回顾NAEPP关于哮喘的诊断和治疗指南2007年的第三次专家组报告（EPR-3）
2008/09/28
背景：1989年国际哮喘教育和预防组织（简称NAEPP）召集一个专家组提供哮喘一般性治疗的报告。专家组报告了“哮喘的诊断和治疗指南”，或称第一次专家组报告（EPR-1），
公开出版于1991年。随后进行了2次更新，1997年的EPR-2和2002年EPR的更新。随着科学的发展和哮喘病理生理学的研究进展，促使NAEPP在2004年召开了第三次专家组会议。总结近三年的工作之后，第三次专家组报告了“哮喘的诊断和治疗指南-2007完整报告”，或称EPR-3，发行于2007年8月29日。EPR-3更新是来自NAEPP提供的专业卫生保健的最新信息，为了改善哮喘患者的管理。包括：⑴通过进一步描述损伤和危险因素，更加综合地讨论哮喘的严重程度；⑵像GOAL研究的治疗方法，更加致力于哮喘的控制；⑶在治疗方面的更新，进一步讨论哮喘的药物治疗学。
目的：⑴在EPR-3更新中总结出关键的教育条目，有效地概述恰当的哮喘患者管理模式；⑵提供支持的文献来证实这些教育条目更新的依据。
方法：9个哮喘专家（4名药剂师和5名内科医师）召开会议一起讨论EPR-3更新，从中提炼出可以操作的临床使用模式，提供给专业卫生保健组织。选择专家的几个标准，包括⑴与NAEPP的联系；⑵哮喘管理的专业技能；⑶熟悉管理的过程。作者提名10名成员并主持会议。
结果：充分分析EPR-3更新中7个关键教育条目改进的结果，能够促进专业卫生保健组织改善哮喘患者的管理。在管理组织内部改进哮喘管理草案时，每一个教育条目都能找到支持的文献，来证实它被引用的关键点。
结论：哮喘及其治疗的复杂性使得NAEPP的几个指南更新是必要的。最近的EPR-3更新发行于2007年8月底。由EPR-3提炼出的，专家一致同意的7条关键信息，能够促进专业卫生保健组织改善哮喘患者的管理。
（苏楠 卫生部中日友好医院呼吸内科 100029 摘译）
（J Manag Care Pharm. 2008 Jan-Feb;14(1):41-49.）
Review of the NAEPP 2007 Expert Panel Report (EPR-3) on Asthma Diagnosis and Treatment Guidelines.
J Manag Care Pharm.2008 Jan-Feb;14(1):41-9.
Urbano FL.
PRIME, 8201 West McNab Rd., Tamarac, FL 33321, USA. f.urbano@primeinc.org
BACKGROUND: In 1989, the National Asthma Education and Prevention Program (NAEPP) convened an expert panel to develop a report that would provide a general approach to the treatment of asthma. Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma, or EPR-1, was published in 1991 and was subsequently updated with 2 other reports, EPR-2 in 1997 and the EPR update in 2002. Advances in science and a greater understanding of the pathophysiology of asthma prompted the NAEPP to convene a 3rd expert panel in 2004. After nearly 3 years of work, Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma-Full Report 2007, or EPR-3, was released on August 29, 2007. EPR-3 update from the NAEPP provides health care professionals with new information to improve the care of patients with asthma, including (1) more comprehensive discussion of asthma severity with expanded descriptions of impairment and risk, (2) increased focus on asthma control as a goal of therapy, and (3) expanded discussion of pharmacologic therapy for asthma with updated treatment algorithms.
OBJECTIVES: To (1) extract key educational messages from the EPR-3 update that effectively summarize the appropriate management of the patient with asthma and (2) provide supporting literature to substantiate the development of these educational messages.
METHODS: A consensus meeting of 9 asthma experts (4 pharmacists and 5 physicians) was held to discuss the EPR-3 update and condense its content into a usable format for the health care professional. Experts were selected on the basis of several criteria, including (1) affiliation with the NAEPP, (2) expertise in asthma management, and (3) familiarity with managed care processes. The author served as the 10th member and moderator of the meeting.
RESULTS: Thorough review of the EPR-3 update resulted in the development of 7 key educational messages that can assist the health care professional in improving the management of the patient with asthma. Each educational message is presented with supporting literature to substantiate its distinction as a key point to be referenced when developing protocols for asthma management within managed care organizations.
CONCLUSION: The complexity of asthma and its treatment has necessitated the development of several guidelines from the NAEPP, with the most recent EPR-3 update being released in late August 2007. One expert consensus has distilled the EPR-3 document into 7 key educational messages that can assist the health care professional in improving the care of the patient with asthma.
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环索奈德改善哮喘患者小气道指标
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变态反应和哮喘的治疗策略
