持续哮喘患者急诊出院前需开始吸入性糖皮质激素治疗
2010/02/03
对于所有年龄段的轻度持续哮喘患者，国家及国际指南均推荐采用吸入性糖皮质激素（ICS）作为长期维持治疗。对于中度及重度持续性哮喘患者，ICS对于优化哮喘管理非常重要，且常与其它治疗方法联合使用。尽管研究及指南强调ICS的使用，但目前ICS的使用仍然不足。急诊（ED）哮喘患者可表现为间歇性哮喘，但大多表现为持续性哮喘，需采用ICS优化治疗。若此时未采用ICS治疗，常导致随后ICS使用不足。伴随短程口服糖皮质激素治疗，急诊持续哮喘患者在出院前就应采用ICS。虽然NIH/NAEPP专家审查小组3建议患者急诊出院带药需包括ICS，全球哮喘防治组织(GINA)2008年指南推荐患者急诊出院前就应开始或继续ICS治疗。在过去10年中，急诊医学相关文献也推荐急诊医生采用ICS治疗哮喘。间歇性哮喘的误诊较为常见，因此，ICS也推荐用于间歇性哮喘患者，同时在随访中需对其进行再次评价。对患者讲解气道炎症（展示气道模型/彩图）及展示其疗效的强力证据对提高患者ICS治疗的依从性具有一定作用。教会患者ICS吸入器的正确使用、环境控制及起草哮喘控制计划也非常重要。对于急诊哮喘患者，出院前常缺乏ICS治疗及适当的宣教，而这些常与患者较差的预后有关。
（苏楠 审校）
J Asthma. 2009 Dec;46(10):974-979.
Inhaled corticosteroids should be initiated before discharge from the emergency department in patients with persistent asthma.
Self TH, Twilla JD, Rogers ML, Rumbak MJ.
University of Tennessee Health Science Center, Methodist University Hospital, Memphis, Tennessee 38163, USA.
National and International Guidelines concur that inhaled corticosteroids (ICS) are the preferred long-term maintenance drug therapy for mild persistent asthma for all ages. For moderate and severe persistent asthma, ICS are essential to optimal management, often concurrent with other key therapies. Despite strong evidence and consensus guidelines, ICS are still underused. While some patients who are treated in the emergency department (ED) have intermittent asthma, most have persistent asthma and need ICS for optimum outcomes. Failure to initiate ICS at this critical juncture often results in subsequent lack of ICS therapy. Along with a short course of oral corticosteroids, ICS should be initiated before discharge from the ED in patients with persistent asthma. Although the NIH/NAEPP Expert Panel Report 3 suggests considering the prescription of ICS on discharge from the ED, The Global Initiative for Asthma (GINA) 2008 guidelines recommend initiation or continuation of ICS before patients are discharged from the ED. The initiation of ICS therapy by ED physicians is also encouraged in the emergency medicine literature over the past decade. Misdiagnosis of intermittent asthma is common; therefore, ICS therapy should be considered for ED patients with this diagnosis with reassessment in follow-up office visits. To help ensure adherence to ICS therapy, patient education regarding both airway inflammation (show airway models/colored pictures) and the strong evidence of efficacy is vital. Teaching ICS inhaler technique, environmental control, and giving a written action plan are essential. Lack of initiation of ICS with appropriate patient education before discharge from the ED in patients with persistent asthma is common but unfortunately associated with continued poor patient outcomes.
J Asthma. 2009 Dec;46(10):974-9.
（苏楠 审校）
J Asthma. 2009 Dec;46(10):974-979.
Inhaled corticosteroids should be initiated before discharge from the emergency department in patients with persistent asthma.
Self TH, Twilla JD, Rogers ML, Rumbak MJ.
University of Tennessee Health Science Center, Methodist University Hospital, Memphis, Tennessee 38163, USA.
National and International Guidelines concur that inhaled corticosteroids (ICS) are the preferred long-term maintenance drug therapy for mild persistent asthma for all ages. For moderate and severe persistent asthma, ICS are essential to optimal management, often concurrent with other key therapies. Despite strong evidence and consensus guidelines, ICS are still underused. While some patients who are treated in the emergency department (ED) have intermittent asthma, most have persistent asthma and need ICS for optimum outcomes. Failure to initiate ICS at this critical juncture often results in subsequent lack of ICS therapy. Along with a short course of oral corticosteroids, ICS should be initiated before discharge from the ED in patients with persistent asthma. Although the NIH/NAEPP Expert Panel Report 3 suggests considering the prescription of ICS on discharge from the ED, The Global Initiative for Asthma (GINA) 2008 guidelines recommend initiation or continuation of ICS before patients are discharged from the ED. The initiation of ICS therapy by ED physicians is also encouraged in the emergency medicine literature over the past decade. Misdiagnosis of intermittent asthma is common; therefore, ICS therapy should be considered for ED patients with this diagnosis with reassessment in follow-up office visits. To help ensure adherence to ICS therapy, patient education regarding both airway inflammation (show airway models/colored pictures) and the strong evidence of efficacy is vital. Teaching ICS inhaler technique, environmental control, and giving a written action plan are essential. Lack of initiation of ICS with appropriate patient education before discharge from the ED in patients with persistent asthma is common but unfortunately associated with continued poor patient outcomes.
J Asthma. 2009 Dec;46(10):974-9.
上一篇：
基于指南的哮喘决策支持系统的有效性：第二步
下一篇：
环索奈德对运动员哮喘的疗效
