Department of Pneumology, University of Rostock, Rostock, Germany.
Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.
Lancet Respir Med. 2023 Jun;11(6):573-576. doi: 10.1016/S2213-2600(22)00490-8. Epub 2023 Jan 27.
The management of asthma has changed fundamentally during the past two decades. Precise assessment and phenotyping are now required to establish individually targeted treatment with disease-modifying anti-asthmatic drugs (DMAADs). Patients with asthma are often managed by primary care doctors or non-respiratory specialists in secondary care. However, the implementation of complex asthma guidelines in non-specialised care remains a challenge. There is a need for easy-to-understand, concise guides for general practice. In this Viewpoint, we propose a one-page practical guide for asthma management, titled ABCD, with four components: dual assessment (A) of asthma (ie, diagnosis and phenotype, plus asthma control and future risks); basic measures (B; eg, education, self-management skills, regular physical activity, and avoidance of asthma triggers); identification and treatment of comorbidities (C) of asthma (eg, chronic rhinosinusitis, obesity, or sleep apnoea); and phenotype-specific, individually targeted treatment with DMAADs (D), including individual inhalation schemes based on inhaled corticosteroids, leukotriene modifiers, biologics, and allergen immunotherapy.
在过去的二十年中,哮喘的管理发生了根本性的变化。现在需要进行精确的评估和表型分析,以确定针对疾病修饰性抗哮喘药物(DMAAD)的个体化靶向治疗。哮喘患者通常由初级保健医生或二级保健中的非呼吸科专家进行管理。然而,在非专科护理中实施复杂的哮喘指南仍然是一个挑战。需要为一般实践提供易于理解、简洁的指南。在本观点中,我们提出了一个名为 ABCD 的一页实用哮喘管理指南,有四个部分:哮喘的双重评估(A)(即诊断和表型,加上哮喘控制和未来风险);基本措施(B;例如,教育、自我管理技能、定期体育活动和避免哮喘诱因);哮喘合并症(C)的识别和治疗(例如,慢性鼻-鼻窦炎、肥胖或睡眠呼吸暂停);以及针对 DMAAD 的表型特异性个体化靶向治疗(D),包括基于吸入皮质类固醇、白三烯调节剂、生物制剂和过敏原免疫治疗的个体化吸入方案。