Pulmonology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Portugal; Centre of Pulmonology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
Serviço de Imunoalergologia, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal; Clínica Universitária de Imunoalergologia, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.
Pulmonology. 2021 Jul-Aug;27(4):313-327. doi: 10.1016/j.pulmoe.2020.10.002. Epub 2020 Nov 8.
We aimed to build a national consensus to optimize the use of oral corticosteroids (OCS) in severe asthma in Portugal.
A modified 3-round Delphi including 65 statements (topics on chronic systemic corticotherapy, therapeutic schemes, asthma safety and monitoring) was performed via online platform (October-November 2019). A five-point Likert-type scale was used (1-'strongly disagree'; 5-'strongly agree'). Consensus threshold was established as a percentage of agreement among participants ≥90% in the 1st round and ≥85% in the 2nd and 3rd rounds. The level of consensus achieved by the panel was discussed with the participants (face-to-face meeting).
Forty-eight expert physicians in severe asthma (specialists in allergology and pulmonology) participated in the study. Almost half of the statements (28/65; 43.1%) obtained positive consensus by the end of round one. By the end of the exercise, 12 (18.5%) statements did not achieve consensus. Overall, 87% of physicians agree that further actions for OCS cumulative risk assessment in acute asthma exacerbations are needed. The vast majority (91.7%) demonstrated a favorable perception for using biological agents whenever patients are eligible. Most participants (95.8%) are more willing to accept some degree of lung function deterioration compared to other outcomes (worsening of symptoms, quality of life) when reducing OCS dose. Monitoring patients' comorbidities was rated as imperative by all experts.
These results can guide an update on asthma management in Portugal and should be supplemented by studies on therapy access, patients' adherence, and costs.
我们旨在建立一个全国共识，以优化葡萄牙严重哮喘患者口服皮质类固醇（OCS）的使用。
采用改良的 3 轮 Delphi 法，包括 65 项陈述（关于慢性全身皮质激素治疗、治疗方案、哮喘安全性和监测的主题），通过在线平台进行（2019 年 10 月至 11 月）。采用 5 分李克特量表（1-“强烈不同意”；5-“强烈同意”）。共识阈值设定为第 1 轮参与者同意率≥90%，第 2 轮和第 3 轮参与者同意率≥85%。与参与者（面对面会议）讨论小组达成的共识水平。
48 名严重哮喘专家医师（变态反应学和肺病学专家）参与了这项研究。几乎一半的陈述（28/65；43.1%）在第 1 轮结束时获得了积极的共识。到研究结束时，仍有 12 项（18.5%）陈述未达成共识。总体而言，87%的医生认为需要进一步采取行动评估急性哮喘发作中 OCS 的累积风险。绝大多数（91.7%）的医生表示，只要患者符合条件，就会赞成使用生物制剂。与其他结果（症状恶化、生活质量）相比，大多数参与者（95.8%）更愿意接受一定程度的肺功能下降，以减少 OCS 剂量。所有专家都认为监测患者的合并症至关重要。
这些结果可以指导葡萄牙哮喘管理的更新，还应补充关于治疗途径、患者依从性和成本的研究。
