难治性哮喘的进展曾军分析.ppt

001-thoraxjnl-2013-203568难治哮喘.full * 001-thoraxjnl-2013-203568难治哮喘.full * 001-thoraxjnl-2013-203568难治哮喘.full * 001-thoraxjnl-2013-203568难治哮喘.full * 001-thoraxjnl-2013-203568难治哮喘.full * 001-thoraxjnl-2013-203568难治哮喘.full * * 001 * crj17074 * If ICS is withdrawn, induced sputum eosinophil count increase is very predictive of a patient who is likely to exacerbate – it offers a fairly predictive warning. On this premise, it could be hypothesised that managing patients with asthma by effectively suppressing eosiniphilic airway inflammation (using standard protocol) may prevent exacerbations of asthma compared with a traditional clinical approach. Trial data demonstrates that using FeNO to help guide treatment is most beneficial in patients with more severe asthma. Prof. Pavord suggested to delegates that the fact that inflammation-guided management works better in more severe asthma once again points to different asthma phenotypes (see Figure 1). Some asthma patients, Prof. Pavord explained, have concordant asthma in which there is a direct correlation to their eosinophilic inflammation and the level of symptoms they experience. Others, however, have discordant disease, which can be either inflammation discordant (high levels of eosinophilic inflammation, but few daily symptoms) or symptom discordant (little eosinophilic inflammation, but high levels of symptoms). While traditional symptom-based control may be appropriate is concordant patients, use of induced sputum eosinophils to measure inflammation in those with discordant inflammation may be beneficial in allowing targeted corticosteroids to lower exacerbation frequency. Strategies for maintaining controlProf. Barnes began by, again, picking up on the findings of the GOAL study. What GOAL established was that most patients achieving guideline-defined control can maintain at least a similar level of control with regular, stable dosing, with little likelihood of losing control. In so doing, GOAL confirmed that GIN