Global Initiative for Asthma Strategy 2021: executive summary and rationale for key changes.
Global Initiative for Asthma Strategy 2021: executive summary and rationale for key changes.
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DOI：
10.1183/13993003.02730-2021
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发表时间：
2022-01
期刊：
影响因子：
--
通讯作者：
Boulet LP
中科院分区：
文献类型：
--
作者：
Reddel HK;Bacharier LB;Bateman ED;Brightling CE;Brusselle GG;Buhl R;Cruz AA;Duijts L;Drazen JM;FitzGerald JM;Fleming LJ;Inoue H;Ko FW;Krishnan JA;Levy ML;Lin J;Mortimer K;Pitrez PM;Sheikh A;Yorgancioglu AA;Boulet LP
全球哮喘倡议(GINA)战略报告为临床医生提供了每年更新的哮喘管理和预防循证战略，该战略可根据当地情况(如药物供应)进行调整。这篇文章总结了GINA 2021的主要建议，以及支持最近变化的证据。GINA建议成人和青少年哮喘不应仅使用短效β2-激动剂(SABA)治疗，因为仅使用SABA治疗和过度使用SABA有风险，而且有证据表明吸入性皮质类固醇(ICS)有好处。大型试验表明，与单用≥相比，按需联合使用ics-formoterol可将轻度哮喘患者的严重哮喘发作减少60%，其恶化程度、症状、肺功能和炎症结果与每日ics加按需saba相似。GINA 2021年的主要变化包括将成人和青少年的治疗数字分为两个轨道。轨道1(首选)在所有步骤中使用低剂量的ics-福莫特罗作为缓释剂：仅在步骤1-2(轻度哮喘)中需要，并在步骤3-5中每日维持ics-formoterol(维护和缓解疗法，简称MART)。轨道2(替代方案)在所有步骤中根据需要使用SABA，外加常规的ics(步骤2)或ics长效β2-激动剂(步骤3-5)。对于患有中到重度哮喘的成年人，GINA在步骤5中建议使用附加的长效毒碱拮抗剂和阿奇霉素，以及用于重度哮喘的附加生物疗法。对于6-11 岁的儿童，在步骤3-4中增加了新的治疗方案。对于所有年龄段和严重程度的儿童，定期进行个性化评估、治疗可改变的风险因素、自我管理教育、技能培训、适当的药物调整和审查仍然是优化哮喘预后的关键。GINA战略报告为临床医生提供了每年更新的哮喘管理和预防循证战略。这篇文章总结了GINA 2021的主要建议，以及支持新变化的证据。Https://bit.ly/3FZblIS
The Global Initiative for Asthma (GINA) Strategy Report provides clinicians with an annually updated evidence-based strategy for asthma management and prevention, which can be adapted for local circumstances (e.g. medication availability). This article summarizes key recommendations from GINA 2021, and the evidence underpinning recent changes. GINA recommends that asthma in adults and adolescents should not be treated solely with short-acting β2-agonist (SABA), because of the risks of SABA-only treatment and SABA overuse, and evidence for benefit of inhaled corticosteroids (ICS). Large trials show that as-needed combination ICS–formoterol reduces severe exacerbations by ≥60% in mild asthma compared with SABA alone, with similar exacerbation, symptom, lung function, and inflammatory outcomes as daily ICS plus as-needed SABA. Key changes in GINA 2021 include division of the treatment figure for adults and adolescents into two tracks. Track 1 (preferred) has low-dose ICS–formoterol as the reliever at all steps: as needed only in Steps 1–2 (mild asthma), and with daily maintenance ICS–formoterol (maintenance-and-reliever therapy, “MART”) in Steps 3–5. Track 2 (alternative) has as-needed SABA across all steps, plus regular ICS (Step 2) or ICS–long-acting β2-agonist (Steps 3–5). For adults with moderate-to-severe asthma, GINA makes additional recommendations in Step 5 for add-on long-acting muscarinic antagonists and azithromycin, with add-on biologic therapies for severe asthma. For children 6–11 years, new treatment options are added at Steps 3–4. Across all age groups and levels of severity, regular personalized assessment, treatment of modifiable risk factors, self-management education, skills training, appropriate medication adjustment, and review remain essential to optimize asthma outcomes. The GINA Strategy Report provides clinicians with an annually updated evidence-based strategy for asthma management and prevention. This article summarizes key recommendations from GINA 2021, and the evidence underpinning the new changes. https://bit.ly/3FZblIS
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影响因子：
158.5
作者：
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168.9
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10
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