Ellis Anne K, Foran Vanessa, Kaplan Alan, Mitchell Patrick D
Division of Allergy & Immunology, Department of Medicine, Queen's University, 76 Stuart St, Kingston, ON, K7L 2V7, Canada.
Asthma Canada, Toronto, ON, Canada.
Allergy Asthma Clin Immunol. 2022 Jun 11;18(1):48. doi: 10.1186/s13223-022-00690-2.
Patients with asthma frequently over rely on short-acting beta-agonists (SABA) to treat acute symptoms. This can adversely impact quality of life and increase the risk of exacerbations. SABA overuse is also associated with an increased risk of mortality. In their 2021 update on the diagnosis and management of mild asthma, the Canadian Thoracic Society (CTS) newly recommended that a combination inhaled corticosteroid (ICS) and long-acting beta-agonist, specifically budesonide/formoterol, may be used as-needed (PRN) as an alternative reliever to SABA. The CTS developed an algorithm as a guide for deciding for whom PRN budesonide/formoterol versus PRN SABA is appropriate as a reliever. While the CTS algorithm provides necessary and precise guidance, the somewhat complicated requirements for determining control and exacerbation risk may still end up leaving some patients at-risk of SABA overreliance. This communication simplifies the reliever decision algorithm developed by the CTS for application in daily practice. A 30-s evaluation of 2 simple questions related to reliever use can usually accurately assess if a patient's asthma is controlled: How many SABA canisters do you use a year AND how many times do you use SABA a week? If the patient indicates use of > 2 SABA canisters per year or > 2 administrations of SABA per week for any reason, the patient does not have controlled asthma and PRN SABA is not an appropriate treatment regimen. Similarly, for patients using PRN ICS/formoterol, more than 2 administrations per week indicates a clinical review and reevaluation of their management, including augmentation. An education process is essential to inform patients, caregivers, and healthcare providers that overuse of any reliever is not acceptable and is potentially harmful.
哮喘患者常常过度依赖短效β受体激动剂（SABA）来治疗急性症状。这可能会对生活质量产生不利影响，并增加病情加重的风险。过度使用SABA还与死亡风险增加有关。在其2021年轻度哮喘诊断和管理的更新中，加拿大胸科学会（CTS）新推荐吸入性糖皮质激素（ICS）和长效β受体激动剂的联合制剂，特别是布地奈德/福莫特罗，可按需（PRN）用作SABA的替代缓解药物。CTS制定了一种算法，作为决定哪些患者按需使用布地奈德/福莫特罗或按需使用SABA作为缓解药物的指南。虽然CTS算法提供了必要且精确的指导，但确定控制情况和病情加重风险的要求有些复杂，最终可能仍会使一些患者面临过度依赖SABA的风险。本交流简化了CTS制定的缓解药物决策算法，以便在日常实践中应用。对与缓解药物使用相关的2个简单问题进行30秒评估，通常可以准确评估患者的哮喘是否得到控制：你一年使用多少个SABA药罐以及你每周使用SABA多少次？如果患者表示因任何原因每年使用>2个SABA药罐或每周使用SABA>2次，则该患者的哮喘未得到控制，按需使用SABA不是合适的治疗方案。同样，对于按需使用ICS/福莫特罗的患者，每周使用超过2次表明需要进行临床检查并重新评估其治疗方案，包括加强治疗。教育过程对于告知患者、护理人员和医疗保健提供者任何缓解药物的过度使用都是不可接受的且可能有害至关重要。
