Colice Gene L
The George Washington University School of Medicine, Pulmonary, Critical Care and Respiratory Services, Washington Hospital Center, Washington DC, USA.
Pragmat Obs Res. 2012 Apr 17;3:11-25. doi: 10.2147/POR.S16671. eCollection 2012.
Asthma and chronic obstructive pulmonary disease (COPD) are common diseases which cause patients and society considerable difficulties. These are costly diseases which cause substantial morbidity and death. Health care policy makers have made improving outcomes in asthma and COPD a priority. Application of guideline recommended approaches to asthma and COPD care in the real-life setting has been emphasized but outcomes have not improved. Failure to improve outcomes may not be because of inconsistent applications of guideline recommendations, but rather because there are difficulties implementing the Expert Panel Report III (EPR 3) method for categorizing asthma severity and the Global Initiative for Obstructive Lung Disease (GOLD) method for diagnosing COPD. As these serve as the foundation for treatment recommendations for these diseases, alternative approaches should be considered for categorizing asthma severity and identifying COPD patients. Claims-based algorithms provide an intriguing option for identifying persistent asthma patients and symptomatic COPD patients in administrative databases. These methods could be used as the basis for pragmatic research, both retrospective and prospective, on assessing outcomes of guideline recommended treatment approaches in asthma and COPD. Important questions urgently need to be answered about how guideline recommended approaches regarding use of long-acting inhaled β-agonist/inhaled corticosteroid (LABA/ICS) in asthma and long-acting inhaled anti-muscarinic agent (LAMA) and LABA/ICS in COPD affect outcomes in real-life situations.
哮喘和慢性阻塞性肺疾病（COPD）是常见疾病，给患者和社会带来了诸多困难。这些疾病成本高昂，会导致大量发病和死亡。医疗保健政策制定者已将改善哮喘和COPD的治疗效果作为优先事项。在现实生活中应用指南推荐的哮喘和COPD护理方法已得到强调，但治疗效果并未改善。治疗效果未能改善可能并非因为指南建议的应用不一致，而是因为在实施专家小组报告III（EPR 3）的哮喘严重程度分类方法以及慢性阻塞性肺疾病全球倡议（GOLD）的COPD诊断方法时存在困难。由于这些方法是这些疾病治疗建议的基础，因此应考虑采用替代方法来分类哮喘严重程度和识别COPD患者。基于索赔的算法为在行政数据库中识别持续性哮喘患者和有症状的COPD患者提供了一个有趣的选择。这些方法可作为对哮喘和COPD指南推荐治疗方法的评估结果进行回顾性和前瞻性实用研究的基础。关于哮喘中长效吸入β受体激动剂/吸入性糖皮质激素（LABA/ICS）以及COPD中长效吸入抗胆碱能药物（LAMA）和LABA/ICS的指南推荐使用方法如何在现实生活中影响治疗效果，迫切需要回答一些重要问题。
