难治性哮喘的进展.pptVIP

那么，如何才能实现哮喘总体控制呢？GINA指南指出：需要建立以哮喘总体控制（Overall Asthma Control）为核心的个体化治疗策略。这意味着：每个患者都要根据目前的哮喘控制水平，同时根据他们的哮喘控制现状的变化，持续不断地调整治疗方案。 具体来说，哮喘治疗绝不会一个方案、终身不变，就是要不断地进行“评估、治疗和监测”的循环，最终目标是实现哮喘总体控制。 * 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* 001-thoraxjnl-2013-203568难治哮喘.full * 001-thoraxjnl-2013-203568难治哮喘.full * * 001 * crj17074 * If ICS is withdrawn, induced sputum eosinophil count increase is very predictive of a patient who is likely to exacerbate – it offers a fairly predictive warning.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 achi