Domingo Christian, Garcia Gabriel, Gemicioglu Bilun, Van Giap Vu, Larenas-Linnemann Désirée, Neffen Hugo, Poachanukoon Orapan, Sagara Hironori, Berend Norbert, Pizzichini Emilio, Irusen Elvis, Aggarwal Bhumika, Eken Volkan, Levy Gur
Pneumology Service, Corporació Parc Taulí, Sabadell, Spain.
Servicio de Neumonología, Hospital Rossi La Plata, La Plata, Argentina.
J Asthma. 2023 Jan;60(1):145-157. doi: 10.1080/02770903.2022.2034850. Epub 2022 Feb 21.
In order to understand the role of regular controller inhaled corticosteroids (ICS) versus as-needed ICS-formoterol in managing mild asthma, we performed a modified Delphi procedure.
Opinions from 16 respiratory experts to three surveys and during a virtual scientific workshop helped to develop final consensus statements (pre-defined as 70% agreement).
Thirteen participants completed all rounds (response rate 81%). At the end of the procedure, there was final consensus on: regular daily ICS being the recommended treatment approach in mild persistent asthma, with better symptom control and robust long-term clinical data compared with as-needed ICS-formoterol (85%); to avoid noncompliance, frequently seen in mild asthma patients, regular ICS dosing should be accompanied by ongoing education on treatment adherence (100%); treatment aims should be targeting asthma control (92%) and reduction of exacerbation risk (85%). No consensus was reached on whether GINA or national guidelines most influence prescribing decisions.
It is important to encourage patients to be adherent and to target both asthma control and exacerbation risk reduction. There is robust clinical evidence to support proactive regular dosing with ICS controller therapy plus as-needed short-acting beta-agonists for the management of patients with mild asthma.
为了解常规控制吸入性糖皮质激素（ICS）与按需使用的ICS-福莫特罗在轻度哮喘管理中的作用，我们进行了一项改良的德尔菲法程序。
16位呼吸专家对三项调查以及在一次虚拟科学研讨会上发表的意见，有助于形成最终的共识声明（预先定义为70%的一致意见）。
13名参与者完成了所有轮次（回复率81%）。在该程序结束时，就以下方面达成了最终共识：在轻度持续性哮喘中，每日规律使用ICS是推荐的治疗方法，与按需使用的ICS-福莫特罗相比，症状控制更好且有可靠的长期临床数据（85%）；为避免在轻度哮喘患者中常见的不依从性，规律使用ICS给药应同时进行关于治疗依从性的持续教育（100%）；治疗目标应针对哮喘控制（92%）和降低加重风险（85%）。关于全球哮喘防治创议（GINA）或国家指南对处方决策的影响最大这一问题，未达成共识。
鼓励患者坚持治疗，并以哮喘控制和降低加重风险为目标非常重要。有充分的临床证据支持对轻度哮喘患者采用ICS控制疗法进行积极的规律给药，并按需使用短效β受体激动剂。
