Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
Department of Clinical Pharmacy & Pharmacology, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
J Allergy Clin Immunol Pract. 2021 Apr;9(4):1516-1519. doi: 10.1016/j.jaip.2020.12.035. Epub 2020 Dec 26.
In 2019, it was reported that changes to asthma management reported in the Global Initiative for Asthma (GINA) "…might be considered the most fundamental changes in asthma management in 30 years." These changes refer to the recommendation that the treatment of asthma in adolescents and adults would no longer include short-acting ß-agonist (SABA) only, but that people with asthma should receive either symptom-driven inhaled corticosteroids (ICS)-containing treatment (mild asthma) or daily ICS-containing treatment. The fundamental reason for this shift was driven by concerns about the risks and consequences associated with SABA-only treatment, the need to improve the day-to-day management of asthma symptoms to prevent exacerbations and emergent evidence. These recommendations have subsequently been reinforced and characterized in GINA 2020, and it is reasonable to say that they are significant, not only in terms of an asthma management framework but also as a management approach in practice. This opinion article specifically focuses on opportunities and challenges associated with the implementation of GINA 2020 in primary care practice that need to be recognized and addressed if the shift in asthma treatment paradigm is to be successfully implemented into day-to-day practice.
2019 年，据报道，全球哮喘倡议（GINA）中报告的哮喘管理变化“……可能被认为是 30 年来哮喘管理最根本的变化。”这些变化指的是建议不再将青少年和成人的哮喘治疗仅限于短效β-激动剂（SABA），而是应根据症状为患有哮喘的人提供含有吸入皮质激素（ICS）的治疗（轻度哮喘）或每天含有 ICS 的治疗。这种转变的根本原因是担心 SABA 单一治疗相关的风险和后果，需要改善哮喘症状的日常管理以预防恶化和出现新的证据。这些建议随后在 GINA 2020 中得到了强化和特征描述，可以合理地说，它们不仅在哮喘管理框架方面具有重要意义，而且在实践中的管理方法方面也具有重要意义。这篇观点文章特别关注在初级保健实践中实施 GINA 2020 时需要认识到的机会和挑战，如果要成功地将哮喘治疗模式的转变实施到日常实践中，这些机会和挑战就需要得到解决。
