Raimondi G A
Instituto de Investigaciones Neurológicas Raúl Carrea, FLENI, Buenos Aires.
Medicina (B Aires). 1998;58(1):29-35.
A survey about asthma management was conducted in a group of 300 chest physicians randomized from a list of the whole country. This paper dealt with the questions about treatment in acute asthma and during maintenance therapy in adults and in children older than 6 years. Of the questionnaires mailed, 98 responses were obtained (32.7%)); 71% of the responders were respiratory medicine specialists (RM), 12% RM + Internal Medicine (IM), 6% in RM + Allergy (A), 5% in A, 4% in IM and 2% in IM + A. For the treatment of acute severe episodes 57.5% of the physicians chose nebulized or inhaled beta agonists (IBA) as the first choice for adults and 63.4% for children, parenteral steroids 26.3% in adults and 22.5% in children. For maintenance therapy, the first choice formulation was IBA for adults in 37.6% of the responders and inhaled steroid (IS) in 34.1% of them. In children, 34.7% of the responders choose IBA, 25.3% cromoglicate or nedocromil and 14.7% IS. IBA were prescribed more commonly for treating symptoms, secondly for preventing symptoms and in third place for continuous preventive treatment in adults and in children. The recommendation of IBA for treating and preventing symptoms were more commonly done in children. The average normal daily dose of IS was 297 and 254 micrograms for adults and children, respectively. The average maximal dose was 1176 and 618 micrograms for adults and children, respectively. The recommendation of hyposensitization for allergic asthma was, as mean score of frequency of use (from 0 = never to 3 = always), 0.96 for adults and 1.13 for children. Important drawbacks were detected in the treatment approach. In acute asthma episodes about 40% of the responders did not use IBA as the first choice of treatment. For maintenance treatment IS were rarely used, and their doses were less than the usually recommended by different guidelines. IBA were seldom recommended for prevention or treatment of symptoms. They are used moderately as continuous preventive treatment. Hyposensitization is commonly recommended and more frequently used than in other countries.
对从全国名单中随机抽取的300名胸科医生进行了一项关于哮喘管理的调查。本文探讨了成人及6岁以上儿童急性哮喘治疗和维持治疗期间的相关问题。在邮寄的问卷中,获得了98份回复(32.7%);71%的回复者是呼吸内科专家(RM),12%是RM + 内科(IM),6%是RM + 过敏科(A),5%是A科,4%是IM科,2%是IM + A科。对于急性重症发作的治疗,57.5%的医生选择雾化或吸入β受体激动剂(IBA)作为成人的首选治疗药物,63.4%作为儿童的首选;成人使用静脉注射类固醇的比例为26.3%,儿童为22.5%。对于维持治疗,37.6%的回复者将IBA作为成人的首选剂型,34.1%选择吸入性类固醇(IS)。在儿童中,34.7%的回复者选择IBA,25.3%选择色甘酸或奈多罗米,14.7%选择IS。IBA在成人和儿童中更常用于治疗症状,其次用于预防症状,排在第三位的是持续预防性治疗。IBA用于治疗和预防症状的建议在儿童中更为常见。成人和儿童IS的平均正常日剂量分别为297微克和254微克。成人和儿童的平均最大剂量分别为1176微克和618微克。对于过敏性哮喘的脱敏治疗建议,以使用频率的平均得分(从0 = 从不使用到3 = 总是使用)计算,成人是0.96,儿童是1.13。在治疗方法中发现了一些重要缺陷。在急性哮喘发作中,约40%的回复者没有将IBA作为首选治疗药物。在维持治疗中,IS很少使用,其剂量低于不同指南通常推荐的剂量。IBA很少被推荐用于预防或治疗症状。它们作为持续预防性治疗使用适度。脱敏治疗通常被推荐,且比其他国家使用更频繁。