重症哮喘胸部CT与支气管活检多学科专家共识
来自西班牙13家三级医院的重症哮喘、支气管镜、胸部影像及肺病理专家通过结构化讨论与投票形成共识。共识明确了胸部CT最可能改变管理的决策节点，并提出了CT采集与报告的最低标准及支气管活检技术、组织病理报告规范。实施该共识可能减少中心间差异，改善个体化决策。
要点
- 开始生物制剂前及生物制剂应答不佳时，CT最可能改变管理。
- 临床怀疑气管支气管软化或中央气道塌陷时，必须加做呼气相成像。
- CT报告应系统评估黏液栓、支气管壁增厚/支扩范围、空气潴留并给出可执行的结论。
核心结论
- 该专家声明为重症哮喘的胸部CT和支气管活检提供实用的多学科建议与最低报告标准。
- 实施这些标准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
- 本共识由AGHORA研讨会期间的专家组制定，来自西班牙13家以三级医院为主的机构。
- 专家组涵盖重症哮喘诊疗、支气管镜、胸部影像及肺病理领域专家，采用全体会议与分学科讨论相结合的方式形成草案。
- 草案经实时修订后以举手表决方式投票，一致性按高、中、低三级定性分类。
关键影像表现/征象
- CT报告需系统评估黏液栓、支气管壁增厚/支气管扩张分布与范围、空气潴留/小气道疾病模式，并尽可能进行量化。
- 当临床怀疑气管支气管软化或中央气道塌陷时，呼气相成像是必要检查。
诊断标准与关键数值
- CT采集与结构化报告的最低数据集被提出，重点包括黏液栓、支扩分布范围及空气潴留的系统性评估，并辅以可执行的结论。
- 支气管活检适用于疑诊T2低型哮喘、生物标志物不一致及生物制剂应答不佳等情况，并提出了最低技术与报告标准。
- 组织病理报告以经验证的11项病理评分（PS评分）为锚定，支持条目级结构化报告以及炎症与重塑域间的基准比较。
临床应用与阅片要点
- 在开始生物制剂前及生物制剂应答不佳时，应优先考虑胸部CT以优化决策。
- CT报告应提供系统化的影像评估并给出可执行的多学科结论，而非仅做描述性报告。
- 支气管活检报告应按照PS评分的条目逐项报告，便于跨中心比较炎症与重塑改变。
局限性
- 共识结论基于专家经验与举手表决，原文未报告系统性证据分级或定量一致性指标。
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）。
英文原文（摘要）· 点击展开
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.
引用
- Garcia-Rivero, Peña, González-Piñeiro, et al. Multidisciplinary Recommendations for the Use of Chest CT and Bronchial Biopsy in Severe Asthma: An Expert Consensus Based on Real-World Experience. J Asthma Allergy. 2026. PMID: 42222522. doi:10.2147/JAA.S604260
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。