TY-JUR T1 - 吸入的皮质类固醇/长效β-激动剂维护和救济疗法方案：来自这里的地方？JF - 欧洲呼吸杂志Jo - Eur Respir J Do - 10.1183/13993003.02338-2017 VL - 51 IS - 1 SP - 1702338 Au - Beasley，Richard Au - Braithwaite，Irene Au - Fingleton，James Au - Weatherall，Mark Y1 - 2018 /01/01 UR - //www.qdcxjkg.com/content/51/1/1702338.abstract n2 - 组合吸入皮质类固醇（ICS）/长效β-激动剂（Laba）吸入器治疗（ICS / Laba疗法）代表适度和严重哮喘管理的主要负担，推荐在哮喘（GINA）步骤3,4和5 [1]的全球诉讼程序中。实际上，在一些国家，例如澳大利亚，ICS / Laba疗法现在代表了默认的ICS治疗，最近的调查报告称，每五名成年人中的每五名成年人都有超过四个患有ICS / Laba治疗[2,3]。结果，IC / Laba治疗的最佳使用是哮喘管理的优先事项，这需要考虑一些关键问题。首先，由于与Laba单疗法的风险与他们的IC吸入器无粘连的患者有关的风险，IC和Laba不应作为哮喘的单独吸入器处方。本建议令人担忧令人讨厌的是，与IC / Laba治疗相比，Laba单药治疗患者对哮喘患者的死亡率增加了患者的患者的风险，没有鉴定出这种风险[5]。其次，有两个主要管理方案，由此可以规定ICS / Laba吸入器。最常见的“标准”方案是固定剂量IC / Laba维护，其具有短效β-激动剂（SABA）作为释放。替代选择是使用组合IC / Laba吸入器作为维护和救济疗法（称为Mart Regimen）。 To implement the MART regimen it is necessary for the LABA component to have a fast onset of action, which allows for its use as a reliever as well as a maintenance therapy. The efficacy of the MART regimen has been illustrated with budesonide/formoterol using both turbuhaler [6] and metered dose inhaler (MDI) [7] devices for delivery, as well as with beclometasone/formoterol using the MDI device [8]. Thirdly, there is evidence that turbuhaler administration of budesonide/formoterol according to the MART regimen is more effective than the regimen comprising fixed-dose ICS/LABA maintenance (at a higher maintenance ICS dose) with “as required” SABA therapy in adults and children with chronic asthma [9]. In the Cochrane systematic review and meta-analysis summarising this evidence, the point estimates for the magnitude of the greater efficacy of the MART regimen were large. For the MART regimen versus the higher fixed-dose ICS/LABA regimen, the odds ratio for risk of exacerbations requiring hospitalisation or a visit to the emergency room was 0.72 (95% CI 0.57–0.90) while the odds ratio for exacerbations requiring oral corticosteroids was 0.75 (95% CI 0.65–0.87). This knowledge-base has now been extended by the publication, by jorup et al. [10] in this issue of the European Respiratory Journal, of an individual patient data subgroup meta-analysis which reports on the efficacy of the MART regimen in children aged 12–17 years. This meta-analysis includes 1847 adolescents from six double-blind randomised controlled trials comparing MART with an active comparator. Five trials required patients to have had at least one asthma exacerbation in the previous year at randomisation, thereby ensuring that the findings could be generalised to high risk adolescents with asthma. Comparator treatments used a SABA or LABA as the reliever therapy and included maintenance ICS at a dose of at least double the equivalent daily maintenance dose of ICS used in the MART regimen, or maintenance ICS/LABA at the same or a higher equivalent daily maintenance ICS dose, thereby representing the main treatment options from GINA steps 2, 3, 4 and 5 [1].ICS/LABA maintenance and reliever therapy is recommended for adolescents with asthma at risk of severe exacerbations http://ow.ly/xhhO30gKZ6W ER -