信必可®维持和缓解治疗（SMART）以及GINA指南中哮喘管理的演变
2018/05/08
摘要
前言：全球哮喘倡议（GINA）年度报告总结了哮喘管理的最新证据。GINA推荐阶梯式药物治疗，单一吸入装置的吸入皮质类固醇（ICS）和快速长效β2受体激动剂（LABA）联合制剂被提倡应用于第3级（中度持续性哮喘，需要1-2种控制剂和按需使用缓解剂）、第4级（严重持续性哮喘，需要≥2种控制剂和按需使用缓解剂）和第5级（更高级别的护理和/或附加治疗）的维持和缓解治疗。
涵盖的领域：随机对照试验和真实世界证据表明，灵活使用布地奈德/福莫特罗维持缓解治疗（信必可®维持和缓解治疗[SMART]）与减少严重急性加重、延长首次急性加重时间和快速症状缓解有相关性。
专家评论：SMART与同等剂量或更高剂量灵活使用ICS/LABA和按需使用短效β2-激动剂（SABA）、更高剂量ICS加按需使用SABA相比，能提供更好或同等水平的持续哮喘控制，总体ICS剂量和成本都较低。简化给药策略可以提高依从性和整体哮喘控制，但依赖于对患者的教育。目前正在进行的两项双盲随机研究（SYGMA1/2 (NCT02149199/NCT02224157)），调查了轻度哮喘患者（规律低剂量ICS使用患者）中按需使用布地奈德/福莫特罗疗效的情况，研究在按需使用布地奈德/福莫特罗、布地奈德联合SABA和单用SABA间进行了对比。
Symbicort® Maintenance and Reliever Therapy (SMART) and the evolution of asthma management within the GINA guidelines.
Lin J, Zhou X, Wang C, Liu C, Cai S, Huang M.
Abstract
Introduction: The Global Initiative for Asthma (GINA) annual report summarizes the latest evidence for asthma management. GINA recommends stepwise pharmacological treatment, advocating inhaled corticosteroids (ICS) plus rapid, long-acting β2-agonists (LABA) delivered in a single inhaler for maintenance and relief at Steps 3 (moderate persistent asthma requiring 1-2 controllers plus as-needed reliever), 4 (severe persistent asthma requiring ≥2 controllers plus as-needed reliever), and 5 (higher level care and/or add-on treatment).
Areas covered: Randomized controlled trials and real-world evidence demonstrate that flexibly dosed budesonide/formoterol for maintenance and relief (Symbicort® Maintenance And Reliever Therapy [SMART]) is associated with reductions in severe exacerbations, prolongs time to first exacerbation, and provides fast symptom relief.
Expert commentary: SMART provides greater or equal levels of sustained asthma control than similar or higher fixed doses of ICS/LABA plus short-acting β2-agonist (SABA) as needed or higher ICS plus SABA as needed, with lower overall ICS doses and cost. The simplified dosing strategy may improve adherence and overall asthma control but relies on patient education. Budesonide/formoterol as needed in mild asthma (patients qualifying for regular low-dose ICS) is currently under investigation in two double-blind randomized studies, SYGMA1/2 (NCT02149199/NCT02224157), comparing budesonide/formoterol as needed with budesonide plus SABA and SABA alone.
前言：全球哮喘倡议（GINA）年度报告总结了哮喘管理的最新证据。GINA推荐阶梯式药物治疗，单一吸入装置的吸入皮质类固醇（ICS）和快速长效β2受体激动剂（LABA）联合制剂被提倡应用于第3级（中度持续性哮喘，需要1-2种控制剂和按需使用缓解剂）、第4级（严重持续性哮喘，需要≥2种控制剂和按需使用缓解剂）和第5级（更高级别的护理和/或附加治疗）的维持和缓解治疗。
涵盖的领域：随机对照试验和真实世界证据表明，灵活使用布地奈德/福莫特罗维持缓解治疗（信必可®维持和缓解治疗[SMART]）与减少严重急性加重、延长首次急性加重时间和快速症状缓解有相关性。
专家评论：SMART与同等剂量或更高剂量灵活使用ICS/LABA和按需使用短效β2-激动剂（SABA）、更高剂量ICS加按需使用SABA相比，能提供更好或同等水平的持续哮喘控制，总体ICS剂量和成本都较低。简化给药策略可以提高依从性和整体哮喘控制，但依赖于对患者的教育。目前正在进行的两项双盲随机研究（SYGMA1/2 (NCT02149199/NCT02224157)），调查了轻度哮喘患者（规律低剂量ICS使用患者）中按需使用布地奈德/福莫特罗疗效的情况，研究在按需使用布地奈德/福莫特罗、布地奈德联合SABA和单用SABA间进行了对比。
(中日友好医院呼吸与危重症医学科 顾宪民 摘译 林江涛 审校)
(Expert Rev Respir Med. 2018 Mar;12(3):191-202)
(Expert Rev Respir Med. 2018 Mar;12(3):191-202)
Symbicort® Maintenance and Reliever Therapy (SMART) and the evolution of asthma management within the GINA guidelines.
Lin J, Zhou X, Wang C, Liu C, Cai S, Huang M.
Abstract
Introduction: The Global Initiative for Asthma (GINA) annual report summarizes the latest evidence for asthma management. GINA recommends stepwise pharmacological treatment, advocating inhaled corticosteroids (ICS) plus rapid, long-acting β2-agonists (LABA) delivered in a single inhaler for maintenance and relief at Steps 3 (moderate persistent asthma requiring 1-2 controllers plus as-needed reliever), 4 (severe persistent asthma requiring ≥2 controllers plus as-needed reliever), and 5 (higher level care and/or add-on treatment).
Areas covered: Randomized controlled trials and real-world evidence demonstrate that flexibly dosed budesonide/formoterol for maintenance and relief (Symbicort® Maintenance And Reliever Therapy [SMART]) is associated with reductions in severe exacerbations, prolongs time to first exacerbation, and provides fast symptom relief.
Expert commentary: SMART provides greater or equal levels of sustained asthma control than similar or higher fixed doses of ICS/LABA plus short-acting β2-agonist (SABA) as needed or higher ICS plus SABA as needed, with lower overall ICS doses and cost. The simplified dosing strategy may improve adherence and overall asthma control but relies on patient education. Budesonide/formoterol as needed in mild asthma (patients qualifying for regular low-dose ICS) is currently under investigation in two double-blind randomized studies, SYGMA1/2 (NCT02149199/NCT02224157), comparing budesonide/formoterol as needed with budesonide plus SABA and SABA alone.
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四倍吸入糖皮质激素治疗哮喘恶化
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