Allergy Unit, Pneumology Department, Hospital Clínic, IDIBAPS, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain.
Menasalbas Primary Health-Care Center, Toledo, Spain.
Expert Rev Respir Med. 2021 Mar;15(3):425-434. doi: 10.1080/17476348.2021.1841639. Epub 2020 Nov 10.
Asthma is managed by health professionals from different specialties. We aim to reach a consensus on the optimal use of inhaled therapy and the initial steps of asthma treatment, taking into account the opinions of the involved specialists.
A modified Delphi approach was used. A scientific committee provided 52 controversial statements, which were submitted to primary care physicians, allergists, and pulmonologists. Discrepancies among specialties were evaluated.
A total of 209 specialists completed the questionnaire (20.2 ± 9.3 years of asthma management experience). A consensus was reached on 37 statements (71.1%), discrepancies among specialties were found in 14. The most recommended maintenance treatment for mild persistent asthma in adults/adolescents was low-dose-inhaled corticosteroids daily. MART (Maintenance and Reliever Therapy) was recommended as salvage treatment for moderate persistent asthma. Panelists agreed on the most frequent critical errors with pressurized Metered-Dose Inhalers or Dry-Powder Inhalers, and considered that Breath-Actuated Inhalers are a suitable option for all patients with the ability to inhale voluntarily.
The experts endorse the main guidelines recommendations; however, do not fully agree on recent GINA recommendations about the treatment of the initial steps of the disease. The experts value positively the differential characteristics of BAI over other devices.
哮喘由不同专业领域的医疗保健专业人员管理。我们旨在就吸入疗法的最佳使用以及哮喘治疗的初始步骤达成共识，同时考虑到相关专家的意见。
采用改良 Delphi 法。一个科学委员会提供了 52 个有争议的陈述，这些陈述被提交给初级保健医生、过敏症专家和肺病专家。评估了专业之间的差异。
共有 209 名专家完成了问卷（哮喘管理经验 20.2±9.3 年）。就 37 项声明达成共识（71.1%），专业之间存在差异的有 14 项。成人/青少年轻度持续性哮喘的最推荐维持治疗是低剂量吸入皮质激素每日治疗。MART（维持和缓解治疗）被推荐为中度持续性哮喘的补救治疗。专家组同意关于加压计量吸入器或干粉吸入器最常见的关键错误，并认为呼吸驱动式吸入器是所有具有自愿吸入能力的患者的合适选择。
专家们认可主要指南推荐；然而，他们不完全同意 GINA 最近关于疾病初始阶段治疗的建议。专家们对 BAI 的差异特征给予了积极的评价，优于其他设备。
