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老年哮喘患者的多重用药:潜在风险与改善机遇

Polypharmacy in older patients with asthma: hidden risks and opportunities for improvement.

作者信息

Tomasello Alessandra, Benfante Alida, Lisotta Alessia, Macaluso Dario, Viswanathan Sengottuwell, Cahill Katherine N, Scichilone Nicola

机构信息

Division of Respiratory Medicine, PROMISE Department, "Paolo Giaccone" University Hospital, University of Palermo, Palermo, Italy.

Division of Allergy, Pulmonary and Critical care Medicine, Vanderbilt University Medical Center, Nashville, USA.

出版信息

Expert Rev Respir Med. 2024 Dec;18(12):1047-1059. doi: 10.1080/17476348.2024.2444331. Epub 2024 Dec 23.

Abstract

INTRODUCTION

Polypharmacy can be considered the norm in elderly patients, because older individuals experience an increasing number of concomitant respiratory and non-respiratory diseases other than asthma, carrying the risk of drug-to-drug-interactions and drug-to-comorbidities interactions. In this context, asthma in older adults, conventionally aging >65 years of age, cannot be adequately managed without considering their individual characteristics, as these challenge the traditional therapeutic algorithms/management strategies commonly applied to younger populations.

AREAS COVERED

The current article aims at addressing pitfalls and advantages of current pharmacological strategies in older individuals with asthma. Comorbidities become more common with increasing age and are also more frequent in adults with asthma than in those without it. Multiple medications are often needed to control asthma symptoms and prevent asthma exacerbations, and older patients with asthma may also take multiple medications for common comorbidities and complex health conditions, such as chronic cardiometabolic diseases. Polypharmacy is an emerging concern in the elderly population.

EXPERT OPINION

A patient-centered approach is crucial and polypharmacy in asthma requires careful management. A multidisciplinary approach will allow for a more holistic care and will ensure that all aspects of a patient's health are considered, optimizing medication management.

摘要

引言

多重用药在老年患者中可能被视为常态,因为老年人除哮喘外还患有越来越多的合并呼吸道和非呼吸道疾病,存在药物相互作用以及药物与合并症相互作用的风险。在这种情况下,如果不考虑老年成年人(传统上年龄>65岁)的个体特征,就无法对其哮喘进行充分管理,因为这些特征对通常应用于年轻人群的传统治疗算法/管理策略构成了挑战。

涵盖领域

本文旨在探讨当前针对老年哮喘患者的药理学策略的陷阱和优势。合并症随着年龄增长变得更加常见,并且在成年哮喘患者中也比非哮喘患者更频繁。通常需要多种药物来控制哮喘症状并预防哮喘发作,而且老年哮喘患者可能还会因常见合并症和复杂健康状况(如慢性心脏代谢疾病)而服用多种药物。多重用药在老年人群中是一个新出现的问题。

专家观点

以患者为中心的方法至关重要,哮喘中的多重用药需要谨慎管理。多学科方法将实现更全面的护理,并确保考虑患者健康的所有方面,优化药物管理。

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