Magnoni M S, Caminati M, Canonica G W, Arpinelli F, Rizzi A, Senna G
Medical and Scientific Department, GlaxoSmithKline, Verona, Italy.
Asthma Center and Allergy Unit, Verona University Hospital, Verona, Italy.
Clin Mol Allergy. 2017 May 8;15:11. doi: 10.1186/s12948-017-0067-2. eCollection 2017.
In Europe more than 50% of asthmatic treated patients have not well-controlled asthma. Asthma affects about 2.5 million of patients in Italy.
The present survey aims at investigating how Italian allergists approach asthmatic patients, in order to highlight pitfalls and unmet needs concerning real-life asthma management.
An anonymous 16 item web questionnaire was available (April-October 2015) to all allergists who visited the web site of SIAAIC (Società Italiana di Allergologia, Asma Immunologia Clinica). Those who wished to give their contribution had the opportunity to answer about epidemiology, risk factors, treatment approaches, and adherence to therapy.
One hundred and seventy four allergists answered the survey. 54% of them reported up to 10 patient visits per week and 35.3% between 10 and 30. The most frequent reasons of follow up visits are routine check-up (56.5% of allergists), and worsening of symptoms (41% of allergists). Nocturnal apnoeas, gastro-esophageal reflux and obesity are the most important comorbidities/risk factors of poorly controlled asthma. Bronchial hyper-responsiveness, increased NO levels and reduced exercise tolerance are the most important indicators of asthma severity. Concerning therapy, ICS combined with LABA is the treatment of choice suitable for the majority of patients. A rapid onset of action and a flexible ICS dosage are indicated as the optimal characteristics for achieving the therapeutic goals. Poor adherence to therapy is an important reason for symptom worsening for the majority of allergists. Complex dosage regimens and economic aspects are considered the most important factors impacting on adherence.
Allergists are involved in the management of asthma, regularly seeing their patients. Co-morbidities are frequent in asthmatic patients and may impact negatively on disease control, thus identifying patients who need a more careful and strict monitoring. Airway hyper-responsiveness to methacholine challenge test and nitric oxide are considered important indicators of asthma severity. The combination of LABA and inhaled steroids is considered the treatment of choice for most asthmatic patients, in keeping with broad evidence indicating that the combination therapy is more effective and rapid in gaining asthma control than inhaled corticosteroids alone. Adherence to medication regimens is considered of essence to achieve the therapeutic goals.
在欧洲，超过50%接受治疗的哮喘患者病情控制不佳。哮喘影响着意大利约250万患者。
本次调查旨在研究意大利过敏症专科医生如何诊治哮喘患者，以突显实际哮喘管理中存在的问题和未满足的需求。
2015年4月至10月期间，一份包含16个项目的匿名网络问卷面向所有访问意大利过敏、哮喘与临床免疫学会（SIAAIC）网站的过敏症专科医生开放。愿意参与的医生有机会回答有关流行病学、危险因素、治疗方法及治疗依从性等问题。
174名过敏症专科医生参与了调查。其中54%报告每周看诊患者多达10例，35.3%报告每周看诊10至30例。随访就诊最常见的原因是常规检查（56.5%的过敏症专科医生）和症状加重（41%的过敏症专科医生）。夜间呼吸暂停、胃食管反流和肥胖是哮喘控制不佳最重要的合并症/危险因素。支气管高反应性、一氧化氮水平升高和运动耐量降低是哮喘严重程度最重要的指标。在治疗方面，吸入性糖皮质激素（ICS）联合长效β2受体激动剂（LABA）是适合大多数患者的首选治疗方法。快速起效和灵活的ICS剂量被认为是实现治疗目标的最佳特性。对大多数过敏症专科医生而言，治疗依从性差是症状加重的重要原因。复杂的给药方案和经济因素被认为是影响依从性的最重要因素。
过敏症专科医生参与哮喘管理，定期诊治患者。哮喘患者常伴有合并症，可能对疾病控制产生负面影响，因此需要识别出需要更仔细和严格监测的患者。气道对乙酰甲胆碱激发试验和一氧化氮的高反应性被认为是哮喘严重程度的重要指标。LABA与吸入性糖皮质激素联合使用被认为是大多数哮喘患者的首选治疗方法，这与广泛的证据一致，即联合治疗在控制哮喘方面比单独使用吸入性糖皮质激素更有效、起效更快。坚持药物治疗方案被认为是实现治疗目标的关键。
