哮喘联盟

   摘要
   全球哮喘防治倡议（GINA）由世界卫生组织和美国心脏、肺、血液研究所于1993年创立，为管理和预防哮喘制定全球性策略。GINA报告，资金来源为销售GINA产品，为许多国家的指南提供了基础。报告由来自于初级、中级和三级医疗机构的专家所筹备，并每年回顾证据后更新。2014年，一项GINA报告的主要校订发布，其不仅收录了哮喘及其治疗的进步，同时也收录了如何在临床实践中提高循证医学应用的新进展。该报告总结了在新的GINA报告中有关初级医疗保健的重要变化。值得注意的差异是报告做法从根本上的改变，目前注重于临床，运用多元实践工具和流程图以提高对于繁忙的一线临床医生的实用性。推荐的报告重要变化包括一项新的、以诊断为主的哮喘定义；更多关于如何评估当前症状控制和未来风险的细节；个体化治疗的综合方法；扩大运用吸入糖皮质激素治疗的适应症；书面哮喘行动计划的新建议；增加哮喘-COPD重叠综合征患者诊断和初始治疗的新章节；修正学龄前儿童哮喘诊断方法。2014版GINA报告（将于2015年更新）改变了“教科书式”的方法，以切实的、以实践为中心的形式，为临床医生提供了控制哮喘症状、减少哮喘风险策略的最新证据。
 

（苏欣 审校）
NPJ Prim Care Respir Med. 2015 Jul 30;25:15050. doi: 10.1038/npjpcrm.2015.50.

 

The GINA asthma strategy report: what's new for primary care?
 

Reddel HK1, Levy ML2.
 

Abstract
The Global Initiative for Asthma (GINA) was established in 1993 by the World Health Organization and National Heart Lung and Blood Institute to develop a global strategy for managing and preventing asthma. GINA reports, now funded independently through the sale of GINA products, have provided the foundation for many national guidelines. They are prepared by international experts from primary, secondary and tertiary care, and are annually updated following a review of evidence. In 2014, a major revision of the GINA report was published, that took into account advances in evidence not only about asthma and its treatment, but also about how to improve implementation of evidence-based recommendations in clinical practice. This paper summarises key changes relevant to primary care in the new GINA report. A noticeable difference is the report's radically different approach, now clinically-focussed, with multiple practical tools and flow charts to improve its utility for busy frontline clinicians. Key changes in recommendations include a new, diagnosis-centred definition ofasthma; more detail about how to assess current symptom control and future risk; a comprehensive approach to tailoring treatment for individual patients; expanded indications for commencing inhaled corticosteroids; new recommendations for written asthma action plans; a new chapter on diagnosis and initial treatment of patients with asthma-COPD overlap syndrome; and a revised approach to diagnosing asthma in preschool children. The 2014 GINA report (further updated in 2015) moved away from a 'textbook' approach to provide clinicians with up-to-date evidence about strategies to control symptoms and minimise asthma risk, in a practical, practice-centred format.
 

NPJ Prim Care Respir Med. 2015 Jul 30;25:15050. doi: 10.1038/npjpcrm.2015.50.