Summary and recommendations Highlights of the Asthma Summit 2009 Beyond the Guidelines 英文参考文献.docVIP

CONFERENCEPROCEEDINGS SummaryandRecommendations HighlightsoftheAsthmaSummit2009:BeyondtheGuidelines MichaelA.Kaliner,MD,1 andJudithR.Farrar,PhD2 D espite intense attention over the past 10–20 years, asthma still offers many potential new targets and ap- use of medications to create the most educated treat- ment plan. proachesforimprovedtreatment.Bronchospasmisthemost obvious target, which is amenable to treatment that relaxes airwaysmoothmuscle.In?ammationisthemostemphasized aspect of the disease and is used to direct maintenance therapyattheunderlyingfacetsofasthma.However,emerg- ing evidence indicates that in?ammation itself represents a morecomplextargetthanpreviouslyunderstood.Thein?am- mationofasthmaismulticellular,andresponsestotreatment canvarybycelltype,sothattreatmentapproachesshouldbe expandedtore?ectthesedifferencesbetweenindividualpa- tients. In addition, no currently available therapies address injury repair, which is also multicellular and contributes to progressivelossoflungfunction,acomponentofrisk. Itisalsoapparentthatpersonalizedand?exibletreat- mentsforpatientswithasthmaareequallyimportant.Infact, manypatientsarealreadypracticingtheirown“brand(s)”of personalized and ?exible therapy; as indicate by re?ll rates for short-acting bronchodilators and maintenance medica- tions. It is widely recognized that full compliance with recommendationsisonlyoccasionallyfollowedbymany,if not most, asthma sufferers. One important outcome of the discussion at the Asthma Summit was that physicians who treat patients with asthma should be willing to work with patientstodevelop?exibleoptionsfortreatmentthatmain- tain optimal asthma control. This approach requires patient education,regularevaluationofasthmacontrol,isbestdone inconjunctionwithhomepeak?owmonitoring,andrequires considerationofarangeoftreatmentoptionsthatmakesense fortheindividualpatient.Speci?crecommendationsfromthe AsthmaSummittowardthisgoalincludethefollowing: Y Asthmacontrolneedstobemonitoredregularl