asthma phenotyping beyond systemic biomarkers, yet real-world implementation re mains heterogeneous and reporting is often non-standardized. Multidisciplinary integration is therefore needed to maximize clinical utility and comparability across centres. METHODS: This manuscript reports a multidisciplinary expert consensus developed during the AGHORA workshop held in Santander, Spain (21-22 November 2025). Experts in severe asthma care, bronchoscopy, thoracic imaging, and pulmonary pathology from 13 predominantly tertiary hospitals participated. Recommendations were generated through structured plenary and discipline-focused sessions followed by cross-disciplinary discussion. Draft statements were refined in real time and submitted to show-of-hands voting; agreement was categorized qualitatively as high, moderate, or low. RESULTS: The panel identified key decision points where CT is most likely to change management, particularly prior to biologic initiation and in cases of inadequate response to biologic therapy. When tracheobronchomalacia/central airway collapse was clinically suspected, expiratory imaging was considered essential. A minimum dataset for CT acquisition and structured reporting was proposed, emphasizing systematic assessment (and, where feasible, quantification) of mucus plugging, bronchial wall thickening/bronchiectasis distribution and extent, and air trapping/small-airway disease patterns, complemented by an actionable impression for multidisciplinary decision-making. For bronchial biopsy, experts agreed on scenarios where tissue assessment adds value (eg, suspected T2 low asthma, discordant biomarkers, and biologic non-response) and proposed minimum technical and reporting standards. Standardized histopathology reporting was anchored to the validated 11-item pathological score (PS score), enabling structured item-level reporting and benchmarking across inflammatory and remodelling domains. CONCLUSION: This expert statement provides pragmatic, multidisciplinary recommendations and minimum reporting standards for CT and bronchial biopsy in severe asthma. Implementation may reduce inter-centre variability, improve personalized clinical decision-making, and facilitate multicentre research and prospective validation. PMID: 42222522 | PMC: PMC13218207 | DOI: 10.2147/JAA.
引用
- 指南共识 · 哮喘：Multidisciplinary Recommendations for the Use of Chest CT and Bronchial Biopsy in Severe Asthma: An Expert Consensus Based on Real-World Experience
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。