Ahlbeck Lars, Stridh Björn, Ställberg Björn, Kiotseridis Hampus, Janson Christer, Romberg Kerstin
Universitetssjukhuset i Linkoping - Linkoping, Sweden Universitetssjukhuset i Linkoping - Linkoping, Sweden.
Kista Vårdcentral - Kista, Sweden Kista Vårdcentral - Kista, Sweden.
Lakartidningen. 2018 Mar 27;115:EY3E.
Swedish asthma guidelines recommend treating asthma with the lowest effective dose possible. These recommendations are both hard to follow and seldom considered enough in asthma care today. As an example, combination therapy with inhaled corticosteroids (ICS) and long acting beta agonists (LABA) should only be considered if asthma control is not achieved with low to medium dose ICS daily. However, the Swedish National Board of Health and Welfare estimates that 120 000 asthma patients are overmedicated with combination therapy. Guidelines are clear in instructions of when and how to step up asthma treatment, while instructions for stepping down are not that obvious. In this article, we present an asthma treatment algorithm for step 1-3 in adults for use in clinical practice (Fig. 1), where stepping down asthma treatment is considered as an alternative. Included are also instructions of how to step down asthma treatment (Fig. 2). We conclude that stepping down is possible to do in a safe way in certain patient groups while maintaining asthma control. If possible risks are taken into consideration, stepping down asthma treatment can be done in every clinical setting.
瑞典哮喘指南建议使用尽可能低的有效剂量治疗哮喘。这些建议在当今的哮喘护理中既难以遵循，也很少得到充分考虑。例如，只有在每日使用低至中等剂量吸入性糖皮质激素（ICS）仍无法实现哮喘控制时，才应考虑使用ICS与长效β受体激动剂（LABA）的联合疗法。然而，瑞典国家卫生和福利委员会估计，有12万名哮喘患者接受了过度的联合治疗。指南对于何时以及如何加强哮喘治疗的说明很明确，但关于逐步减少治疗的说明却不那么明显。在本文中，我们提出了一种适用于临床实践的成人哮喘治疗1-3级算法（图1），其中将逐步减少哮喘治疗视为一种选择。还包括了如何逐步减少哮喘治疗的说明（图2）。我们得出结论，在某些患者群体中，以安全的方式逐步减少治疗并维持哮喘控制是可行的。如果考虑到可能的风险，在每种临床环境中都可以逐步减少哮喘治疗。
