Pneumology, Kantonsspital Graubünden, Chur, Switzerland.
University Clinic of Medicine, Kantonsspital Baselland, Liestal, Switzerland.
Respiration. 2018;95(5):364-380. doi: 10.1159/000486797. Epub 2018 Apr 3.
The Global Initiative for Asthma (GINA) is a network of individuals, organizations, and public health officials that was established to disseminate information about the care of patients with asthma and to improve asthma care. The GINA ("Global Strategy for Asthma Management and Prevention") report has been updated annually since 2002. Due to new knowledge and therapeutic development in the field, the Swiss Respiratory Society felt the need to provide a new document that is based on both the available literature and the recommendations of the 2016 GINA report. Key new features of the 2016 GINA report include a "new" definition of asthma, underscoring its heterogeneous nature, and the core elements of variable symptoms and variable expiratory airflow limitation; the importance of confirming the diagnosis of asthma in order to minimize both under- and overtreatment; practical tools for the assessment of symptom control and risk factors for adverse outcomes; a comprehensive approach to asthma management that acknowledges the foundational role of inhaled corticosteroid therapy, but also provides a framework for individualizing patient care; an emphasis on maximizing the benefit of available medications by addressing common problems such as incorrect inhaler technique and poor adherence; a continuum of care for worsening asthma, starting with early self-management and progressing to primary care or acute care management; and diagnosis of the asthma/chronic obstructive pulmonary disease overlap syndrome. This document is meant to advice the key stakeholders on the diagnosis and management of asthma and highlights the need to individualize the care of each and every asthmatic patient.
全球哮喘倡议 (GINA) 是一个由个人、组织和公共卫生官员组成的网络，旨在传播有关哮喘患者护理的信息，并改善哮喘护理。自 2002 年以来，GINA（“哮喘管理和预防全球策略”）报告每年都在更新。由于该领域的新知识和治疗方法的发展，瑞士呼吸学会认为有必要提供一份新的文件，该文件既基于现有文献，又基于 2016 年 GINA 报告的建议。2016 年 GINA 报告的主要新特点包括对哮喘的“新”定义，强调其异质性，以及症状和呼气气流受限的可变核心要素；为了最大限度地减少治疗不足和过度治疗，确诊哮喘的重要性；用于评估症状控制和不良结果危险因素的实用工具；一种综合的哮喘管理方法，承认吸入皮质类固醇治疗的基础作用，但也为个体化患者护理提供了框架；强调通过解决常见问题（如吸入器技术不正确和依从性差）来最大限度地提高现有药物的效益；逐步升级的哮喘恶化管理，从早期自我管理开始，发展到初级保健或急性保健管理；以及哮喘/慢性阻塞性肺疾病重叠综合征的诊断。本文件旨在为哮喘的诊断和管理的主要利益相关者提供建议，并强调需要个体化每个哮喘患者的护理。
