Ryan Dermot, Murphy Anna, Ställberg Björn, Baxter Noel, Heaney Liam G
General Practitioner, Woodbrook Medical Centre, Loughborough, UK; Honorary Clinical Research Fellow, Allergy and Respiratory Research Group, The University of Edinburgh, Edinburgh, UK.
Prim Care Respir J. 2013 Sep;22(3):365-73. doi: 10.4104/pcrj.2013.00075.
The substantial majority of patients with asthma can expect minimal breakthrough symptoms on standard doses of inhaled corticosteroids with or without additional add-on therapies. SIMPLES is a structured primary care approach to the review of a person with uncontrolled asthma which encompasses patient education monitoring, lifestyle and pharmacological management and addressing support needs which will achieve control in most patients. The small group of patients presenting with persistent asthma symptoms despite being prescribed high levels of treatment are often referred to as having 'difficult asthma'. Some will have difficult, 'therapy resistant' asthma, some will have psychosocial problems which make it difficult for them to achieve asthma control and some may prove to have an alternative diagnosis driving their symptoms. A few patients will benefit from referral to a 'difficult asthma' clinic. The SIMPLES approach, aligned with close co-operation between primary and specialist care, can identify this patient group, avoid inappropriate escalation of treatment, and streamline clinical assessment and management.
绝大多数哮喘患者在使用标准剂量吸入性糖皮质激素（无论是否联合其他附加治疗）时，预计只会出现极少的突破性症状。SIMPLES是一种针对未控制哮喘患者的结构化初级保健方法，包括患者教育、监测、生活方式和药物管理以及满足支持需求，这将使大多数患者实现病情控制。尽管接受了高强度治疗仍出现持续性哮喘症状的一小部分患者通常被称为患有“难治性哮喘”。其中一些患者患有难治性“治疗抵抗性”哮喘，一些患者存在心理社会问题，这使得他们难以实现哮喘控制，还有一些患者可能被证明有其他诊断导致其出现症状。少数患者将受益于转诊至“难治性哮喘”诊所。SIMPLES方法与初级保健和专科护理之间的密切合作相结合，可以识别出这一患者群体，避免不适当的治疗升级，并简化临床评估和管理。
