2019新型冠状病毒流行期间暂时性哮喘管理指导意见
2020/03/27
建议哮喘患者继续使用处方的哮喘药物，尤其是处方的吸入糖皮质激素(ICS)及口服糖皮质激素(OCS)。
在2019新型冠状病毒流行期间，哮喘患者应该像往常一样持续使用哮喘药物。包括含有吸入糖皮质激素（ICS）的药物（单独或联合），以及包括生物疗法在内的治疗重症哮喘的附加治疗药物。停止吸入糖皮质激素，通常导致哮喘恶化的潜在风险增加。
对于一小部分重症哮喘患者来说，有时可能需要长期使用口服糖皮质激素（OCS），突然停止用药是非常危险的。建议患者在停止任何哮喘药物治疗前与您（负责医生）讨论。
确保所有患者都有书面的哮喘行动计划。
行动计划告诉患者如何识别哮喘恶化，如何调整他们的缓解和控制药物，以及何时寻求医疗帮助。重症哮喘恶化（急性加重）时，可能需要短期使用口服糖皮质激素（OCS）。有关哮喘行动计划的更多信息，请参阅《GINA2020报告》。
在可能的情况下，避免使用雾化器，因为具有传播给医护人员和其他患者的风险。
雾化器可传播呼吸道病毒粒子达1米远。成人和儿童的急性哮喘发作时，短效β2激动剂应替换为手揿式定量吸入器（pMDI）和储雾罐（spacer）吸入，必要时，还应配有口器或紧密贴合的面罩。
避免对确诊/疑似2019新型冠状病毒感染患者进行肺功能测定。
肺功能测定可以传播病毒颗粒，使工作人员和患者暴露于感染风险。如果出现2019新型冠状病毒的社区传播，除非有紧急需要，否则应推迟在卫生保健设施内测定肺量计和峰值流量。
如果有其他产生气溶胶的操作，请遵循相关感染控制建议。
这些操作包括氧疗（包括用鼻导管）、诱导痰、人工通气、无创通气和插管。以下是世界卫生组织(WHO)的建议: www.who.int/publications-detail/infection-prevention-and-control-during-health-care-when-novel-coronavirus-(ncov)-infection-is-suspected-20200125
当您的国家或地区有可应用的指导意见时，请遵循当地关于卫生策略和个人防护装备使用建议。
附加资料：
美国疾病控制和预防中心（CDC）网站提供了关于2019新型冠状病毒的最新消息，医护专业人士可浏览www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html，患者可浏览www.cdc.gov/coronavirus/2019-ncov/index.html。
世界卫生组织（WHO）网站为卫生专业人员和卫生系统提供关于2019新型冠状病毒的预防和管理的全面建议：www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance
Asthma medications should be continued as usual during the COVID-19 pandemic. This includes ICS-containing medications (alone or in combination), and add-on therapy including biologic therapy for severe asthma. Stopping ICS often leads to potentially dangerous worsening of asthma.
For a small proportion of patients with severe asthma, long-term OCS may sometimes be needed, and it is very dangerous to stop these suddenly. Advise patients to discuss with you before stopping any asthma medication.
Make sure that all patients have a written asthma action plan
An action plan tells the patient how to recognize worsening asthma, how to change their reliever and controller medications, and when to seek medical help. A short course of OCS may be needed during severe asthma flare-ups (exacerbations). See the GINA 2020 report for more information about the options for asthma action plans.
Where possible, avoid using nebulizers due to the risk of transmitting infectionto healthcare workers and other patients
Nebulizers can transmit respiratory viral particles for ~1 meter. Instead, to deliver short-acting b2-agonist for acute asthma in adults and children, use a pressurized metered-dose inhaler and spacer, with a mouthpiece or tightly fitting face mask, if required.
Avoid spirometry in patients with confirmed/suspected COVID-19
Spirometry can disseminate viral particles and expose staff and patients to risk of infection. If there is community transmission of COVID-19, postpone spirometryand peak flow measurement within health care facilities unless there is an urgent need.
Follow infection control recommendationsif other aerosol-generating procedures are needed
These include oxygen therapy (including with nasal prongs), sputum induction, manual ventilation, non-invasive ventilation andintubation.World Health Organization (WHO) recommendations are found here: www.who.int/publications-detail/infection-prevention-and-control-during-health-care-when-novel-coronavirus-(ncov)-infection-is-suspected-20200125
Follow local health advice about hygiene strategies and use of personal protective equipment, as new information becomes available in your country or region
Additional resources
The website of the Centers for Disease Control and Prevention (CDC) provides up to date information about COVID-19 for health professionals: www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html, and patients: https://www.cdc.gov/coronavirus/2019-ncov/index.html.
The website of the World Health Organization (WHO) provides comprehensive advice for health professionals and health systems about prevention and management of COVID-19:www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance
Global Initiative for Asthma, March 26, 2020
在2019新型冠状病毒流行期间，哮喘患者应该像往常一样持续使用哮喘药物。包括含有吸入糖皮质激素（ICS）的药物（单独或联合），以及包括生物疗法在内的治疗重症哮喘的附加治疗药物。停止吸入糖皮质激素，通常导致哮喘恶化的潜在风险增加。
对于一小部分重症哮喘患者来说，有时可能需要长期使用口服糖皮质激素（OCS），突然停止用药是非常危险的。建议患者在停止任何哮喘药物治疗前与您（负责医生）讨论。
确保所有患者都有书面的哮喘行动计划。
行动计划告诉患者如何识别哮喘恶化，如何调整他们的缓解和控制药物，以及何时寻求医疗帮助。重症哮喘恶化（急性加重）时，可能需要短期使用口服糖皮质激素（OCS）。有关哮喘行动计划的更多信息，请参阅《GINA2020报告》。
在可能的情况下，避免使用雾化器，因为具有传播给医护人员和其他患者的风险。
雾化器可传播呼吸道病毒粒子达1米远。成人和儿童的急性哮喘发作时，短效β2激动剂应替换为手揿式定量吸入器（pMDI）和储雾罐（spacer）吸入，必要时，还应配有口器或紧密贴合的面罩。
避免对确诊/疑似2019新型冠状病毒感染患者进行肺功能测定。
肺功能测定可以传播病毒颗粒，使工作人员和患者暴露于感染风险。如果出现2019新型冠状病毒的社区传播，除非有紧急需要，否则应推迟在卫生保健设施内测定肺量计和峰值流量。
如果有其他产生气溶胶的操作，请遵循相关感染控制建议。
这些操作包括氧疗（包括用鼻导管）、诱导痰、人工通气、无创通气和插管。以下是世界卫生组织(WHO)的建议: www.who.int/publications-detail/infection-prevention-and-control-during-health-care-when-novel-coronavirus-(ncov)-infection-is-suspected-20200125
当您的国家或地区有可应用的指导意见时，请遵循当地关于卫生策略和个人防护装备使用建议。
附加资料：
美国疾病控制和预防中心（CDC）网站提供了关于2019新型冠状病毒的最新消息，医护专业人士可浏览www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html，患者可浏览www.cdc.gov/coronavirus/2019-ncov/index.html。
世界卫生组织（WHO）网站为卫生专业人员和卫生系统提供关于2019新型冠状病毒的预防和管理的全面建议：www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance
全球哮喘防治创议
2020年3月26日
（中日友好医院 林江涛编译）
2020年3月26日
（中日友好医院 林江涛编译）
Interim guidance onasthma MANAGEMENT during the COVID-19 pandemic
Advise patients with asthma to continue taking their prescribed asthma medications, particularly inhaled corticosteroid (ICS)medications, and oral corticosteroids (OCS) if prescribed
Asthma medications should be continued as usual during the COVID-19 pandemic. This includes ICS-containing medications (alone or in combination), and add-on therapy including biologic therapy for severe asthma. Stopping ICS often leads to potentially dangerous worsening of asthma.
For a small proportion of patients with severe asthma, long-term OCS may sometimes be needed, and it is very dangerous to stop these suddenly. Advise patients to discuss with you before stopping any asthma medication.
Make sure that all patients have a written asthma action plan
An action plan tells the patient how to recognize worsening asthma, how to change their reliever and controller medications, and when to seek medical help. A short course of OCS may be needed during severe asthma flare-ups (exacerbations). See the GINA 2020 report for more information about the options for asthma action plans.
Where possible, avoid using nebulizers due to the risk of transmitting infectionto healthcare workers and other patients
Nebulizers can transmit respiratory viral particles for ~1 meter. Instead, to deliver short-acting b2-agonist for acute asthma in adults and children, use a pressurized metered-dose inhaler and spacer, with a mouthpiece or tightly fitting face mask, if required.
Avoid spirometry in patients with confirmed/suspected COVID-19
Spirometry can disseminate viral particles and expose staff and patients to risk of infection. If there is community transmission of COVID-19, postpone spirometryand peak flow measurement within health care facilities unless there is an urgent need.
Follow infection control recommendationsif other aerosol-generating procedures are needed
These include oxygen therapy (including with nasal prongs), sputum induction, manual ventilation, non-invasive ventilation andintubation.World Health Organization (WHO) recommendations are found here: www.who.int/publications-detail/infection-prevention-and-control-during-health-care-when-novel-coronavirus-(ncov)-infection-is-suspected-20200125
Follow local health advice about hygiene strategies and use of personal protective equipment, as new information becomes available in your country or region
Additional resources
The website of the Centers for Disease Control and Prevention (CDC) provides up to date information about COVID-19 for health professionals: www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html, and patients: https://www.cdc.gov/coronavirus/2019-ncov/index.html.
The website of the World Health Organization (WHO) provides comprehensive advice for health professionals and health systems about prevention and management of COVID-19:www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance
Global Initiative for Asthma, March 26, 2020
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