Section 1. EPR-3 versus GINA 2008 guidelines - asthma control and step 3 care Highlights of the asthma summit 2009 beyond the guidelines 英文参考文献.docVIP

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Section 1. EPR-3 versus GINA 2008 guidelines - asthma control and step 3 care Highlights of the asthma summit 2009 beyond the guidelines 英文参考文献.doc

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Section 1. EPR-3 versus GINA 2008 guidelines - asthma control and step 3 care Highlights of the asthma summit 2009 beyond the guidelines 英文参考文献

CONFERENCEPROCEEDINGS Section1.EPR-3versusGINA2008Guidelines–Asthma ControlandStep3Care HighlightsoftheAsthmaSummit2009:BeyondtheGuidelines JeanBousquet,MD,1 andWilliamW.Busse,MD2 riesbasedonthefrequencyofsymptoms,exacerbations,noc- Abstract: RecentupdatestoasthmaguidelinesfromtheGlobalIni- turnalsymptoms,forcedexpiratoryvolumeinthe?rstsecond tiative for Asthma (GINA) and the National Asthma Education and (FEV),orpeakexpiratory?ow(PEF)beforetreatmentbegan. 2 PreventionProgram(ExpertPanelReport3,EPR-3)sharemanysim- ilarities,re?ectingafocusonasthmacontrolbasedonclinicalmani- festations of disease and responsiveness to therapy. Both documents build upon the recommendations of former guidelines utilizing evi- dence-basedreviewofthepublishedliteraturetorevisealgorithmsfor practice. A major difference between the 2 reports is the preferred treatmentatStep3.TheGINAguidelinesrecommendacombinationof low-dose inhaled corticosteroid (ICS) plus long-acting ?-agonist (LABA),whereastheEPR-3adviseseithermonotherapywithmedium- doseICSorthelow-doseICS?LABAcombination.Bothapproaches aresupportedbyclinicalexperienceandLevelAevidence.Theoption ofpersonalizedtherapyisapointofdiscussionforfutureguidelines. 1 However,manypatientswerealreadyontreatmentwhenphy- sicians?rstsawthem,makingclassi?cationofdiseaseseverity dif?cult. Later discussion suggested accounting for these pa- tientsbyclassifyingdiseaseseverityandrecommendingtreat- mentbasedonclinicalfeaturesandstepofmedicationregimen. 3 However,thisschemewascomplexandpresentedaconsider- able challenge to primary care physicians, who are often the mainprovidersforpatientswithasthma. Data suggesting that poorly controlled asthma days weremoreimportantintreatmentconsiderations playedan 4 importantroleinprovidingthe2002updatedguidelineswith afocusonasthmacontrol. Thedif?cultywiththisapproach 3 KeyWords:EPR-3,GINA,asthma,guidelines (WAOJournal2010;3:16–22) isthatthede?nitionofasthmacontrolcandifferbasedonthe assessmentused,andwhoisasse