International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma
International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma
复制标题
DOI：
10.1183/09031936.00202013
复制
发表时间：
2014-02-01
影响因子：
24.3
通讯作者：
Teague, W. Gerald
中科院分区：
文献类型：
--
作者：
Chung, Kian Fan;Wenzel, Sally E.;Teague, W. Gerald
严重或难治性哮喘越来越被认为是一个主要的未满足的需求。在欧洲呼吸学会和美国胸科学会的支持下，一个特别工作组审查了该定义，并提供了有关儿童和成人严重哮喘评估和治疗的建议和指南。进行了文献综述，然后由专家委员会进行讨论根据GRADE（建议分级、评估发展和评估）的方法，以制定具体的临床建议。当哮喘的诊断得到证实和合并症的解决，重度哮喘定义为需要用高剂量吸入皮质类固醇加第二控制剂和/或全身皮质类固醇治疗以防止其变得“不受控制”或尽管进行了这种治疗仍“不受控制”的哮喘。重度哮喘是一种异质性疾病，包括嗜酸性粒细胞性哮喘等表型。特别推荐使用痰嗜酸性粒细胞计数和呼出的一氧化氮来指导治疗，以及抗IgE抗体、甲氨蝶呤、大环内酯类抗生素、抗真菌药物和支气管热成形术的治疗。
Severe or therapy-resistant asthma is increasingly recognised as a major unmet need. A Task Force, supported by the European Respiratory Society and American Thoracic Society, reviewed the definition and provided recommendations and guidelines on the evaluation and treatment of severe asthma in children and adults.A literature review was performed, followed by discussion by an expert committee according to the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach for development of specific clinical recommendations.When the diagnosis of asthma is confirmed and comorbidities addressed, severe asthma is defined as asthma that requires treatment with high dose inhaled corticosteroids plus a second controller and/or systemic corticosteroids to prevent it from becoming "uncontrolled" or that remains "uncontrolled" despite this therapy. Severe asthma is a heterogeneous condition consisting of phenotypes such as eosinophilic asthma. Specific recommendations on the use of sputum eosinophil count and exhaled nitric oxide to guide therapy, as well as treatment with anti-IgE antibody, methotrexate, macrolide antibiotics, antifungal agents and bronchial thermoplasty are provided.Coordinated research efforts for improved phenotyping will provide safe and effective biomarker-driven approaches to severe asthma therapy.