Maneechotesuwan Kittipong, Aggarwal Bhumika, Garcia Gabriel, Tan Daniel, Neffen Hugo, Javier Ramon Jason M, Al-Ahmad Mona, Khadada Mousa, Quan Vu Tran Thien, Teerapuncharoen Krittika, Ramos Mario Soto, Levy Gur, Plank Maximilian, Phansalkar Abhay, Gibson Peter G
Division of Respiratory Disease and Tuberculosis, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Emerging Markets, GSK, Singapore, 139234, Singapore.
Pulm Ther. 2024 Sep;10(3):279-295. doi: 10.1007/s41030-024-00262-2. Epub 2024 Jun 4.
Clinical remission is a relatively new concept in asthma but recent research initiatives suggest it could be an ambitious and achievable therapeutic target for patients with asthma.
In this modified Delphi study (comprising two online surveys, completed either side of a virtual scientific workshop), the opinions of a panel of respiratory physicians were evaluated to summarize perspective statements on key therapeutic outcomes and criteria for on-treatment clinical remission in patients with moderate asthma. An agreement threshold was pre-defined as agreement by ≥ 75% of participants.
Surveys 1 and 2 were completed by 20 and 18 participants, respectively. Most participants (95%) agreed with the concept of clinical remission in moderate asthma and that this should be a desirable treatment goal (90%). Based on a composite measure of 4-6 desirable therapeutic outcomes, current understanding of clinical remission was considered as 12 months with no exacerbations, no oral corticosteroids, no daytime or night-time asthma symptoms (Asthma Control Test score ≥ 20 or Asthma Control Questionnaire score ≤ 0.75), stable lung function, and no treatment-related adverse events. No agreement was reached on the role of relievers in defining therapeutic outcomes or on the wider use of biomarkers and airway hyperresponsiveness for defining asthma remission in clinical practice.
In line with recent consensus statements from the United States and Europe, there was a high level of agreement on the elements of clinical remission among a panel of respiratory physicians from Asia, the Middle East, and South America. Extension of the concept of clinical remission to patients with moderate asthma was considered aligned with the potential of clinical remission as a goal of therapy.
临床缓解是哮喘领域一个相对较新的概念，但近期的研究倡议表明，它可能是哮喘患者一个宏伟且可实现的治疗目标。
在这项改良的德尔菲研究（包括两项在线调查，在虚拟科学研讨会前后完成）中，对一组呼吸内科医生的意见进行了评估，以总结关于中度哮喘患者治疗期间临床缓解的关键治疗结果和标准的观点陈述。预先将共识阈值定义为≥75%的参与者达成一致。
调查1和调查2分别有20名和18名参与者完成。大多数参与者（95%）同意中度哮喘临床缓解的概念，并且认为这应该是一个理想的治疗目标（90%）。基于4 - 6项理想治疗结果的综合衡量标准，目前对临床缓解的理解是12个月无急性加重、无口服糖皮质激素、无日间或夜间哮喘症状（哮喘控制测试评分≥20或哮喘控制问卷评分≤0.75）、肺功能稳定且无治疗相关不良事件。对于缓解药物在定义治疗结果中的作用以及在临床实践中更广泛地使用生物标志物和气道高反应性来定义哮喘缓解，未达成一致意见。
与美国和欧洲最近的共识声明一致，来自亚洲、中东和南美洲的一组呼吸内科医生对临床缓解的要素达成了高度一致。将临床缓解的概念扩展到中度哮喘患者被认为与临床缓解作为治疗目标的潜力相一致。
