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首页> 外文期刊>The Internet Journal of Academic Physician Assistants >Asthma Diagnosis and Management: A Review of the Updated National Asthma Education and Prevention Program Treatment Guidelines
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Asthma Diagnosis and Management: A Review of the Updated National Asthma Education and Prevention Program Treatment Guidelines

机译：哮喘的诊断和管理：更新的《国家哮喘教育和预防计划治疗指南》

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Asthma is a common chronic inflammatory disorder of the airways. The National Asthma Education and Prevention Program guidelines provide recommendations for asthma management based on the components of assessment and monitoring of asthma severity and control, patient education, control of environmental factors and comorbid conditions affecting asthma, and pharmacologic therapy. The 2002 version of these guidelines was recently updated. The purpose of this review is to describe the major changes and to provide a concise summary of the key asthma diagnosis and management recommendations contained within this newly updated version. Study funding: This article was supported by AstraZeneca LP. Introduction Recently, the National Asthma Education and Prevention Program (NAEPP) released updated guidelines for the treatment of patients with asthma. 1 Although many recommendations in the guidelines remain unchanged, some key elements have been revised or introduced. This review summarizes this vital information as it relates to the diagnosis and treatment of asthma for the physician assistant (PA) audience. I begin with a brief description of the major changes from the previous version, followed by an integrated summary of recommendations for asthma diagnosis and management, according to the revised guidelines. Overview of Major Guideline Changes The updated guidelines continue to recommend a stepwise approach to treating asthma symptoms; however, in contrast to the single-scheme approach used in previous guidelines, 2,3 diagnosis and disease management have now been divided into 2 phases. In the first phase, asthma severity is evaluated to establish initial therapy and is determined by assessment of current impairment (eg, quality of life and functional capacity) and future risk (eg, exacerbations, loss of pulmonary function, and adverse events). In the second phase, responsiveness to asthma therapy and the achieved level of asthma control are routinely assessed, which may result in therapy adjustment over time based on the outcome of these assessments. 1 Several key revisions to the NAEPP guidelines involve changes to pharmacologic recommendations. Assessment and treatment are now stratified into 3 age groups (0–4 y, 5–11 y, and ≥12 y) instead of 2. Age stratification is appropriate because many children with asthma develop symptoms before the age of 5 years, 4 yet clinical data for children aged <5 years are limited, making it difficult to draw firm conclusions regarding appropriate treatment in this age group. Furthermore, diagnosing children aged <5 years with asthma is difficult and may require different therapeutic approaches compared with older children because of the potential for reduced capability of the patient or caregiver to adequately use drug delivery devices. Moreover, children aged <5 years generally have different patterns of asthma symptoms than older children, suggesting that treatment approaches in the 2 populations should not be identical. 1 Finally, although the revised guidelines still recommend a stepwise approach for the combination of long-term and short-term anti-inflammatory medications, the recommendations for the individual steps have been substantially revised. Most importantly, the stepwise treatment approach is now divided into 6 steps rather than 4. 1 By doing this, the treatment steps were simplified to reduce the number of multiple treatment choices within a single step. Other revisions include changes regarding the appropriate time for the introduction of adjuvant therapy to an inhaled corticosteroid (ICS) regimen in the management of persistent asthma. The revised guidelines have changed the recommendations for the introduction of a long-acting β2-agonist (LABA) for adults and adolescents aged ≥12 years whose asthma is not adequately controlled on low-dose ICS therapy, and equal emphasis is now placed on either increasing the dose of the ICS to a medium dose or to adding a LABA to a low-dose ICS.
机译：哮喘是气道的常见慢性炎症性疾病。 《美国国家哮喘教育和预防计划指南》根据评估和监测哮喘严重程度和控制，患者教育，控制环境因素和影响哮喘的合并症以及药物治疗的组成部分，为哮喘管理提供建议。这些准则的2002年版本最近进行了更新。这篇综述的目的是描述主要变化，并简要概述本最新版本中包含的关键哮喘诊断和治疗建议。研究经费：本文由AstraZeneca LP支持。简介最近，美国国家哮喘教育和预防计划（NAEPP）发布了治疗哮喘患者的最新指南。 1尽管准则中的许多建议保持不变，但已对某些关键要素进行了修订或引入。这篇综述总结了这一重要信息，因为它与医师助理（PA）受众的哮喘诊断和治疗有关。首先，我将简要介绍与先前版本相比的主要变化，然后根据修订后的指南对哮喘的诊断和治疗建议进行综合总结。主要指南变更概述更新后的指南继续推荐逐步治疗哮喘症状的方法。但是，与以前的指南中使用的单一方案方法相比，现在将2,3诊断和疾病管理分为两个阶段。在第一阶段，评估哮喘的严重程度以建立初始治疗，并通过评估当前的障碍（例如生活质量和功能能力）和未来的风险（例如恶化，肺功能丧失和不良事件）来确定。在第二阶段，常规评估对哮喘治疗的反应性和达到的哮喘控制水平，这可能导致根据这些评估的结果随时间调整治疗。 1对NAEPP指南的几个关键修订涉及药理学建议的变更。现在将评估和治疗分为3个年龄段（0-4岁，5-11岁和≥12岁），而不是2个年龄段。因为许多哮喘儿童在5岁之前就出现了症状，所以年龄分层是适当的，4个<5岁儿童的临床数据有限，因此很难就该年龄组的适当治疗得出确切的结论。此外，与年龄较大的儿童相比，诊断<5岁的哮喘儿童非常困难，并且可能需要不同的治疗方法，因为这可能会降低患者或护理人员充分使用药物输送装置的能力。此外，年龄小于5岁的儿童通常与年龄较大的儿童有不同的哮喘症状模式，这表明这两个人群的治疗方法不应相同。 1最后，尽管修订后的指南仍建议长期和短期抗炎药联合使用逐步方法，但对各个步骤的建议已进行了实质性修订。最重要的是，现在逐步治疗方法被分为6个步骤而不是4个步骤。1通过这样做，简化了治疗步骤，以减少单个步骤中多个治疗选择的数量。其他修订包括在持续性哮喘的治疗中对吸入皮质类固醇（ICS）方案引入辅助治疗的适当时间进行了更改。修订后的指南改变了对≥12岁且哮喘在小剂量ICS治疗中不能得到充分控制的成人和青少年使用长效β2-激动剂（LABA）的建议，并且现在同等重视将ICS的剂量增加到中等剂量，或在低剂量的ICS中添加LABA。

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