ORIGINALLY PUBLISHED
13 September 2021
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Surveillance data from both Europe and the US have shown that nearly half of asthma patients remain uncontrolled on their current treatment.1-3 哮喘患者有哮喘加重(发作)的危险, regardless of age, severity, adherence to controller medication, or asthma control.1,4,5 病情恶化是发病和死亡的主要原因;6 即使被诊断为轻度哮喘的患者也有病情恶化的风险.4
据估计，全球每年有1.36亿例哮喘加重，7 with 全世界每年因哮喘就诊的急诊人数估计为1.16亿.8 在美国，每年有超过1000万例病情加重，9 resulting in more than 1.8 million visits to emergency department,9 170,000 hospitalisations9 and more than 4,000 deaths.9
这些攻击对许多患者来说既具有身体上的威胁，又具有重大的情感意义10 and can be fatal.11,12
Beyond the emotional and physical cost, 管理不善的哮喘也带来沉重的经济和社会负担. When accounting for the amount spent annually on asthma-related medication and hospital admissions, 以及间接成本，如失去工作和上学时间, this puts a significant strain on not only the people living with this disease and their families, but also on healthcare systems.12
仅使用saba的方法会使患者面临哮喘发作的风险
哮喘是一种慢性炎症性呼吸道疾病，症状多样.6,12 这种炎症导致气道狭窄和恶化，导致哮喘症状.13
Many patients with asthma use short-acting beta2-agonist (SABA) rescue inhalers (or bronchodilators), such as albuterol*, to treat their disease.14-16 虽然沙巴能快速缓解症状, 它不能解决潜在的炎症, 使患者面临严重恶化的风险.17 病情恶化反过来会导致生活质量受损，18 frequent oral corticosteroid (OCS) use19 and hospitalisation.19
In the US, around 44% of patients across all asthma severities exacerbated once or more over a 12-month period, regardless of SABA or maintenance use,20 通常需要短期的OCS疗程来控制症状.21
Even short-term treatment of exacerbations with OCS is associated with an increased risk of adverse health conditions, including type 2 diabetes, depression/anxiety, renal impairment, cataracts, cardiovascular disease, pneumonia and fracture.6,22,23 这些不良反应可进一步加重哮喘的负担.
SABA use of more than three canisters per year is associated with an increased risk of exacerbations, 独立于哮喘控制和吸入皮质类固醇(ICS)维持治疗.24,25 数据来自最大的真实世界哮喘吸入器治疗观察性分析, SABA Use IN Asthma (SABINA), showed that in Europe and North America, the incidence of severe exacerbations increased with increasing SABA canister prescription/possession, independent of maintenance therapy.24,25 Data from the UK showed that using three or more SABA inhalers a year resulted in a 20% increased risk of exacerbations in people with mild asthma and a 24% increased risk in people with moderate to severe asthma.26
确保临床指南得到落实
International recommendations from the Global Initiative for Asthma (GINA) recommend anti-inflammatory rescue therapy to treat symptoms and inflammation concomitantly, 并且不再推荐单独使用SABA治疗.6 The National Asthma Education and Prevention Programme (NAEPP) guidelines in the US conditionally recommend either daily low-dose ICS and as-needed SABA for quick relief therapy, or as-needed ICS and SABA used concomitantly for individuals aged 12 years and older with mild persistent asthma to reduce the risk of exacerbations.27
However, 患者开始依赖于他们的SABA抢救吸入器, 相信这是控制哮喘的最好方法. Patient behaviour underestimates the need to take daily maintenance medication and prioritises quick relief when needed. In one survey, 90% of patients reported they want treatments that provide immediate relief and 34% said they used less maintenance medication (通常与SABA吸入器一起开)当他们感觉良好时.28
Early reliance by patients on SABA is quickly established as it is often the first medicine prescribed and because it provides rapid 缓解他们经历的呼吸困难症状.29-31 这意味着在症状发作时，许多患者本能地伸手去拿他们的沙巴吸入器.
The rationale for prescribing a combination of an ICS and a bronchodilator together is that it aligns with the patients’ preference for an as-needed treatment approach for their asthma, driven by day-to-day symptom levels and following their natural behaviour to treat symptoms as and when they arise. However, at the same time, 它还在最需要的时候为气道炎症升高提供治疗.29,32
What needs to change in asthma management?
Far too many people with asthma have their lives disrupted by exacerbations that could be prevented. A combined approach focusing on inhaled combination medicines that provide symptom relief whilst also addressing underlying inflammation should be central to asthma management to optimise patient outcomes.
Strategies to achieve better outcomes for patients will also need to include increased awareness of the risks of using a SABA alone to manage asthma, as well as careful monitoring of SABA use to help identify those patients at risk of future exacerbations.
*Albuterol is also known as salbutamol
References
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Veeva ID: Z4-51128
Date of preparation: December 2022