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Management of Severe Asthma: a European Respiratory Society/American Thoracic Society Guideline
European Respiratory Journal ( IF 16.6 ) Pub Date : 2019-09-26 , DOI: 10.1183/13993003.00588-2019
Fernando Holguin 1, 2 , Juan Carlos Cardet 3 , Kian Fan Chung 4 , Sarah Diver 5 , Diogenes S Ferreira 6, 7 , Anne Fitzpatrick 8 , Mina Gaga 9 , Liz Kellermeyer 10 , Sandhya Khurana 11 , Shandra Knight 10 , Vanessa M McDonald 12 , Rebecca L Morgan 13 , Victor E Ortega 14 , David Rigau 15 , Padmaja Subbarao 16 , Thomy Tonia 17 , Ian M Adcock 18 , Eugene R Bleecker 19 , Chris Brightling 20 , Louis-Philippe Boulet 21 , Michael Cabana 22 , Mario Castro 23 , Pascal Chanez 24 , Adnan Custovic 25 , Ratko Djukanovic 26 , Urs Frey 27 , Betty Frankemölle 28 , Peter Gibson 29 , Dominique Hamerlijnck 28 , Nizar Jarjour 30 , Satoshi Konno 31 , Huahao Shen 32 , Cathy Vitary 33 , Andy Bush 34, 35
Affiliation  

This document provides clinical recommendations for the management of severe asthma. Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the European Respiratory Society/American Thoracic Society Task Force's questions. The evidence was appraised using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of asthma experts, who made specific recommendations on six specific questions. After considering the balance of desirable and undesirable consequences, quality of evidence, feasibility, and acceptability of various interventions, the Task Force made the following recommendations: 1) suggest using anti-interleukin (IL)-5 and anti-IL-5 receptor α for severe uncontrolled adult eosinophilic asthma phenotypes; 2) suggest using a blood eosinophil cut-point ≥150 μL−1 to guide anti-IL-5 initiation in adult patients with severe asthma; 3) suggest considering specific eosinophil (≥260 μL−1) and exhaled nitric oxide fraction (≥19.5 ppb) cut-offs to identify adolescents or adults with the greatest likelihood of response to anti-IgE therapy; 4) suggest using inhaled tiotropium for adolescents and adults with severe uncontrolled asthma despite Global Initiative for Asthma (GINA) step 4–5 or National Asthma Education and Prevention Program (NAEPP) step 5 therapies; 5) suggest a trial of chronic macrolide therapy to reduce asthma exacerbations in persistently symptomatic or uncontrolled patients on GINA step 5 or NAEPP step 5 therapies, irrespective of asthma phenotype; and 6) suggest using anti-IL-4/13 for adult patients with severe eosinophilic asthma and for those with severe corticosteroid-dependent asthma regardless of blood eosinophil levels. These recommendations should be reconsidered as new evidence becomes available. The ERS/ATS Task Force makes recommendations on the use of novel therapies for severe asthma, specifically biologicals for type 2 high asthma, and antimuscarinic agents and macrolides, as well as on biomarkers for predicting treatment response http://bit.ly/2kZLRaD

中文翻译:

严重哮喘的管理:欧洲呼吸学会/美国胸科学会指南

本文件为严重哮喘的管理提供了临床建议。进行了全面的证据合成,包括荟萃分析,以总结与欧洲呼吸学会/美国胸科学会工作组的问题相关的所有可用证据。使用 GRADE(推荐、评估、制定和评价分级)方法对证据进行评估,并将结果总结在证据资料中。由哮喘专家组成的多学科工作组讨论了证据综合并制定了建议,他们针对六个具体问题提出了具体建议。在考虑了各种干预措施的理想和不良后果、证据质量、可行性和可接受性之间的平衡后,工作组提出了以下建议:1) 建议使用抗白细胞介素 (IL)-5 和抗 IL-5 受体 α 治疗严重不受控制的成人嗜酸性粒细胞哮喘表型;2) 建议使用≥150 μL−1 的血液嗜酸性粒细胞临界值来指导成人重度哮喘患者的抗 IL-5 启动;3) 建议考虑特定的嗜酸性粒细胞 (≥260 μL−1) 和呼出的一氧化氮分数 (≥19.5 ppb) 临界值,以确定对抗 IgE 治疗有最大反应可能性的青少年或成人;4) 建议对患有严重未控制哮喘的青少年和成人使用吸入噻托溴铵,尽管全球哮喘倡议 (GINA) 的第 4-5 步或国家哮喘教育和预防计划 (NAEPP) 的第 5 步治疗;5) 建议在接受 GINA 第 5 步或 NAEPP 第 5 步治疗的持续有症状或不受控制的患者中,进行慢性大环内酯治疗以减少哮喘恶化,与哮喘表型无关;6) 建议对患有严重嗜酸性粒细胞哮喘的成年患者和患有严重皮质类固醇依赖性哮喘的患者使用抗 IL-4/13,而不管血液嗜酸性粒细胞水平如何。随着新证据的出现,应重新考虑这些建议。ERS/ATS 工作组就严重哮喘的新疗法的使用提出建议,特别是 2 型高度哮喘的生物制剂、抗毒蕈碱药物和大环内酯类药物,以及用于预测治疗反应的生物标志物 http://bit.ly/2kZLRaD
更新日期:2019-09-26
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