哮喘控制的评价和其对最佳治疗策略的影响
2007/10/26
Bo Lundback教授2007年6月在《Allergy》发表的“哮喘控制的评价和其对最佳治疗策略的影响”一文中指出：获得并维持哮喘的最佳控制是全球哮喘防治创议（GINA）所倡导的哮喘管理的主要目标。最近的证据提示，大多数患者的哮喘可得到控制，而并非所有患者获得了最佳控制。其困难是因为患者、医生以及管理组织对哮喘控制的认识不一样。所以如何评价哮喘控制以及制定管理策略来获得并维持控制仍是一个挑战。尽管有许多基于患者的评价哮喘控制与否的工具，但这些工具大部分用于研究或在某些选出的专业诊所。基于症状的治疗方法也有一些局限，因为患者对疾病症状及严重度判断不准确，低估病情而仅给予按需使用缓解药物时可能导致对气道炎症和气道高反应性（AHR）治疗不足，因为对其的治疗效果通常要一段比较长的时间才表现出来。持续维持治疗至少3个月的临床益处在最近关于沙美特罗/丙酸氟替卡松联合治疗的研究中已经阐述了，显示出气道炎症/AHR的降低与加重减少之间的相关性。
通过回顾仅根据症状制定的哮喘管理计划可能存在的局限性，作者认为治疗应当着眼于管理疾病的所有方面，而不是仅仅治疗症状，用最佳剂量治疗至少3个月以保证获得哮喘控制、气道炎症、肺功能以及重塑的最大效果。
通过回顾仅根据症状制定的哮喘管理计划可能存在的局限性，作者认为治疗应当着眼于管理疾病的所有方面，而不是仅仅治疗症状，用最佳剂量治疗至少3个月以保证获得哮喘控制、气道炎症、肺功能以及重塑的最大效果。
（陈莉娜 四川大学华西第二医院 610041 摘译）
（Allergy 62 (6)： 611–619）
Assessment of Asthma Control and Its Impact on Optimal Treatment Strategy
B.Lundback, R.Dahl
Abstract 摘要
Achieving and maintaining optimal asthma control is a major asthma management goal advocated by the Global Initiative for Asthma (GINA). Recent evidence suggests that while asthma control is clearly achievable in most asthmatics, not all asthmatics attain optimal asthma control. The difficulty is compounded further because patients, physicians and regulatory bodies have different perceptions of what is meant by asthma control. The challenge therefore remains as to how best to assess asthma control and define management strategies to ensure that this control is achieved and maintained. Despite the availability of several patient-based tools for assessing asthma control, these are mostly employed in a research setting or in selected specialist clinics. A symptom-based treatment approach also may have its limitations because patients can be poor judges of disease symptoms and severity and under-estimation may lead to inadequate treatment of airway inflammation and airway hyperresponsiveness (AHR) when treatment is administered as on-demand reliever therapy, since the effect of treatment on these underlying features occurs over a longer time course. The clinical benefits of sustained maintenance treatment for at least 3 months has been documented in recent studies of salmeterol/fluticasone propionate combination, which have demonstrated correlations between reduction in airway inflammation/AHR and reduction in exacerbation rates.
In view of the putative limitations of a purely symptom-based asthma management plan, we suggest that treatment should be focussed on management of all aspects of the disease rather than management of symptoms alone, with a practical approach being treatment for a minimum of 3 months with an optimal dose to ensure maximal effects are seen on asthma control, airway inflammation, lung function, and remodelling
Key words: asthma control; exacerbation; hyperesponsiveness;inhaled corticosteroids;longacting beta2-agonists.
上一篇：
哮喘控制和健康状态的相关性：GOAL研究
下一篇：
没有了
