Brigham & Women's Hospital, Boston, MA, USA.
J Allergy Clin Immunol. 2012 Mar;129(3 Suppl):S34-48. doi: 10.1016/j.jaci.2011.12.983.
The goals of asthma treatment include preventing recurrent exacerbations. Yet there is no consensus about the terminology for describing or defining "exacerbation" or about how to characterize an episode's severity.
National Institutes of Health institutes and other federal agencies convened an expert group to propose how asthma exacerbation should be assessed as a standardized asthma outcome in future asthma clinical research studies.
We used comprehensive literature reviews and expert opinion to compile a list of asthma exacerbation outcomes and classified them as either core (required in future studies), supplemental (used according to study aims and standardized), or emerging (requiring validation and standardization). This work was discussed at a National Institutes of Health-organized workshop in March 2010 and finalized in September 2011.
No dominant definition of "exacerbation" was found. The most widely used definitions included 3 components, all related to treatment, rather than symptoms: (1) systemic use of corticosteroids, (2) asthma-specific emergency department visits or hospitalizations, and (3) use of short-acting β-agonists as quick-relief (sometimes referred to as "rescue" or "reliever") medications.
The working group participants propose that the definition of "asthma exacerbation" be "a worsening of asthma requiring the use of systemic corticosteroids to prevent a serious outcome." As core outcomes, they propose inclusion and separate reporting of several essential variables of an exacerbation. Furthermore, they propose the development of a standardized, component-based definition of "exacerbation" with clear thresholds of severity for each component.
哮喘治疗的目标包括预防反复发作。然而，目前对于描述或定义“发作”的术语以及如何确定发作的严重程度尚未达成共识。
美国国立卫生研究院（NIH）及其它联邦机构召集专家组，提出如何将哮喘发作评估作为未来哮喘临床研究中的标准化哮喘结局。
我们综合文献回顾和专家意见，编制了一份哮喘发作结局列表，并将其分为核心（未来研究中必需）、补充（根据研究目的和标准化使用）和新兴（需要验证和标准化）类别。这项工作在 2010 年 3 月 NIH 组织的研讨会上进行了讨论，并于 2011 年 9 月最终确定。
未发现占主导地位的“发作”定义。最广泛使用的定义包括 3 个与治疗相关的组成部分，而不是症状：（1）全身使用皮质类固醇，（2）哮喘特定的急诊就诊或住院，以及（3）使用短效β-激动剂作为快速缓解（有时称为“抢救”或“缓解”）药物。
工作组参与者建议将“哮喘发作”定义为“需要使用全身皮质类固醇治疗以预防严重后果的哮喘恶化”。作为核心结局，他们建议纳入和单独报告发作的几个基本变量。此外，他们建议制定一种标准化的、基于组件的“发作”定义，并为每个组件设定明确的严重程度阈值。
