Russell Richard E K, Attar-Zadeh Darush, Harper Natalie, Mosgrove Fiona, Rush Laura, Singh Dave
Department of Immunobiology, King's College London, London, United Kingdom.
London North West University Healthcare NHS Trust, London, United Kingdom.
J Family Med Prim Care. 2024 Dec;13(12):5885-5893. doi: 10.4103/jfmpc.jfmpc_1082_24. Epub 2024 Dec 9.
An inhaled corticosteroid (ICS) in combination with a long-acting β2-agonist (LABA) is a common treatment approach for asthma patients not controlled on ICS alone, but a significant proportion of patients remain uncontrolled on this combination and treatment adherence can also be a challenge. One of the options for adults whose asthma is uncontrolled in an ICS/LABA is the addition of a long-acting muscarinic receptor antagonist (LAMA), an approach commonly referred to as 'triple therapy'. The use of medium-strength ICS/LABA/LAMA is established in treating chronic obstructive pulmonary disease but is less well-established in asthma. Lack of clarity exists regarding who should prescribe ICS/LABA/LAMA and in which patients, and this is compounded by a lack of consistency among guidelines.
To define the optimal prescribing of medium-strength ICS/LABA/LAMA triple therapy in adult asthma patients uncontrolled on ICS/LABA.
Using a modified Delphi method, a panel of experts developed 39 scale statements across six key domains. These statements were used to develop an online survey that was distributed to healthcare providers (HCPs) working with adult asthma throughout the UK. The threshold for consensus was set at 75%.
In total, 314 responses were received from primary and secondary care stakeholders involved in the management of asthma. On analysis, 22/39 statements reached a very strong agreement (≥90%) and 16/39 attained strong agreement (≥75% and < 90). From these results, the panellists developed a set of twelve recommendations to help define how an optimal approach for prescribing triple therapy in patients who are uncontrolled on an ICS/LABA can be achieved.
The strength of agreement shows that HCPs support the use of medium-strength ICS/LABA/LAMA triple therapy in appropriate asthma patients, and that clarity is needed regarding how best this can be achieved. The proposed set of recommendations provides such guidance to support the prescribing of triple therapy in primary care.
吸入性糖皮质激素（ICS）联合长效β2受体激动剂（LABA）是单独使用ICS无法控制病情的哮喘患者的常用治疗方法，但仍有相当一部分患者使用这种联合治疗方案后病情仍未得到控制，而且治疗依从性也可能是一个挑战。对于ICS/LABA治疗方案无法控制哮喘病情的成年人，一种选择是加用长效毒蕈碱受体拮抗剂（LAMA），这种方法通常称为“三联疗法”。中效ICS/LABA/LAMA联合使用已被确立用于治疗慢性阻塞性肺疾病，但在哮喘治疗中的应用尚不明确。对于谁应该开具ICS/LABA/LAMA处方以及适用于哪些患者存在不明确之处，而且指南之间缺乏一致性，这使问题更加复杂。
确定在ICS/LABA治疗方案下病情未得到控制的成年哮喘患者中，中效ICS/LABA/LAMA三联疗法的最佳处方开具方法。
专家小组采用改良的德尔菲法，在六个关键领域制定了39条量表陈述。这些陈述被用于开发一项在线调查，并分发给全英国从事成年哮喘患者治疗工作的医疗保健提供者（HCP）。达成共识的阈值设定为75%。
总共收到了参与哮喘管理的初级和二级医疗利益相关者的314份回复。经分析，39条陈述中有22条达成了非常强烈的共识（≥90%），16条达成了强烈共识（≥75%且<90%）。根据这些结果，专家小组成员制定了一套十二条建议，以帮助确定如何在ICS/LABA治疗方案下病情未得到控制的患者中实现三联疗法的最佳处方开具方法。
达成共识的力度表明，医疗保健提供者支持在合适的哮喘患者中使用中效ICS/LABA/LAMA三联疗法，并且需要明确如何才能最好地实现这一点。提议的这一套建议提供了此类指导，以支持初级保健中三联疗法的处方开具。
