Nanda Anil, Siles Roxana, Park Henna, Louisias Margee, Ariue Barbara, Castillo Maria, Anand Mahesh Padukudru, Nguyen Anh P, Jean Tiffany, Lopez Michael, Altisheh Roula, Pappalardo Andrea A
Asthma and Allergy Center, Lewisville-Flower Mound; Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas.
Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Foundation, Cleveland.
J Allergy Clin Immunol. 2023 Apr;151(4):869-880. doi: 10.1016/j.jaci.2023.01.017. Epub 2023 Jan 28.
The most recent recommendations from the 2020 National Asthma Education and Prevention Program Update and Global Initiative for Asthma 2021 guide evidence-based clinical decision making. However, given the present state of health disparities by age, income, and race, the equitable implementation and dissemination of these guidelines will be unlikely without further guidance. This work group report reviews the current state of the new asthma guideline implementation; presents updated evidence-based therapeutic options with attention to specific patient populations; and addresses barriers to the implementation of these guidelines in minoritized, historically marginalized, and underresourced communities. Allergists and immunologists can use practical ways to accomplish the goals of improved asthma care access and advanced asthma care across the life span, with specific considerations to historically marginalized populations. Modifiable barriers to guideline implementation include financial barriers, environmental factors, and allergy subspecialty access and care coordination. Various programs to improve access to guideline-based asthma care include community programs, school-based asthma programs, and digital health solutions, with an emphasis on reducing disparities by race.
2020年国家哮喘教育与预防计划更新版以及2021年全球哮喘防治创议的最新建议为循证临床决策提供了指导。然而,考虑到目前在年龄、收入和种族方面存在的健康差异状况,如果没有进一步的指导,这些指南的公平实施和传播将不太可能实现。本工作组报告回顾了新哮喘指南实施的现状;介绍了针对特定患者群体的最新循证治疗选择;并探讨了在少数族裔、历史上被边缘化以及资源不足的社区实施这些指南的障碍。过敏症专科医生和免疫学家可以采用切实可行的方法,实现改善哮喘护理可及性以及在整个生命周期提供高级哮喘护理的目标,同时特别考虑历史上被边缘化的人群。指南实施中可改变的障碍包括经济障碍、环境因素以及过敏专科诊疗可及性和护理协调。各种旨在改善基于指南的哮喘护理可及性的项目包括社区项目、学校哮喘项目和数字健康解决方案,重点是减少种族差异。