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首页> 外文期刊>Seminars in Respiratory and Critical Care Medicine >Emerging Concepts in Evidence-Based Asthma Management
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Emerging Concepts in Evidence-Based Asthma Management

机译：基于证据的哮喘管理中的新兴概念

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Asthma management is in an intriguing phase, with acceptance of asthma as a heterogeneous condition with different phenotypes and underlying mechanisms and the potential for personalized asthma care, in parallel with increasing evidence about the population-level impact of basic strategies to increase access to medicines and improve inhaler technique and adherence. These changes have been facilitated by a more comprehensive view of evidence, including both randomized controlled trials with high internal validity and pragmatic and observational studies with high generalizability to patients in clinical practice. Evolving concepts of asthma control have led to new approaches to asthma assessment, recognizing the potential for discordance between symptom control and risk of exacerbations. A re-evaluation of evidence has also led to substantial changes in initial treatment of asthma, with the focus moving away from bronchodilator-only treatment, toward early use of inhaled corticosteroids and novel strategies for mild asthma. Sputum-guided treatment, where available, is successful in patients with moderate-severe asthma, but exhaled nitric oxide has not yet satisfied initial assumptions about its utility for biomarker-guided treatment. New interventions are emerging to improve adherence with asthma controller medications. A re-evaluation of evidence about written asthma action plans has led to encouragement of a rapid increase in controller dose, rather than relying on bronchodilator treatment and oral corticosteroids. Finally, new models of asthma care are emerging, utilizing the skills of allied health professionals and recognizing the potential role of telehealth.
机译：哮喘管理处于一种有趣的阶段，接受哮喘作为异质条件，具有不同的表型和潜在的机制以及个性化哮喘护理的潜力，并行随着关于基本策略的基本策略的人口水平影响而增加对药品的持续影响提高吸入器技术和依从性。通过更全面的证据观察，包括随机对照试验，包括具有高内部有效性和务实和观察研究的随机对照试验，对临床实践中的患者提供了很大的普遍性。哮喘控制的不断发展的概念导致了哮喘评估的新方法，认识到症状控制与恶化风险之间不间断的可能性。对证据的重新评估也导致了对哮喘初始治疗的大量变化，焦点远离支气管扩张剂的治疗，旨在早期使用吸入的皮质类固醇和轻度哮喘的新策略。在适用的哮喘患者中，痰导施加的痰液是成功的，但呼出的一氧化氮尚未满足其对其生物标枪的效用的初始假设。新的干预措施正在出现改善哮喘控制器药物的依从性。重新评估关于书面哮喘行动计划的证据导致控制器剂量快速增加，而不是依赖于支气管扩张剂治疗和口服皮质类固醇。最后，新型的哮喘护理模型正在出现，利用盟军卫生专业人士的技能，并认识到远程医疗的潜在作用。

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