Despite the advent of sophisticated and efficient new biologics to treat inflammation in asthma, the disease persists. Even following treatment, many patients still experience the well-known symptoms of wheezing, shortness of breath, and coughing. What are we missing? Here we examine the evidence that mucus plugs contribute to a substantial portion of disease, not only by physically obstructing the airways but also by perpetuating inflammation. In this way, mucus plugs may act as an immunogenic stimulus even in the absence of allergen or with the use of current therapeutics. The alterations of several parameters of mucus biology, driven by type 2 inflammation, result in sticky and tenacious sputum, which represents a potent threat, first due to the difficulties in expectoration and second by acting as a platform for viral, bacterial, or fungal colonization that allows exacerbations. Therefore, in this way, mucus plugs are an overlooked but critical feature of asthmatic airway disease.

中文翻译：

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哮喘的病理学：是什么阻碍了我们的视野？

尽管出现了复杂且有效的新型生物制剂来治疗哮喘炎症，但这种疾病仍然存在。即使在治疗后，许多患者仍然会出现众所周知的喘息、气短和咳嗽症状。我们缺少什么？在这里，我们检查了粘液塞导致大部分疾病的证据，不仅通过物理阻塞气道，而且通过持续炎症。通过这种方式，即使在没有过敏原或使用当前治疗方法的情况下，粘液塞也可以充当免疫原性刺激物。由 2 型炎症驱动的粘液生物学多个参数的改变导致粘稠且顽固的痰液，这是一种潜在的威胁，首先是由于排痰困难，其次是作为病毒、细菌或真菌定植的平台这会导致病情恶化。因此，这样看来，粘液栓是哮喘气道疾病的一个被忽视但却至关重要的特征。