背景:2019年全球哮喘倡议(GINA)和2020年国家心肺和血液研究所(NHLBI)哮喘指南对轻度哮喘进行了重大更新。这些小组不再推荐短效β-激动剂(SABA)作为轻度(GINA)或轻度持续性(NHLBI)哮喘的单药治疗。由于指南或证据更新与实践变化之间可能出现的滞后,这项研究试图评估是否采用了指南.
方法:在这篇回顾性图表综述中,从2021年7月1日至2022年7月1日,我们对来自大型医疗系统的患者电子病历进行了评估,以确定有多少轻度哮喘患者根据需要进行处方,或根据需要在SABA的基础上每天使用吸入性糖皮质激素(ICS).次要结果是评估轻度哮喘患者急性发作的发生率,比较指南指导治疗与否。此外,我们评估了增加轻度哮喘急性发作风险的其他患者因素.
结果:对于主要结果,在符合纳入标准的1,107名患者中,284例患者(26%)在研究期间没有针对轻度哮喘的指南指导治疗文件,而823(74%)接受指南指导的治疗(Diff:48.7%;95%CI:45.1至52.3%,p<0.001)。对于次要目标,161例患者出现恶化(12%的患者接受指南指导的治疗,15.4%不接受指南指导的治疗)。两个治疗组之间的恶化发生率差异无统计学意义(Diff:-3.4%;95%CI:-8至1.1%;p=0.133)。此外,作为女性,有GERD,在我们的患者人群中,肥胖是与哮喘加重相关的统计学显著因素.
结论:近1/4的轻度持续性哮喘患者没有接受指南指导的治疗,尽管哮喘指南有更新(GINA2019,NHLBI2020)。诸如女性等因素,有GERD,在轻度持续性哮喘患者中,肥胖是与哮喘加重相关的统计学显著因素.
BACKGROUND: A significant update was made to both the Global Initiative for Asthma (GINA) in 2019 and the National Heart Lung and Blood Institute (NHLBI) asthma
guidelines in 2020 for mild asthma. These groups no longer recommend short-acting beta-agonists (SABA) as monotherapy for mild (GINA) or mild-persistent (NHLBI) asthma. With the lag that can occur between guideline or evidence updates and changes in practice, this study sought to evaluate whether guideline adoption had occurred.
METHODS: In this retrospective chart review, patient electronic medical records from a large healthcare system were evaluated from July 1 of 2021 to July 1 of 2022 to determine how many patients with mild asthma were prescribed as needed or daily inhaled corticosteroids (ICS) in addition to as needed SABA. The secondary outcome was to evaluate the incidence of exacerbations in patients with mild asthma, comparing those on guideline-directed therapy or not. In addition, we evaluated other patient factors increasing
exacerbation risk in mild asthma.
RESULTS: For the primary outcome, of the 1,107 patients meeting inclusion criteria, 284 patients (26%) did not have documentation of guideline-directed therapy for mild asthma during the study period, while 823 (74%) were on guideline-directed therapy (Diff:48.7%; 95% CI:45.1 to 52.3%, p < 0.001). For the secondary objective, 161 patients had an
exacerbation (12% on
guideline-directed therapy, 15.4% not on guideline-directed therapy). This difference in incidence of
exacerbation between the two treatment groups was not statistically significant (Diff: -3.4%; 95% CI: -8 to 1.1%; p = 0.133). In addition, being female, having GERD, and being obese were all statistically significant factors associated with having asthma exacerbations among our patient population.
CONCLUSIONS: Nearly one-fourth of patients with mild persistent asthma were not on guideline-directed therapy, despite updates in asthma
guidelines (GINA 2019, NHLBI 2020). Factors such as being female, having GERD, and being obese were all statistically significant factors associated with having asthma exacerbations among patients with mild persistent asthma.