Changi General Hospital, Singapore, Singapore
The Alfred Hospital, Melbourne, VIC.
Med J Aust. 2018 Jul 16;209(S2):S3-S10. doi: 10.5694/mja18.00125.
Patients with asthma that is uncontrolled despite high intensity medication can present in both primary and specialist care. An increasing number of novel (and expensive) treatments are available for patients who fail conventional asthma therapy, but these may not be appropriate for all such patients. It is essential that a rigorous evaluation process be undertaken for these patients to identify those with biologically severe asthma who will require novel therapies, and those who may improve with control of contributory factors. In this article, we describe three key steps in the diagnostic evaluation process for severe asthma. The first step is confirmation of asthma diagnosis with objective evidence of variable airflow obstruction. The second involves management of contributory factors such as non-adherence, poor inhaler technique, ongoing asthma triggers, and comorbidities. The third step involves phenotyping and endotyping of patients with severe asthma. We provide a practical approach to implementing these measures in both primary and secondary care.
尽管使用了高强度药物治疗，但哮喘仍未得到控制的患者可能会在初级保健和专科护理中就诊。对于那些对常规哮喘治疗无效的患者，有越来越多的新型（且昂贵）治疗方法可用，但这些方法并非对所有此类患者都适用。对于这些患者，必须进行严格的评估过程，以确定那些需要新型疗法的患者具有生物学意义上的严重哮喘，以及那些可能通过控制促成因素而改善的患者。在本文中，我们描述了严重哮喘诊断评估过程中的三个关键步骤。第一步是通过客观证据确认哮喘诊断，包括可变气流阻塞。第二步涉及管理促成因素，如不遵医嘱、吸入器使用技术不佳、持续存在的哮喘触发因素和合并症。第三步涉及严重哮喘患者的表型和内型分析。我们提供了一种在初级和二级保健中实施这些措施的实用方法。
