The Global Initiative for Asthma guidelines (2019): Change in the recommendation for the management of mild asthma based on the SYGMA-2 trial - A critical appraisal
The Global Initiative for Asthma guidelines (2019): Change in the recommendation for the management of mild asthma based on the SYGMA-2 trial - A critical appraisal
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DOI：
10.4103/lungindia.lungindia_308_19
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发表时间：
2020-03-01
期刊：
影响因子：
1.6
通讯作者：
Thatte, Urmila Mukund
中科院分区：
文献类型：
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作者：
Rajan, Sujeet;Gogtay, Nithya J.;Thatte, Urmila Mukund
全球哮喘倡议（GINA）最近发布了最新的《哮喘管理和预防全球战略指南（2019）》。执业临床医生的口袋指南指出，“2019年GINA战略报告代表了30年来哮喘管理领域最重要的变化。”一项重要的建议是改变轻度哮喘的治疗策略，指南建议“所有患有哮喘的成人和青少年应接受症状驱动（轻度哮喘）或每日低剂量吸入皮质类固醇（ICS）控制治疗，以降低严重恶化的风险。”我们的研究对SYGMA-2试验进行了批判性评估，该试验在很大程度上构成了本推荐的基础，并讨论了仅使用长效β -2激动剂+ ICS与常规每日低剂量的短效β -2激动剂相比的潜在后果。我们的评论包括气道炎症、疾病异质性、理解非劣效性边际及其后果、霍桑效应和利益冲突。我们认为，这一重大声明将对临床实践产生深远的影响，这将符合一些患者的利益，但也不利于其他患者的利益。
The Global Initiative for Asthma (GINA) recently released their updated Global Strategy for Asthma Management and Prevention Guide (2019). The pocket guide for practicing clinicians states that "the 2019 GINA strategy report represents the most important change in asthma management in 30 years." An important recommendation is the change in treatment strategy for the management of mild asthma where the guideline recommends that" all adults and adolescents with asthma should receive either symptom driven (in mild asthma) or daily low dose inhaled corticosteroid (ICS) containing controller treatment to reduce the risk of serious exacerbations." Our study critically appraises the SYGMA-2 trial, a key trial that largely formed the basis of this recommendation and discusses the potential consequences of using only long-acting beta-2-agonist + ICS as needed as against regular, daily low-dose ICS with as-needed short-acting beta-2-agonist. Our critique covers airway inflammation, disease heterogeneity, understanding the noninferiority margin and its consequences, the Hawthorne effect, and conflict of interest. It is our view that statement of this magnitude will have far-reaching implications for clinical practice which will be in the interests of some patients but also against the interests of others.