Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK
North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
Eur Respir Rev. 2021 Sep 15;30(161). doi: 10.1183/16000617.0132-2021. Print 2021 Sep 30.
Guidelines aim to standardise and optimise asthma diagnosis and management. Nevertheless, adherence to guidelines is suboptimal and may vary across different healthcare professional (HCP) groups.Further to these concerns, this European Respiratory Society (ERS)/European Academy of Allergy and Clinical Immunology (EAACI) statement aims to: 1) evaluate the understanding of and adherence to international asthma guidelines by HCPs of different specialties an international online survey; and 2) assess strategies focused at improving implementation of guideline-recommended interventions, and compare process and clinical outcomes in patients managed by HCPs of different specialties systematic reviews.The online survey identified discrepancies between HCPs of different specialties which may be due to poor dissemination or lack of knowledge of the guidelines but also a reflection of the adaptations made in different clinical settings, based on available resources. The systematic reviews demonstrated that multifaceted quality improvement initiatives addressing multiple challenges to guidelines adherence are most effective in improving guidelines adherence. Differences in outcomes between patients managed by generalists or specialists should be further evaluated.Guidelines need to consider the heterogeneity of real-life settings for asthma management and tailor their recommendations accordingly. Continuous, multifaceted quality improvement processes are required to optimise and maintain guidelines adherence. Validated referral pathways for uncontrolled asthma or uncertain diagnosis are needed.
指南旨在规范和优化哮喘的诊断和管理。然而，指南的遵循情况并不理想，可能因不同医疗保健专业人员（HCP）群体而异。除了这些问题之外，欧洲呼吸学会（ERS）/欧洲过敏与临床免疫学学会（EAACI）的这份声明旨在：1）评估不同专业的 HCP 对国际哮喘指南的理解和遵循情况，采用国际在线调查；2）评估旨在改善指南推荐干预措施实施的策略，并比较不同专业的 HCP 管理的患者的过程和临床结果，进行系统评价。在线调查发现，不同专业的 HCP 之间存在差异，这可能是由于指南的传播不佳或缺乏了解，也可能反映了根据现有资源在不同临床环境中进行的调整。系统评价表明，针对指南遵循的多个挑战的多方面质量改进措施在提高指南遵循方面最为有效。应由一般医生或专家管理的患者的结果差异应进一步评估。指南需要考虑到管理哮喘的实际情况的异质性，并相应地调整其建议。需要持续进行多方面的质量改进过程，以优化和维持指南的遵循。需要为未控制的哮喘或不确定的诊断建立有效的转诊途径。
