Capital Allergy & Respiratory Disease Center, Sacramento, California.
Washington University School of Medicine and St. Louis Children's Hospital, Division of Allergy, Immunology and Pulmonary Medicine, Saint Louis, Missouri.
Ann Allergy Asthma Immunol. 2019 Mar;122(3):241-262.e4. doi: 10.1016/j.anai.2018.12.004. Epub 2018 Dec 12.
Asthma guidelines recommend a control-based approach to disease management in which the assessment of impairment and risk is linked to step-based therapy. Using this model, controller treatment is adjusted-upward or downward-according to a patient's level of asthma control over time. Strategies for stepping up controller therapy are well described, and the adult and pediatric Asthma Yardsticks provide operational recommendations based on patient profiles. Strategies for stepping down controller treatment are less clear, although stepping down to the minimum effective therapy is important and should be considered when a patient's asthma has been well controlled for an adequate period as defined by risk and impairment. This Yardstick presents recommendations for when and how to step down asthma controller therapy according to guideline-defined control levels. The objective is to provide clinicians who treat patients with asthma with a practical and clinically relevant framework for implementing a step-down in controller therapy.
哮喘指南建议采用基于控制的疾病管理方法，其中损害和风险的评估与基于阶梯的治疗相关联。使用这种模式，根据患者哮喘控制的时间变化，调整控制器治疗的（治疗）强度——向上或向下。控制器治疗升级策略有详细描述，成人和儿科哮喘尺规提供了基于患者特征的操作建议。控制器治疗降级策略则不太明确，尽管降级到最低有效治疗是重要的，并且应该在患者的哮喘在定义的风险和损害期内得到充分控制时考虑。该尺规根据指南定义的控制水平，提出了何时以及如何降级哮喘控制器治疗的建议。目的是为治疗哮喘患者的临床医生提供一个实用的、具有临床相关性的框架，以实施控制器治疗的降级。
