Managing comorbid conditions in severe asthma
Managing comorbid conditions in severe asthma
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DOI：
10.5694/mja18.00196
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发表时间：
2018-07-16
影响因子：
11.4
通讯作者：
Yo, Shaun W.
中科院分区：
文献类型：
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作者：
Bardin, Philip G.;Rangaswamy, Jhanavi;Yo, Shaun W.
哮喘护理越来越注重对严重哮喘的个性化管理，并且对合并症的作用和重要性的认识也有所提高。相关的合并症通常在重大疾病发病率中发挥关键作用，并且经常导致严重且难以治疗的哮喘表型。合并症可大致分为气道相关或气道无关。影响最大的气道相关合并症是过敏性鼻炎、慢性鼻窦炎、声带功能障碍、肺真菌致敏和潜在的结构性肺疾病。最重要的气道无关合并症疾病包括肥胖、阻塞性睡眠呼吸暂停、胃食管反流病以及焦虑和抑郁。概述了严重哮喘合并症的诊断和管理算法。它最初集中于具有可在初级保健中进行管理的常见合并症的群体。如果哮喘仍然很麻烦，重点可以转移到识别不常见和更复杂的因素上。该算法允许实施个性化诊断和管理途径。共病的个性化诊断和管理对于重度哮喘患者获得有效和改善的结果至关重要。
Asthma care has increasingly focused on personalised management for severe asthma, and recognition of the role and importance of comorbid conditions has increased.Severe asthma can be crippling; associated comorbid conditions often play a key role in the significant disease morbidity and frequently contribute to a severe and difficult-to-treat asthma phenotype.Comorbid conditions can be broadly grouped as being either airway-related or airway-unrelated.Airway-related comorbid conditions with the greatest impact are allergic rhinitis, chronic rhinosinusitis, vocal cord dysfunction, lung fungal sensitisation and underlying structural lung disease.The most important airway-unrelated comorbid conditions are obesity, obstructive sleep apnoea, gastro-oesophageal reflux disease and anxiety and depression.A diagnostic and management algorithm for comorbid conditions in severe asthma is outlined. It concentrates initially on the group with common comorbid conditions that can be managed in primary care. If asthma remains troublesome, emphasis can shift to identifying uncommon and more complex factors. The algorithm allows for personalised diagnostic and management pathways to be implemented.Personalised diagnosis and management of comorbid conditions are essential to achieving effective and improved outcomes for patients with severe asthma.