Tchen Stephanie, Vu Truong, Fleischman Megan, Ward Jory, Trapp Caitlyn, Hu Kurt
Department of Pharmacy, Froedtert Hospital, 9200 W Wisconsin Ave, Milwaukee, WI, 53226, USA.
Department of Pharmacy, Oregon Health & Science University, 181 SW Sam Jackson Park Rd, Portland, OR, 972001, USA.
Intern Emerg Med. 2023 Oct;18(7):2029-2036. doi: 10.1007/s11739-023-03401-w. Epub 2023 Sep 11.
In 2019, a landmark change was made to the Global Initiative for Asthma (GINA) guidelines in which an as-needed low-dose inhaled corticosteroid (ICS)-formoterol inhaler was updated to be the preferred reliever therapy for all asthma patients. Use of short-acting beta-agonist monotherapy is no longer recommended. The purpose of this study was to assess provider adherence with the GINA guidelines in regards to reliever therapy. This was a retrospective cohort study of patients presenting with an acute asthma exacerbation from January to May of 2020 and 2021. The primary objective of this study was to quantify provider adherence with the GINA guidelines in terms of reliever therapy. Preferred reliever therapy was defined as use of an as-needed low-dose ICS-formoterol combination inhaler. Alternative reliever therapy was defined as use of a SABA inhaler with ICS-containing controller therapy. Secondary objectives included the number of patients discharged on any form of corticosteroid and the number of patients who may have been ideal candidates for transition to preferred reliever therapy. A total of 127 patients were included in the analyses. Upon hospital discharge, three patients (2.4%) received preferred reliever therapy and 97 (76.4%) received alternative reliever therapy. Rates of recommended reliever therapy prescription increased from 55 to 79% upon hospital discharge (p < 0.001). Prescription of GINA guideline-recommended reliever therapy was 79% within the patient population evaluated; however, rates significantly improved following hospitalization for asthma exacerbation. Additional studies that assess barriers to guideline adherence may be recommended.
2019年，全球哮喘防治创议（GINA）指南发生了一项具有里程碑意义的变化，即按需使用的低剂量吸入性糖皮质激素（ICS）-福莫特罗吸入器被更新为所有哮喘患者的首选缓解药物治疗。不再推荐使用短效β受体激动剂单一疗法。本研究的目的是评估医疗服务提供者在缓解药物治疗方面对GINA指南的依从性。这是一项回顾性队列研究，研究对象为2020年1月至5月以及2021年1月至5月出现急性哮喘加重的患者。本研究的主要目的是量化医疗服务提供者在缓解药物治疗方面对GINA指南的依从性。首选缓解药物治疗定义为按需使用低剂量ICS-福莫特罗联合吸入器。替代缓解药物治疗定义为使用含有ICS的控制药物治疗的短效β受体激动剂吸入器。次要目标包括接受任何形式糖皮质激素出院的患者数量以及可能是转为首选缓解药物治疗理想人选的患者数量。共有127名患者纳入分析。出院时，3名患者（2.4%）接受了首选缓解药物治疗，97名患者（76.4%）接受了替代缓解药物治疗。出院时推荐的缓解药物治疗处方率从55%提高到79%（p<0.001）。在评估的患者群体中，GINA指南推荐的缓解药物治疗处方率为79%；然而，哮喘加重住院后该比率显著提高。可能建议开展更多评估指南依从性障碍的研究。
