Bateman E D, Bousquet J, Braunstein G L
UCT Lung Institute, University of Cape Town, South Africa.
Eur Respir J. 2001 Apr;17(4):589-95. doi: 10.1183/09031936.01.17405890.
The efficacy of asthma therapy is traditionally measured using single end-points. In contrast, the aim of therapy is to achieve overall control, defined by management guidelines as achieving a number of treatment goals. These goals reflect expert opinion, rather than being evidence based. The objective of this study was to determine whether guideline-defined asthma control is achievable. Eight studies of salmeterol/fluticasone propionate combination therapy were analysed using three asthma control measures of varying stringency, derived from the guideline goals. For each measure, only patients meeting all goals were classified as controlled. The analysis demonstrated that asthma control, as defined by management guidelines, can be achieved. For a given therapy, similar proportions of patients achieved control irrespective of disease severity, suggesting that outcome expectations should not be reduced for patients with more severe disease. Substantially more patients achieved the target values for individual goals than achieved overall control, indicating that reliance on individual end-points is likely to result in significant overestimation of true control. The findings of this hypothesis-generating study should be prospectively tested. Future research will include a randomized controlled study designed to assess the proportion of patients able to achieve overall control of asthma when treatment is titrated appropriately.
传统上，哮喘治疗的疗效是通过单一终点来衡量的。相比之下，治疗的目标是实现全面控制，管理指南将其定义为达成一系列治疗目标。这些目标反映的是专家意见，而非基于证据。本研究的目的是确定指南定义的哮喘控制是否能够实现。使用从指南目标衍生出的三种不同严格程度的哮喘控制指标，对八项沙美特罗/丙酸氟替卡松联合治疗的研究进行了分析。对于每项指标，只有达到所有目标的患者才被归类为病情得到控制。分析表明，管理指南所定义的哮喘控制是可以实现的。对于给定的治疗方法，无论疾病严重程度如何，达到控制的患者比例相似，这表明对于病情更严重的患者，不应降低其预期疗效。实现各个目标的靶值的患者数量远多于实现全面控制的患者数量，这表明依赖单个终点可能会导致对真正控制情况的显著高估。这项产生假设的研究结果应进行前瞻性检验。未来的研究将包括一项随机对照研究，旨在评估在适当调整治疗方案时能够实现哮喘全面控制的患者比例。
