PDF(Pubmed)
Abstract：
BACKGROUND: Since the last guidance was published by the Canadian Thoracic Society, there have been several advances in the clinical management of severe asthma. To gain a better understanding of the current standards of care and treatment patterns of patients, the CASCADE practice reflective program was established to conduct a real-world analysis of severe asthma management among specialists in Canada with a goal of identifying areas of opportunity to enhance patient management and outcomes.
METHODS: The CASCADE program was a two-part practice reflective and assessment program delivered through an on-line portal for selected specialists (Respirologists and Allergists) in Canada. The program consisted of a one-time overview survey of physician practice to establish overall practice parameters, followed by a review of at least 5 severe asthma patients to establish the current landscape of severe asthma management.
RESULTS: The program collected practice overview surveys from 78 specialists (52 Respirologists, 24 Allergists, and 2 General practice physicians with an interest in respiratory disease) in 8 provinces. Practices included a variety of types in both large metropolitan centres and smaller regional settings. There were 503 patients reviewed and included in the program. Most (65%) patients were currently using a biologic treatment, 30% were biologic naive, and 5% had used a biologic treatment in the past. Most patients (53%) were reported to have mixed allergic and eosinophilic phenotypes, despite a perception that allergic, eosinophilic and mixed phenotypes were evenly balanced in the physician practice. Overall, patients currently treated with biologic agents had parameters suggesting higher control and were more satisfied with treatment. However, there was less than optimal treatment satisfaction for more than half of all patients, particularly for those patients not treated with a biologic agent.
CONCLUSIONS: Phenotyping is hampered by poor availability for several assessments, and the full range of treatments are not currently fully utilized, partly due to physician familiarity with the agents and partly due to prescribing restrictions. Even when treated with biologic agents, patient satisfaction can still be improved.
METHODS: The CASCADE program was a two-part practice reflective and assessment program delivered through an on-line portal for selected specialists (Respirologists and Allergists) in Canada. The program consisted of a one-time overview survey of physician practice to establish overall practice parameters, followed by a review of at least 5 severe asthma patients to establish the current landscape of severe asthma management.
RESULTS: The program collected practice overview surveys from 78 specialists (52 Respirologists, 24 Allergists, and 2 General practice physicians with an interest in respiratory disease) in 8 provinces. Practices included a variety of types in both large metropolitan centres and smaller regional settings. There were 503 patients reviewed and included in the program. Most (65%) patients were currently using a biologic treatment, 30% were biologic naive, and 5% had used a biologic treatment in the past. Most patients (53%) were reported to have mixed allergic and eosinophilic phenotypes, despite a perception that allergic, eosinophilic and mixed phenotypes were evenly balanced in the physician practice. Overall, patients currently treated with biologic agents had parameters suggesting higher control and were more satisfied with treatment. However, there was less than optimal treatment satisfaction for more than half of all patients, particularly for those patients not treated with a biologic agent.
CONCLUSIONS: Phenotyping is hampered by poor availability for several assessments, and the full range of treatments are not currently fully utilized, partly due to physician familiarity with the agents and partly due to prescribing restrictions. Even when treated with biologic agents, patient satisfaction can still be improved.
摘要：
背景：自上次指南由加拿大胸科学会出版以来，在重症哮喘的临床管理方面取得了一些进展.为了更好地了解当前患者的护理标准和治疗模式，CASCADE实践反思计划的建立是为了对加拿大专家中的严重哮喘管理进行真实世界分析,目的是确定改善患者管理和结局的机会领域.
方法：CASCADE计划是一个由两部分组成的实践反思和评估计划，通过在线门户为加拿大的选定专家（呼吸道学家和变态反应学家）提供。该计划包括对医师实践的一次性概述调查，以建立总体实践参数，随后对至少5名重度哮喘患者进行了回顾,以确定目前的重度哮喘管理状况.
结果：该计划收集了78位专家的实践概述调查（52位生殖学家，24名过敏症患者,和2名对呼吸系统疾病感兴趣的全科医生）在8个省。实践包括大城市中心和较小区域环境中的各种类型。有503名患者被审查并纳入该计划。大多数（65％）患者目前正在使用生物治疗，30%是生物学幼稚，5%的人过去曾使用过生物治疗。据报道，大多数患者（53％）具有混合的过敏和嗜酸性粒细胞表型，尽管人们认为过敏，在医师实践中，嗜酸性粒细胞和混合表型均匀平衡。总的来说,目前接受生物制剂治疗的患者的参数表明控制较高,并且对治疗更满意.然而,超过一半的患者的治疗满意度低于最佳治疗满意度，特别是对于那些没有用生物制剂治疗的患者。
结论：表型分析因几项评估的可用性差而受阻，目前还没有充分利用全方位的治疗方法，部分原因是医生熟悉药物，部分原因是处方限制。即使用生物制剂治疗，患者满意度仍可提高。
方法：CASCADE计划是一个由两部分组成的实践反思和评估计划，通过在线门户为加拿大的选定专家（呼吸道学家和变态反应学家）提供。该计划包括对医师实践的一次性概述调查，以建立总体实践参数，随后对至少5名重度哮喘患者进行了回顾,以确定目前的重度哮喘管理状况.
结果：该计划收集了78位专家的实践概述调查（52位生殖学家，24名过敏症患者,和2名对呼吸系统疾病感兴趣的全科医生）在8个省。实践包括大城市中心和较小区域环境中的各种类型。有503名患者被审查并纳入该计划。大多数（65％）患者目前正在使用生物治疗，30%是生物学幼稚，5%的人过去曾使用过生物治疗。据报道，大多数患者（53％）具有混合的过敏和嗜酸性粒细胞表型，尽管人们认为过敏，在医师实践中，嗜酸性粒细胞和混合表型均匀平衡。总的来说,目前接受生物制剂治疗的患者的参数表明控制较高,并且对治疗更满意.然而,超过一半的患者的治疗满意度低于最佳治疗满意度，特别是对于那些没有用生物制剂治疗的患者。
结论：表型分析因几项评估的可用性差而受阻，目前还没有充分利用全方位的治疗方法，部分原因是医生熟悉药物，部分原因是处方限制。即使用生物制剂治疗，患者满意度仍可提高。
