哮喘治疗策略.ppt

What is optimal asthma management strategy? 哮喘治疗最佳策略 What we learn from GOAL and CONCEPT studies? 我们从GOAL和CONCEPT研究中能学到什么？ The Debate Controlling eosinophilic inflammation in asthma leads to a reduction in asthma exacerbations AHR Continues to improve even after lung function has plateaued Timecourse for the Improvement of Various Parameters - % improvement TOTAL CONTROL achieved withsustained treatment (Phase II) Patients are poor at assessing asthma control Accuracy of Patient Perception of Symptoms Gauging symptoms accurately is fundamental to a symptom-based approach to asthma management However, a significant proportion of asthmatics cannot reliably detect changes in lung function (1), thereby either over or under-estimating symptom severity Under-estimation is believed to be a major reason for delays in treatment which may result in increased morbidity mortality (2) Too much focus on symptoms may result in unwarranted illness behaviours and restrictions, excessive medication use, overutilisation of medical services and negative emotions (3.) 1-3 References available in bibliography CONtrol CEntred Patient Treatment study Stable dose regimen with salmeterol/fluticasone (Seretide? Diskus?) 50/250μg bid vs Symptom-based, AMD with formoterol/budesonide (Symbicort Turbuhaler?) 6/200μg 52-week randomised controlled trial Double-blind, double-dummy CONCEPT: Study schematic CONCEPT: Study endpoints Primary endpoint: Symptom-free days Key Secondary endpoints: Exacerbations (requiring oral steroids and/or ER visits and/or hospitalisation) Exposure to oral steroids Primary endpoint:Symptom-free days Symptom-free days by study phase Time to first exacerbation Significantly lower exacerbation rate with SALM/FP stable dose Exposure to oral steroids Step-up of Turbuhaler dose to 4 inhalations twice daily CONCEPT SummaryStable vs AMD Significant findings More symptom-free days Reduced exacerbations (moderate/severe) Less oral steroids Less rescue medication use Gr