A shorter course for anti-relapse therapy against vivax malaria.
A shorter course for anti-relapse therapy against vivax malaria.
复制标题
针对间日疟疾的抗复发治疗的较短疗程。
DOI：
10.1016/s0140-6736(19)31605-8
复制
发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Rosenthal PJ
中科院分区：
文献类型：
--
作者：
Rosenthal PJ
疗法轻度哮喘通常通过最小和间歇性症状来识别，具有罕见的加重和正常的肺功能。症状或加重的程度或频率应如何，才能保证吸入性皮质类固醇-β-激动剂治疗？在PRACTICAL中，基线治疗期间1秒用力呼气容积（FEV 1）百分比预测值和症状不能预测治疗疗效，并且没有生物标志物可用于选择患者。另一个问题是何时应停止按需联合治疗？在PRACTICAL研究中，与维持治疗的布地奈德+特布他林相比，布地奈德-福莫特罗按需治疗组发生一次急性加重的患者数量为1/2，而两组发生两次或两次以上急性加重的患者数量相似。一小部分哮喘患者是大多数急性发作的原因，但频繁急性发作的患者分布在全球哮喘治疗指南倡议的所有步骤中。7，8频繁急性发作的患者在急性发作之间相对无症状，识别可能具有挑战性，需要警惕以识别这些患者并根据需要修改治疗。建立对间歇治疗有反应的轻度哮喘的生物标志物可能与重度哮喘患者生物治疗的生物标志物一样重要。现在许多研究支持按需吸入皮质类固醇-β-激动剂治疗作为轻度哮喘患者甚至一些中度哮喘患者的有效治疗。更好地了解哮喘频繁恶化背后的生物学（包括生物标志物）可能有助于确定哪些患者最有可能受益或哪些患者需要维持治疗。尽管在某些国家（包括美国），与SABA吸入器相比，联合治疗的成本更高，可能会减少按需吸入皮质类固醇-β-激动剂方案的采用，但与每日维持治疗相比，这种联合治疗可适度改善哮喘结局，降低总体吸入皮质类固醇负荷，并可能提高患者满意度，使其成为一种非常实用的选择。
therapy. Mild asthma typically is identified by minimal and intermittent symptoms, with rare exacerbations and normal lung function. How mild or how often should symptoms or exacerbations occur to warrant inhaled corticosteroid–β-agonist therapy? In PRACTICAL, baseline on-treatment forced expiratory volume in 1 s (FEV1) percentage predicted and symptoms did not predict the efficacy of therapy, and there were no biomarkers to select patients. An additional question is when should as-needed combination therapy be stopped? In PRACTICAL, 1 half as many patients had one exacerbation with as-needed budesonide–formoterol compared with maintenance budesonide plus as-needed terbutaline, whereas the number of patients with two or more exacerbations was similar between groups. A small proportion of patients with asthma account for most exacerbations, but patients with frequent exacerbations are spread through all steps of the Global Initiative for Asthma therapy guidelines. 7, 8 Patients with frequent exacerbations who are relatively asymptomatic between exacerbations can be challenging to identify, and vigilance is necessary to identify these patients and revise therapy as needed. Establishment of biomarkers for mild asthma responsive to intermittent therapy might be just as important as biomarkers for biological therapy in patients with severe asthma. Many studies now support as-needed inhaled corticosteroid–β-agonist therapy as an effective treatment for patients with mild asthma and even some with moderate asthma. A better understanding of the biology behind frequently exacerbating asthma (including biomarkers) might help to identify which patients are most likely to benefit or which warrant maintenance therapy. Although the higher cost of combination therapies compared with SABA inhalers in some countries (including the USA) might reduce adoption of the as-needed inhaled corticosteroid–β-agonist regimen, this combination could modestly improve asthma outcomes over daily maintenance therapy, reduce overall inhaled corticosteroid burden, and possibly improve patient satisfaction, making it a very PRACTICAL option.