抽象的
拟议的抗炎缓解剂(空气)疗法算法和行动计划为在临床实践中使用该方案提供了实用的指导https://bit.ly/3c0w7ec
来自作者:
We thank B. Lipworth and colleagues for their insightful comments and for raising the important issue of distinguishing between maintenance and reliever budesonide–formoterol use within the anti-inflammatory reliever (AIR) therapy regimen. We agree that such a distinction may be artificial and not be possible in clinical practice. We consider that this is an important conceptual issue but one that may have limited clinical relevance, when prescribing budesonide–formoterol according to a maintenance and reliever therapy regimen in asthma. Indeed it has been shown, from electronic monitoring of inhaler use, that there is such marked variation in medication use when budesonide–formoterol is used as a maintenance and reliever therapy, both long term and prior to severe exacerbations, that such differentiation is both unrealistic and not required in clinical practice [1,,,,2]。Despite the potential for confusion as to how to differentiate between maintenance and reliever medication use, there is substantive evidence that when inhaled corticosteroid (ICS)–formoterol is prescribed according to the regular maintenance ICS–formoterol and reliever regimen, greater efficacy is obtained compared with regular maintenance ICS or ICS–long-acting β-agonist together with short-acting β-agonist (SABA) reliever therapy [3,,,,4]。提供了概念示意性视频,以说明该方案的维护和补充组件的重要性[5]。
B. Lipworth及其同事提出的另一项提议是,要实施布德索尼德 - 成甲醇空气方案,首选仅建议患者“在需要时使用更多的芽/FM,而在他们不需要的情况下则更少”。,,,,IE。仅作为救济者疗法,没有定期安排的维护使用。虽然这很可能是有多少患者在处方为维护和缓解疗法的情况下使用ICS-构酚醇,但目前的证据表明这不是首选方法。唯一检查了布德索尼 - 甲醇缓解剂的临床试验相对定期维护布德索尼 - 成甲醇(加上需要的Terbutaline)报告说,尽管严重恶化风险没有差异,但布德索尼 - 甲烯醇缓解方案的疗效较小(复合主要结果变量),尽管没有差异[6]。相比之下,与维护布德索尼尼德 - 甲烯醇 - 甲烯醇加上ASEADEDED的Terbutaline相比3,,,,4]。This strongly suggests that budesonide–formoterol maintenance and reliever therapy would likewise reduce severe exacerbation risk compared with budesonide–formoterol reliever alone.
提出的另一个问题是简单性与证据之间的平衡与治疗方案的实施之间。迄今为止,仅在轻度和中度哮喘中评估了Budesonide -formoterol的“按需”方案,而不是在严重疾病中进行评估,而该方案已被评估为该人群中的维持使用,这是最大的发病率和风险[3,,,,4,,,,6]。The simple asthma action plan proposed for “on demand” use is novel, whereas the proposed AIR asthma action plan is a modified version of those in current use in New Zealand and Australia, which are based on prototypes shown to improve outcomes in adult asthma [7]。但是,我们承认,尽管有证据表明空气算法和相关计划是基于的[4], it will still be necessary to undertake research to determine how the plan is used in clinical practice, and what modifications may be required. The importance of research of the integration of treatments across asthma severity, as well as the treatments at each step, is evident from the review of the historical Global Initiative for Asthma (GINA) algorithms, in which it was proposed that the stepwise approach to asthma management may have led to excessive doses of ICS therapy in clinical practice [8]。同样,将需要对新的2019年GINA算法进行正式评估,以确定其在简单性和证据之间是否具有适当的平衡[9]。
B. Lipworth及其同事得出结论,提出处方者的挑战是说服患者不再需要单独的SABA REALIVER吸入器,尤其是那些过度依赖Salbutamol的人。我们建议他们的结论有一个警告,即更大,更重要的挑战可能是说服开处方接受哮喘管理的这种基于证据的范例[9]。我们希望我们提出的空气算法和行动计划可以提供这种变化所需的实际指导。
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脚注
利益冲突:R。Beasley报告了在提交工作之外的阿斯利康和新西兰健康研究委员会的赠款和个人费用。
利益冲突:I。Braithwaite在提交的工作之外报告了阿斯利康和新西兰卫生研究委员会的赠款。
利益冲突:A。Semprini无需披露。
利益冲突:C。Kearns无话可说。
利益冲突:M。Weatherall没有什么可披露的。
利益冲突:T。Harrison报告了Astrazeneca的赠款,个人费用和非财务支持,在提交工作之外的GSK和Chiesi的个人费用和非财务支持。
利益冲突:A。Papi报告董事会成员资格,咨询,讲座的付款,glaxosmithkline,Astrazeneca,Boehringer Ingelheim,Chiesi farmaceutici和Teva的研究和旅行费用赠款,董事会成员,咨询,咨询,咨询费用,咨询和旅行费用的支付和旅行支出Mundipharma,Zambon,Novartis和Sanofi/Regeneron,赠款,付款和旅行费用的付款,从Menarini偿还了销售费用,董事会会员资格,咨询和旅行费用的个人费用,Roche的董事会成员资格,咨询费用,FONDAZIONE MIMAUGEI和FONDAZIONE CHIESIYE,FONDAZIONE CHIESIYE的赠款来自Edmondpharma,在提交的工作之外。
利益冲突:I.D。帕沃德(Pavord)向阿斯利康(Astrazeneca)的演讲,咨询委员会工作,会议的出席和教育活动报告个人费来自Almirall和Novartis的顾问委员会工作,Genentech,Regeneron,Sanofi,Circassia和Knopp的顾问委员会工作费用,讲座的个人费用,Teva的出席和教育活动,来自NIHR的Teva,来自NIHR的赠款。
- received2020年3月11日。
- 公认2020年3月12日。
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