Lugogo Njira, O'Connor Maeve, George Maureen, Merchant Rajan, Bensch Greg, Portnoy Jay, Oppenheimer John, Castro Mario
Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
Allergy Asthma and Immunology Relief, Charlotte, NC, USA.
Curr Allergy Asthma Rep. 2023 Nov;23(11):621-634. doi: 10.1007/s11882-023-01111-z. Epub 2023 Nov 22.
A modified Delphi process was undertaken to provide a US expert-led consensus to guide clinical action on short-acting beta-agonist (SABA) use. This comprised an online survey (Phase 1), forum discussion and statement development (Phase 2), and statement adjudication (Phase 3).
In Phase 1 (n = 100 clinicians), 12% routinely provided patients with ≥4 SABA prescriptions/year, 73% solicited SABA use frequency at every patient visit, and 21% did not consult asthma guidelines/expert reports. Phase 3 experts (n = 8) reached consensus (median Likert score, interquartile range) that use of ≥3 SABA canisters/year is associated with increased risk of exacerbation and asthma-related death (5, 4.75-5); SABA use history should be solicited at every patient visit (5, 4.75-5); usage patterns over time, not absolute thresholds, should guide response to SABA overuse (5, 4.5-5). Future asthma guidelines should include clear recommendations regarding SABA usage, using expert-led thresholds for action.
采用改良的德尔菲法，以美国专家主导达成共识，为短效β受体激动剂（SABA）的使用提供临床指导。这包括在线调查（第1阶段）、论坛讨论和声明制定（第2阶段）以及声明裁决（第3阶段）。
在第1阶段（n = 100名临床医生），12%的医生常规每年为患者开具≥4份SABA处方，73%的医生在每次患者就诊时询问SABA使用频率，21%的医生未参考哮喘指南/专家报告。第3阶段的专家（n = 8）达成共识（李克特量表中位数得分，四分位间距），即每年使用≥3个SABA吸入器与加重风险和哮喘相关死亡风险增加相关（5，4.75 - 5）；每次患者就诊时均应询问SABA使用史（5，4.75 - 5）；应根据随时间变化的使用模式而非绝对阈值来指导应对SABA过度使用的措施（5，4.5 - 5）。未来的哮喘指南应纳入关于SABA使用的明确建议，采用专家主导的行动阈值。
