Fiona Stanley Hospital, Perth, WA
Fiona Stanley Hospital, Perth, WA.
Med J Aust. 2018 Jul 16;209(S2):S34-S40. doi: 10.5694/mja18.00119.
Severe asthma encompasses treatment-refractory asthma and difficult-to-treat asthma. There are a number of barriers in primary, secondary and tertiary settings which compromise optimal care for severe asthma in Australia. Guidelines recommend a multidimensional assessment of severe asthma, which includes confirming the diagnosis, severity and phenotype and identifying and treating comorbidities and risk factors. This approach has been found to improve severe asthma symptoms and quality of life and reduce exacerbations. Primary care providers can contribute significantly to the multidimensional approach for severe asthma by performing spirometry, optimising therapy and addressing risk factors such as non-adherence and smoking before referring the patient to a respiratory physician for review. Primary care practitioners are encouraged to remain engaged with the management of a patient with severe asthma following specialist review by assisting with community-based allied health referrals, managing general medical comorbidities and administering prescribed biological therapies. Specialists can support primary care by providing advice to individuals with indeterminate diagnosis, streamlining investigation and management of unrecognised risk factors and complex comorbidities, optimising treatment for severe or difficult asthma including assessment of suitability for and, if appropriate, initiating advanced therapies such as biological therapies. When discharging patients back to primary care, specialists should provide clear recommendations regarding ongoing management and should specify the indications requiring further specialist review, ideally offering a streamlined re-referral pathway.
严重哮喘包括治疗抵抗性哮喘和难以治疗的哮喘。在初级、二级和三级医疗保健环境中存在许多障碍，这影响了澳大利亚严重哮喘的最佳治疗。指南建议对严重哮喘进行多维评估，包括确认诊断、严重程度和表型，以及识别和治疗合并症和危险因素。这种方法已被发现可改善严重哮喘症状和生活质量，并减少恶化。初级保健提供者可以通过进行肺功能检查、优化治疗以及在将患者转介给呼吸科医生进行审查之前解决非依从性和吸烟等危险因素，为严重哮喘的多维方法做出重大贡献。鼓励初级保健从业者在专科医生审查后继续参与严重哮喘患者的管理，通过协助社区基础联合健康转诊、管理一般医学合并症和管理规定的生物疗法来协助管理。专科医生可以通过为诊断不确定的个体提供建议、简化未被识别的危险因素和复杂合并症的调查和管理、优化严重或难治性哮喘的治疗（包括评估适合性以及是否适当启动高级治疗，如生物疗法）来支持初级保健。当将患者转回初级保健时，专科医生应就持续管理提供明确建议，并应指定需要进一步专科审查的指征，理想情况下提供简化的重新转诊途径。
