是时候替代仅限saba的哮喘抢救治疗了

Surveillance data from both Europe and the US have shown that nearly half of asthma patients remain uncontrolled on their current treatment.^1-3 哮喘患者有哮喘加重(发作)的危险, 不论年龄大小, 严重程度, 控制者用药依从性, 或者哮喘控制.^1,4,5 病情恶化是发病和死亡的主要原因;⁶ 即使被诊断为轻度哮喘的患者也有病情恶化的风险.⁴

 

据估计，全球每年有1.36亿例哮喘加重，⁷ 与 全世界每年因哮喘就诊的急诊人数估计为1.16亿.⁸ 在美国，每年有超过1000万例病情加重，⁹ 结果大于1.急诊科800万人次⁹ 170000年住院治疗上⁹ 超过4000人死亡.⁹

这些攻击对许多患者来说既具有身体上的威胁，又具有重大的情感意义¹⁰ 可能是致命的.^11,12

除了情感和身体上的代价, 管理不善的哮喘也带来沉重的经济和社会负担. When accounting for the amount spent annually on asthma-related medication and hospital admissions, 以及间接成本，如失去工作和上学时间, this puts a significant strain on not only the people living 与 this disease and their families, 还有医疗保健系统.¹²

仅使用saba的方法会使患者面临哮喘发作的风险

哮喘是一种慢性炎症性呼吸道疾病，症状多样.^6,12 这种炎症导致气道狭窄和恶化，导致哮喘症状.¹³

Many patients 与 asthma use short-acting beta2-agonist (SABA) rescue inhalers (or bronchodilators), 例如沙丁胺醇, 来治疗他们的疾病.^14-16 虽然沙巴能快速缓解症状, 它不能解决潜在的炎症, 使患者面临严重恶化的风险.¹⁷ 病情恶化反过来会导致生活质量受损，¹⁸ 频繁使用口服皮质类固醇(OCS)¹⁹ 和住院治疗.¹⁹

在美国, around 44% of patients across all asthma severities exacerbated once or more over a 12-month period, 无论SABA或维护使用,²⁰ 通常需要短期的OCS疗程来控制症状.²¹

Even short-term treatment of 急性加重 与 OCS is associated 与 an increased risk of adverse health conditions, 包括2型糖尿病, 抑郁/焦虑, 肾功能损害, 白内障, 心血管病, 肺炎和骨折.^6,22,23 这些不良反应可进一步加重哮喘的负担.

SABA use of more than three canisters per year is associated 与 an increased risk of 急性加重, 独立于哮喘控制和吸入皮质类固醇(ICS)维持治疗.^24,25 数据来自最大的真实世界哮喘吸入器治疗观察性分析, 沙巴在哮喘中的应用(SABINA), 在欧洲和北美都有, the incidence of severe 急性加重 increased 与 increasing SABA canister prescription/possession, 独立于维持治疗.^24,25  Data from the UK showed that using three or more SABA inhalers a year resulted in a 20% increased risk of 急性加重 in people 与 mild asthma and a 24% increased risk in people 与 moderate to severe asthma.²⁶

确保临床指南得到落实

International recommendations from the 全球哮喘倡议 (GINA) recommend anti-inflammatory rescue therapy to treat symptoms and inflammation concomitantly, 并且不再推荐单独使用SABA治疗.⁶ The National Asthma Education and Prevention Programme (NAEPP) guidelines in the US conditionally recommend either daily low-dose ICS and as-needed SABA for quick relief therapy, or as-needed ICS and SABA used concomitantly for individuals aged 12 years and older 与 mild persistent asthma to reduce the risk of 急性加重.²⁷

然而, 患者开始依赖于他们的SABA抢救吸入器, 相信这是控制哮喘的最好方法. Patient behaviour underestimates the need to take daily maintenance medication and prioritises quick relief when needed. 在一项调查中, 90% of patients reported they want treatments that provide immediate relief and 34% said they used less maintenance medication (通常与SABA吸入器一起开)当他们感觉良好时.²⁸

Early reliance by patients on SABA is quickly established as it is often the first medicine prescribed and because it 提供了快速 缓解他们经历的呼吸困难症状.^29-31 这意味着在症状发作时，许多患者本能地伸手去拿他们的沙巴吸入器.

The rationale for prescribing a combination of an ICS and a bronchodilator together is that it aligns 与 the patients’ preference for an as-needed treatment approach for their asthma, driven by day-to-day symptom levels and following their natural behaviour to treat symptoms as and when they arise. 然而, 同时, 它还在最需要的时候为气道炎症升高提供治疗.^29,32

哮喘管理需要改变什么?

Far too many people 与 asthma have their lives disrupted by 急性加重 that could be prevented. A combined approach focusing on inhaled combination medicines that provide symptom relief whilst also addressing underlying inflammation should be central to asthma management to optimise patient outcomes.

Strategies to achieve better outcomes for patients will also need to include increased awareness of the risks of using a SABA alone to manage asthma, as well as careful monitoring of SABA use to help identify those patients at risk of future 急性加重.

 

沙丁胺醇也被称为沙丁胺醇

参考文献

1.     价格, 等. 8 .哮喘控制与管理,000名欧洲患者:认识哮喘并与症状和经验联系(realize)调查. NPJ整洁护理呼吸医学. 2014; 24: 14009.

2.     疾病预防控制中心. 成人未控制哮喘，2016. [在线]/可在:http://www.疾病预防控制中心.gov /哮喘/ asthma_stats / uncontrolled-asthma-adults.htm. [上次访问:2022年12月.]

3.     疾病预防控制中心. 2018-2020年哮喘患儿哮喘未控制. [在线]/可在:http://www.疾病预防控制中心.gov /哮喘/ asthma_stats /控制-哮喘儿童- 2018 - 2020.htm[最后访问日期:2022年12月].

4.     布鲁姆CI, 等. 英国哮喘人群从婴儿到老年的恶化风险和特征. 胸腔. 2018; 73: 313-320.

5.     爸爸, 等. Relationship of Inhaled Corticosteroid Adherence to Asthma Exacerbations in Patients 与 Moderate-to-Severe Asthma. 变态反应临床免疫实践. 2018; 6: 1989-1998.

6.     全球哮喘倡议. 《澳门葡京赌博游戏》，2022年. 可在:http://ginasthma.org/wp content/uploads/2022/07/gina -主要报告- 2022 - 22 - 07 - 01 - wms.pdf. [最后访问日期:2022年12月].

7.     澳门葡京网赌游戏制药. 存档数据. 布地奈德/福莫特罗存档数据:全球哮喘加重年发生率.  (ID: DoFP REF-173201

8.     Anenberg SC, 等. Estimates of the Global Burden of Ambient, Ozone, and on Asthma Incidence and Emergency Room Visits. 环境健康展望. 2018; 126 (10): 107004[BG1]

9.     疾病预防控制中心. 最新的国家哮喘数据. [在线]/可在:http://www.疾病预防控制中心.gov /哮喘/ most_recent_national_asthma_data.htm. [最后访问日期:2022年12月].

10.  即将J, 等. 的见解, 的态度, and perceptions about asthma and its treatment: a multinational survey of patients from Europe and Canada. 世界过敏器官. 2016; 9: 13.

11.  费尔南德斯AG) 等. 严重哮喘患者死亡的危险因素. [J]. 2014; 40 (4): 364-372.

12.  全球哮喘网络. 2022年全球哮喘报告. (在线). 可在:http://globalasthmareport.org/index.html[最后访问日期:2022年12月].

13.  华克PA, 等. 哮喘加重·3:发病机制. 胸腔. 2006; 61 (10): 909-15.

14.  约翰逊DB, 等. 沙丁胺醇. 2022年5月1日. 来源:StatPearls[互联网]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–. PMID: 29489143.

15.  Montemayor T, 等. 沙丁胺醇:经常使用和严重滥用. 呼吸道护理 十一月2021,66(增刊10)3603775.

16.  ClinCalc.com. 沙丁胺醇:药物使用统计，美国2013 - 2020. 可在:http://clincalc.com/DrugStats/Drugs/沙丁胺醇. [最后访问日期:2022年12月].

17.  Nwaru BI, 等. Overuse of short-acting β2-agonists in asthma is associated 与 increased risk of exacerbation and mortality: a nationwide cohort study of the global SABINA programme. Eur呼吸器. 2020; 55 (4): 1901872.

18.  劳埃德, 等. The impact of asthma 急性加重 on health-related quality of life in moderate to severe asthma patients in the UK. Prim Care呼吸器. 2007; 16 (1): 22-7.

19.  布, 等. ERS/EAACI关于成人哮喘严重恶化的声明:事实, 优先事项和关键研究问题. Eur呼吸器. 2019; 54 (3): 1900900.

20.   Pate CA等. 哮喘监测-美国，2006-2018. 毫米波监测大会. 2021; 70 (No. SS-5): 1–32.

21.  Lugogo N, 等. Relations of Annual Short-Acting Beta2-Agonist Use and Systemic Corticosteroid Exposure in Children and Adults 与 Asthma in the United States. 海报于2021年5月14日至19日在ATS 2021虚拟会议上发布. 胸部. 2021; 160 (4): A1889-1892 http://doi.org/10.1016/j.胸部.2021.07.1679.  

22.  价格数据库, 等. Adverse outcomes from initiation of systemic corticosteroids for asthma: long-term observational study. J哮喘过敏. 2018; 11: 193–204.

23.  EPR-3:专家小组报告. 2007年哮喘诊断和管理指南(EPR-3). (在线). 可在:http://www.nhlbi.国家卫生研究院.gov /健康话题/ guidelines-for-diagnosis-management-of-asthma. [最后访问日期:2022年12月].

24.  五胞胎JK, 等; SABINA North American and European Study contributors. Short-Acting Beta-2-Agonist Exposure and Severe Asthma Exacerbations: SABINA Findings From Europe and North America. 变态反应临床免疫实践. 2022; 10 (9): 2297-2309.e10.

25.  贝特曼, 等. 短效β₂-激动剂处方与哮喘临床预后差相关:多国, 横断面SABINA III研究. Eur呼吸器. 2022; 59 (5): 2101402. 

26.  布鲁姆CI, 等. 短效β与哮喘相关的健康结果₂激动剂吸入器的使用:作为SABINA全球项目一部分的一项英国观察性研究. 人其他. 2020; 37: 4190-4208.

27.  2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. 可在:http://www.nhlbi.国家卫生研究院.gov/health-topics/asthma-management guidelines-2020-updates[最后访问:2022年12月].

28.  帕特里奇先生, 等. 哮喘患者对定期维持治疗的态度和行动:INSPIRE研究. BMC内科. 2006; 6: 13.

29.  报道点, 等. 哮喘管理的悖论:是时候采用新方法了? Eur呼吸器. 2017; 50 (3): 1701103.

30.  Reddel香港, 等. 在没有预防剂的情况下管理哮喘的风险:紧急医疗保健, 在横断面人群调查中，哮喘控制不良和非处方缓解药的使用. BMJ开放. 2017; 7 (9): e016688-e.

31.  科尔的年代, 等. ‘The blue one takes a battering’ why do young adults 与 asthma overuse bronchodilator inhalers? 定性研究. BMJ开放. 2013; 3 (2): e002247.

32.  Pavord ID, 等. 哮喘之后:重新定义呼吸道疾病. 《澳门葡京赌博游戏》. 2018; 391 (10118): 350-400.

Veeva ID: Z4-51128

筹备日期:2022年12月