National asthma education and prevention program - Expert panel report 3 (EPR-3): Guidelines for the diagnosis and management of asthma - Summary report 2007
National asthma education and prevention program - Expert panel report 3 (EPR-3): Guidelines for the diagnosis and management of asthma - Summary report 2007
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DOI：
10.1016/j.jaci.2007.09.029
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发表时间：
2007-11-01
影响因子：
14.2
通讯作者：
中科院分区：
文献类型：
--
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国家哮喘教育和预防计划专家小组报告3 （EPR-3）的亮点：哮喘诊断和管理指南- 2007年完整报告在本EPR-3总结报告中提出。新版指南强调了哮喘控制的重要性。哮喘控制是指通过治疗干预将哮喘的表现减少到最低程度，并达到治疗目标的程度。由于哮喘是高度可变的，必须定期监测控制水平，以确定是否应维持或调整治疗（必要时加强，可能时减少）。另一方面，哮喘严重程度是疾病过程的内在强度，在未接受长期对照治疗的患者中最容易和直接测量。对于哮喘的管理，建议是评估严重程度以开始治疗，评估控制以调整治疗。管理哮喘的建议包括扩大儿童哮喘部分，增加5至11岁年龄组（早期指南将该年龄组与成人结合）。该指南提供了在医生办公室以外的环境中对患者进行教育的新建议，以及控制可能引起哮喘症状的环境因素的新建议。当前损害（症状的频率和强度、肺功能低下和日常活动的限制）和未来风险（恶化的可能性、肺功能的进行性丧失或药物不良副作用）的概念支持一种通过使用多种措施来评估和监测患者哮喘控制水平的新方法。该指南强调，一些患者即使几乎没有哮喘的日常影响，也可能处于频繁发作的高风险中。此外，EPR-3证实了教导患者自我监测和管理哮喘技能以及使用书面哮喘行动计划的重要性，该计划应包括日常治疗指导以及识别和处理恶化哮喘的方法。新的建议鼓励扩大教育机会，以便在药房、学校、社区中心和患者家中等各种环境中为患者提供教育。一个新的部分解决了临床医生教育计划的需要，以改善与患者的沟通，并使用全系统的方法将指南整合到医疗保健实践中。该指南描述了使用多种方法限制暴露于过敏原和其他可能加重哮喘的物质的新证据；研究表明，单步是远远不够的。EPR-3还扩展了关于可能影响哮喘的常见疾病的部分，并指出对这些疾病的管理可能有助于改善哮喘控制。专家小组报告3继续采用逐步控制哮喘的方法。在评估哮喘控制水平以确定是否需要调整治疗时，EPR-3再次确认了在加强治疗之前评估患者对药物、吸入器技术和环境控制措施的依从性的重要性。渐进式护理方法从4步扩展到6步。药物在这6个步骤中被重新定位。对药物建议进行更新，以反映有关有效性和安全性的最新证据。EPR-3重申，持续性哮喘患者既需要长期控制药物来控制哮喘和预防恶化，也需要根据需要快速缓解症状的药物。EPR-3还重申，吸入皮质类固醇是所有年龄组中最有效的长期控制药物。关于长期控制白三烯受体拮抗剂和色莫利等治疗方案的新建议；长效受体激动剂作为吸入皮质类固醇的辅助治疗；Omalizumab治疗严重哮喘；沙丁胺醇、左旋沙丁胺醇和皮质类固醇用于急性发作。
Highlights of the National Asthma Education and Prevention Program's Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma-Full Report 2007 are presented in this EPR-3 summary report. The updated guidelines emphasize the importance of asthma control. Asthma control is the degree to which the manifestations of asthma are minimized by therapeutic intervention and the goals of therapy are met. Because asthma is highly variable, the level of control must be monitored on a periodic basis to determine whether therapy should be maintained or adjusted (stepped up if necessary, stepped down if possible). On the other hand, asthma severity is the intrinsic intensity of the disease process, most easily and directly measured in a patient not receiving long-term control therapy. For managing asthma, the recommendation is to assess severity to initiate therapy and assess control to adjust therapy.Recommendations for managing asthma include an expanded section on childhood asthma with addition of an age group 5 to 11 years old (earlier guidelines combined this group with adults). The guidelines provide new recommendations on patient education in settings beyond the physician's office, and new advice for controlling environmental factors that can cause asthma symptoms.The concepts of current impairment (frequency and intensity of symptoms, low lung function, and limitations of daily activities) and future risk (likelihood of exacerbations, progressive loss of lung function, or adverse side effects from medications) support a new approach to assessing and monitoring the patient's level of asthma control through use of multiple measures. The guidelines stress that some patients can still be at high risk for frequent exacerbations even if they have few day-to-day effects of asthma.Moreover, EPR-3 confirms the importance of teaching patients skills to self-monitor and manage asthma and to use a written asthma action plan, which should include instructions for daily treatment and ways to recognize and handle worsening asthma. New recommendations encourage expanding educational opportunities to reach patients in a variety of settings, such as pharmacies, schools, community centers, and patients' homes. A new section addresses the need for clinician education programs to improve communication with patients and to use system-wide approaches to integrate the guidelines into health care practice.The guidelines describe new evidence for using multiple approaches to limit exposure to allergens and other substances that can worsen asthma; research shows that single steps are rarely sufficient. EPR-3 also expands the section on common conditions that can affect asthma and notes that management of these conditions may help to improve asthma control. Expert Panel Report 3 continues the use of a stepwise approach to control asthma. When assessing the level of asthma control to determine the need for adjusting therapy, EPR-3 reconfirms the importance of assessing patient adherence to medication, inhaler technique, and environmental control measures before making a step up in therapy.The stepwise approach expands from 4 steps to 6 steps of care. Medications have been repositioned within these 6 steps. Recommendations on medications are updated to reflect the latest evidence on effectiveness and safety. EPR-3 reaffirms that patients with persistent asthma need both long-term control medications to control asthma and prevent exacerbations and quick-relief medication for symptoms, as needed. EPR-3 also reaffirms that inhaled corticosteroids are the most effective long-term control medication across all age groups. New recommendations on treatment options such as leukotriene receptor antagonists and cromolyn for long-term control; long-acting beta-agonists as adjunct therapy with inhaled corticosteroids; omalizumab for severe asthma; and albuterol, levalbuterol, and corticosteroids for acute exacerbations are included.