哮喘患者和医生对哮喘负担和治疗的看法
2021/07/28
摘要
背景：2021年全球哮喘倡议（GINA）部分基于SYGMA研究，建议不论何种严重程度按需吸入皮质类固醇（ICS）/福莫特罗，并将GINA步骤3中的维持和缓解治疗（MART）作为初始治疗。我们调查了澳大利亚、加拿大、中国和菲律宾目前的临床实践与GINA最新建议的关系。
方法：在2020年7月至8月期间，在线招募患者和医生，邀请他们完成在线调查。
纳入标准：年龄≥18岁，目前/过去的哮喘诊断（患者）；初级保健（加拿大也包括呼吸科医生/呼吸治疗师），治疗≥每月4名哮喘患者，≥3年临床实践经验（内科医生）。
结果：总体而言，1216/70183名患者和803/8376名医生回答并符合纳入条件。只有8%～15%的患者使用MART；66%～81%的患者使用常规维持治疗，有/无必要的缓解剂。在这四个国家，医生将48%～63%的患者分为轻度（GINA步骤1-2），28%～36%的患者分为中度（GINA步骤3-4）。一般来说，医生把控制症状而不是减轻急性发作作为他们的主要治疗目标；患者也认为症状缓解非常重要。大约9%～29%的患者和24%～45%的医生不知道MART，而在那些MART的患者中，80%～95%的人根据需要额外的（非ICS）缓解剂。
解释：大多数医生优先处理哮喘症状超过急性发作。医生对MART剂量缺乏认识和理解。为了在现实世界的临床实践中有效地实施GINA建议，并为MART确定合适的患者，需要更实际的策略。
Asthma patients' and physicians' perspectives on the burden and management of asthma
Kenneth R Chapman, Li An, Sinthia Bosnic-Anticevich, Celeste M Campomanes, Jerónimo Espinosa, Priya Jain, Kim L Lavoie, Jing Li, Aman K Butta
Abstract
Background: The 2021 Global Initiative for Asthma (GINA) report recommends as-needed inhaled corticosteroid (ICS)/formoterol irrespective of severity, and maintenance and reliever treatment (MART) from GINA Step 3 as part of Treatment Track 1, partly based on the SYGMA studies. We investigated how current clinical practice in Australia, Canada, China and the Philippines relates to latest GINA recommendations.
Methods: Patients and physicians were recruited from online panels between July and August 2020 and invited to complete an online survey.
Inclusion criteria: age ≥18 years, current/past physician diagnosis of asthma (patients); primary care (Canada also included respirologists/respiratory therapists), treating ≥4 patients with asthma per month, ≥3 years in clinical practice (physicians).
Results: Overall, 1216/70,183 patients and 803/8376 physicians replied and were eligible for inclusion. Only 8-15% of patients were using MART; 66-81% used regular maintenance therapy with/without an as-needed reliever. Across the four countries, physicians classified 48-63% of their patients as mild (GINA Steps 1-2) and 28-36% as moderate (GINA Steps 3-4). Generally, physicians rated symptom control over exacerbation reduction as their main treatment goal; patients also ranked symptom relief as very important. Approximately 9-29% of patients and 24-45% of physicians were unaware of MART, and among those who prescribed MART, 80-95% prescribed an additional (non-ICS) as-needed reliever.
Interpretation: Most physicians prioritized managing asthma symptoms over exacerbations. A lack of awareness and understanding of MART dosing exists among physicians. Practical strategies are required to implement GINA recommendations effectively in real-world clinical practice and to identify appropriate patients for MART.
背景：2021年全球哮喘倡议（GINA）部分基于SYGMA研究，建议不论何种严重程度按需吸入皮质类固醇（ICS）/福莫特罗，并将GINA步骤3中的维持和缓解治疗（MART）作为初始治疗。我们调查了澳大利亚、加拿大、中国和菲律宾目前的临床实践与GINA最新建议的关系。
方法：在2020年7月至8月期间，在线招募患者和医生，邀请他们完成在线调查。
纳入标准：年龄≥18岁，目前/过去的哮喘诊断（患者）；初级保健（加拿大也包括呼吸科医生/呼吸治疗师），治疗≥每月4名哮喘患者，≥3年临床实践经验（内科医生）。
结果：总体而言，1216/70183名患者和803/8376名医生回答并符合纳入条件。只有8%～15%的患者使用MART；66%～81%的患者使用常规维持治疗，有/无必要的缓解剂。在这四个国家，医生将48%～63%的患者分为轻度（GINA步骤1-2），28%～36%的患者分为中度（GINA步骤3-4）。一般来说，医生把控制症状而不是减轻急性发作作为他们的主要治疗目标；患者也认为症状缓解非常重要。大约9%～29%的患者和24%～45%的医生不知道MART，而在那些MART的患者中，80%～95%的人根据需要额外的（非ICS）缓解剂。
解释：大多数医生优先处理哮喘症状超过急性发作。医生对MART剂量缺乏认识和理解。为了在现实世界的临床实践中有效地实施GINA建议，并为MART确定合适的患者，需要更实际的策略。
(中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校)
(Respir Med. 2021 Jun 29;186:106524. doi: 10.1016/j.rmed.2021.106524.)
(Respir Med. 2021 Jun 29;186:106524. doi: 10.1016/j.rmed.2021.106524.)
Asthma patients' and physicians' perspectives on the burden and management of asthma
Kenneth R Chapman, Li An, Sinthia Bosnic-Anticevich, Celeste M Campomanes, Jerónimo Espinosa, Priya Jain, Kim L Lavoie, Jing Li, Aman K Butta
Abstract
Background: The 2021 Global Initiative for Asthma (GINA) report recommends as-needed inhaled corticosteroid (ICS)/formoterol irrespective of severity, and maintenance and reliever treatment (MART) from GINA Step 3 as part of Treatment Track 1, partly based on the SYGMA studies. We investigated how current clinical practice in Australia, Canada, China and the Philippines relates to latest GINA recommendations.
Methods: Patients and physicians were recruited from online panels between July and August 2020 and invited to complete an online survey.
Inclusion criteria: age ≥18 years, current/past physician diagnosis of asthma (patients); primary care (Canada also included respirologists/respiratory therapists), treating ≥4 patients with asthma per month, ≥3 years in clinical practice (physicians).
Results: Overall, 1216/70,183 patients and 803/8376 physicians replied and were eligible for inclusion. Only 8-15% of patients were using MART; 66-81% used regular maintenance therapy with/without an as-needed reliever. Across the four countries, physicians classified 48-63% of their patients as mild (GINA Steps 1-2) and 28-36% as moderate (GINA Steps 3-4). Generally, physicians rated symptom control over exacerbation reduction as their main treatment goal; patients also ranked symptom relief as very important. Approximately 9-29% of patients and 24-45% of physicians were unaware of MART, and among those who prescribed MART, 80-95% prescribed an additional (non-ICS) as-needed reliever.
Interpretation: Most physicians prioritized managing asthma symptoms over exacerbations. A lack of awareness and understanding of MART dosing exists among physicians. Practical strategies are required to implement GINA recommendations effectively in real-world clinical practice and to identify appropriate patients for MART.
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