哮喘缓解作为治疗目标的专家共识框架
2020/01/07
摘要
随着新疗法的发展，有机会将哮喘缓解视为治疗目标。在此，我们提供了基于医学文献和专家共识的哮喘临床和完全缓解的一般性框架（无论是否正接受治疗）。改良的Delphi调查方法用于确定作为核心部分的以哮喘缓解的作为治疗目标的专家共识。第1阶段用缓解定义确定了其他慢性炎症性疾病。第2阶段评估了这些定义以及已发表的自发性哮喘缓解的定义的组成部分。第3阶段评估了使用共识结果建立的缓解框架。临床缓解包括≥12个月的以下表现，1）无明显临床症状，2）肺功能最佳状态/稳定，3）患者/病史提供者自认为缓解，以及4）不使用全身性皮质类固醇。完全缓解的定义为临床缓解加上哮喘相关炎症的客观缓解，必要时还包括支气管高反应性缓解。缓解治疗不需要≥12个月的哮喘治疗。拟议的框架只是将哮喘缓解发展为治疗目标的第一步，还应通过将来的研究、患者意见和临床研究加以完善。
An Expert Consensus Framework for Asthma Remission as a Treatment Goal.
Menzies-Gow A, Bafadhel M, Busse WW, Casale TB, Kocks JWH, Pavord ID, Szefler SJ, Woodruff PG, de Giorgio-Miller A, Trudo F, Fageras M, Ambrose CS.
Abstract
With novel therapies in development, there is an opportunity to consider asthma remission as a treatment goal. In this Rostrum, we present a generalized framework for clinical and complete remission in asthma, on and off treatment, developed based on medical literature and expert consensus. A modified Delphi survey approach was used to ascertain expert consensus on core components of asthma remission as a treatment target. Phase 1 identified other chronic inflammatory diseases with remission definitions. Phase 2 evaluated components of those definitions as well as published definitions of spontaneous asthma remission. Phase 3 evaluated a remission framework created using consensus findings. Clinical remission comprised ≥12 months with 1) absence of significant symptoms by validated instrument, 2) lung function optimization/stabilization, 3) patient/provider agreement regarding remission, and 4) no use of systemic corticosteroids. Complete remission was defined as clinical remission plus objective resolution of asthma-related inflammation and, if appropriate, negative bronchial hyperresponsiveness. Remission off treatment required no asthma treatment for ≥12 months. The proposed framework is a first step toward developing asthma remission as a treatment target and should be refined through future research, patient input, and clinical study.
随着新疗法的发展，有机会将哮喘缓解视为治疗目标。在此，我们提供了基于医学文献和专家共识的哮喘临床和完全缓解的一般性框架（无论是否正接受治疗）。改良的Delphi调查方法用于确定作为核心部分的以哮喘缓解的作为治疗目标的专家共识。第1阶段用缓解定义确定了其他慢性炎症性疾病。第2阶段评估了这些定义以及已发表的自发性哮喘缓解的定义的组成部分。第3阶段评估了使用共识结果建立的缓解框架。临床缓解包括≥12个月的以下表现，1）无明显临床症状，2）肺功能最佳状态/稳定，3）患者/病史提供者自认为缓解，以及4）不使用全身性皮质类固醇。完全缓解的定义为临床缓解加上哮喘相关炎症的客观缓解，必要时还包括支气管高反应性缓解。缓解治疗不需要≥12个月的哮喘治疗。拟议的框架只是将哮喘缓解发展为治疗目标的第一步，还应通过将来的研究、患者意见和临床研究加以完善。
(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)
(J Allergy Clin Immunol. 2019 Dec 19. pii: S0091-6749(19)31708-7. doi: 10.1016/j.jaci.2019.12.006.)
(J Allergy Clin Immunol. 2019 Dec 19. pii: S0091-6749(19)31708-7. doi: 10.1016/j.jaci.2019.12.006.)
An Expert Consensus Framework for Asthma Remission as a Treatment Goal.
Menzies-Gow A, Bafadhel M, Busse WW, Casale TB, Kocks JWH, Pavord ID, Szefler SJ, Woodruff PG, de Giorgio-Miller A, Trudo F, Fageras M, Ambrose CS.
Abstract
With novel therapies in development, there is an opportunity to consider asthma remission as a treatment goal. In this Rostrum, we present a generalized framework for clinical and complete remission in asthma, on and off treatment, developed based on medical literature and expert consensus. A modified Delphi survey approach was used to ascertain expert consensus on core components of asthma remission as a treatment target. Phase 1 identified other chronic inflammatory diseases with remission definitions. Phase 2 evaluated components of those definitions as well as published definitions of spontaneous asthma remission. Phase 3 evaluated a remission framework created using consensus findings. Clinical remission comprised ≥12 months with 1) absence of significant symptoms by validated instrument, 2) lung function optimization/stabilization, 3) patient/provider agreement regarding remission, and 4) no use of systemic corticosteroids. Complete remission was defined as clinical remission plus objective resolution of asthma-related inflammation and, if appropriate, negative bronchial hyperresponsiveness. Remission off treatment required no asthma treatment for ≥12 months. The proposed framework is a first step toward developing asthma remission as a treatment target and should be refined through future research, patient input, and clinical study.
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