PDF(Pubmed)
Abstract：
A modified Delphi process was undertaken to provide a US expert-led consensus to guide clinical action on short-acting beta2-agonist (SABA) use. This comprised an online survey (Phase 1), forum discussion and statement development (Phase 2), and statement adjudication (Phase 3).
In Phase 1 (n = 100 clinicians), 12% routinely provided patients with ≥4 SABA prescriptions/year, 73% solicited SABA use frequency at every patient visit, and 21% did not consult asthma guidelines/expert reports. Phase 3 experts (n = 8) reached consensus (median Likert score, interquartile range) that use of ≥3 SABA canisters/year is associated with increased risk of exacerbation and asthma-related death (5, 4.75-5); SABA use history should be solicited at every patient visit (5, 4.75-5); usage patterns over time, not absolute thresholds, should guide response to SABA overuse (5, 4.5-5). Future asthma guidelines should include clear recommendations regarding SABA usage, using expert-led thresholds for action.
In Phase 1 (n = 100 clinicians), 12% routinely provided patients with ≥4 SABA prescriptions/year, 73% solicited SABA use frequency at every patient visit, and 21% did not consult asthma guidelines/expert reports. Phase 3 experts (n = 8) reached consensus (median Likert score, interquartile range) that use of ≥3 SABA canisters/year is associated with increased risk of exacerbation and asthma-related death (5, 4.75-5); SABA use history should be solicited at every patient visit (5, 4.75-5); usage patterns over time, not absolute thresholds, should guide response to SABA overuse (5, 4.5-5). Future asthma guidelines should include clear recommendations regarding SABA usage, using expert-led thresholds for action.
摘要：
目的：进行了改良的Delphi程序，以提供美国专家主导的共识，以指导短效β2激动剂（SABA）使用的临床行动。这包括一项在线调查(第一阶段)，论坛讨论和陈述发展(第二阶段)，和陈述裁决(第三阶段)。
结果：在第一阶段（n=100名临床医生），12％的患者常规提供≥4SABA处方/年，73%的患者在每次就诊时都要求SABA使用频率，21%的患者未咨询哮喘指南/专家报告.第三阶段专家(n=8)达成共识(李克特得分中位数，四分位数范围）每年使用≥3个SABA罐与加重和哮喘相关死亡的风险增加相关（5，4.75-5）；每次患者就诊时都应征求SABA使用史（5，4.75-5）；随着时间的推移，使用模式，不是绝对阈值，应指导对SABA过度使用的反应（5，4.5-5）。未来的哮喘指南应包括关于SABA使用的明确建议，使用专家主导的行动门槛。
结果：在第一阶段（n=100名临床医生），12％的患者常规提供≥4SABA处方/年，73%的患者在每次就诊时都要求SABA使用频率，21%的患者未咨询哮喘指南/专家报告.第三阶段专家(n=8)达成共识(李克特得分中位数，四分位数范围）每年使用≥3个SABA罐与加重和哮喘相关死亡的风险增加相关（5，4.75-5）；每次患者就诊时都应征求SABA使用史（5，4.75-5）；随着时间的推移，使用模式，不是绝对阈值，应指导对SABA过度使用的反应（5，4.5-5）。未来的哮喘指南应包括关于SABA使用的明确建议，使用专家主导的行动门槛。
