Section 1. EPR-3 versus GINA 2008 Guidelines - Asthma Control and Step 3 Care: Highlights of the Asthma Summit 2009: Beyond the Guidelines

World Allergy Organization Journal

William W Busse¹  Jean Bousquet² 

[1] Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI;Montpelier University and INSERM, Montpelier, France

关键词: guidelines;    asthma;    GINA;    EPR-3;   

Others  :  1180801
DOI  :  10.1097/WOX.0b013e3181cb90c3

【 摘 要 】

Recent updates to asthma guidelines from the Global Initiative for Asthma (GINA) and the National Asthma Education and Prevention Program (Expert Panel Report 3, EPR-3) share many similarities, reflecting a focus on asthma control based on clinical manifestations of disease and responsiveness to therapy. Both documents build upon the recommendations of former guidelines utilizing evidence-based review of the published literature to revise algorithms for practice. A major difference between the 2 reports is the preferred treatment at Step 3. The GINA guidelines recommend a combination of low-dose inhaled corticosteroid (ICS) plus long-acting β-agonist (LABA), whereas the EPR-3 advises either monotherapy with medium-dose ICS or the low-dose ICS + LABA combination. Both approaches are supported by clinical experience and Level A evidence. The option of personalized therapy is a point of discussion for future guidelines.

【 授权许可】

   
2010 World Allergy Organization; licensee BioMed Central Ltd.

【 图 表 】

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Figure 2.

【 参考文献 】

• [1]Global Initiative for Asthma (GINA): Global strategy for asthma management and prevention. [http://www.ginasthma.org] webcite 2008. Accessed December 2008
• [2]Global Initiative for Asthma (GINA): Global strategy for asthma management and prevention. NHLBI/WHO Workshop report. Bethesda, MD: National Institutes of Health; 1995. Publication No. 95-3659
• [3]Global Initiative for Asthma (GINA): Global strategy for asthma management and prevention. NHLBI/WHO Workshop report. Bethesda, MD: National Institutes of Health Publication No. 95-3659; updated 2002. Available at: http://www.ginaasthma.com webcite. Accessed December 2008
• [4]O'Byrne PM, Barnes PJ, Rodriguez-Roisin R, Runnerstrom E, Sandstrom T, Svensson K, Tattersfield A: Low dose inhaled budesonide and formoterol in mild persistent asthma: the OPTIMA randomized trial. Am J Respir Crit Care Med 2001, 164:1392-1397.
• [5]Irvine L, Crombie IK, Alder EM, Neville RG, Clark RA: What predicts poor collection of medication among children with asthma? A case-control study. Eur Respir J 2002, 20:1464-1469.
• [6]Kuna P, Peters MJ, Manjra AI, Jorup C, Naya IP, Martinez-Jimenez NE, Buhl R: Effect of budesonide/formoterol maintenance and reliever therapy on asthma exacerbations. Int J Clin Pract 2007, 61:725-736.
• [7]National Asthma Education and Prevention Program: Expert Panel Report 3. Guidelines for the diagnosis and management of asthma. [http://www.nhlbi.nih.gov/guidelines/asthma/] webciteNational Heart, Lung, and Blood Institute; 2007.
• [8]Bateman ED, Boushey HA, Bousquet J, Busse WW, Clark TJ, Pauwels RA, Pedersen SE, GOAL Investigators Group: Can guideline-defined asthma control be achieved? The Gaining Optimal Asthma ControL study. Am J Respir Crit Care Med 2004, 170:836-844.
• [9]Greenstone IR, Ni Chroinin MN, Masse V, Danish A, Magdalinos H, Zhang X, Ducharme FM: Combination of inhaled long-acting beta2-agonists and inhaled steroids versus higher dose of inhaled steroids in children and adults with persistent asthma. Cochrane Database Syst Rev 2005, 4:CD005533.
• [10]Masoli M, Weatherall M, Holt S, Beasley R: Moderate dose inhaled corticosteroids plus salmeterol versus higher doses of inhaled corticosteroids in symptomatic asthma. Thorax 2005, 60:730-734.
• [11]Nelson HS, Weiss ST, Bleecker ER, Yancey SW, Dorinsky PM: The Salmeterol Multicenter Asthma Research Trial: a comparison of usual pharmacotherapy for asthma or usual pharmacotherapy plus salmeterol. Chest 2006, 129:15-26.
• [12]Mann M, Chowdhury B, Sullivan E, Nicklas R, Anthracite R, Meyer RJ: Serious asthma exacerbations in asthmatics treated with high-dose formoterol. Chest 2003, 124:70-74.
• [13]Nelson HS: Long-acting beta-agonists in adult asthma: evidence that these drugs are safe. Prim Care Respir J 2006, 15:271-277.
• [14]Woolcock A, Lundback B, Ringdal N, Jacques LA: Comparison of addition of salmeterol to inhaled steroids with doubling of the dose of inhaled steroids. Am J Respir Crit Care Med 1996, 153:1481-1488.
• [15]Greening AP, Ind PW, Northfield M, Shaw G: Added salmeterol versus higher-dose corticosteroid in asthma patients with symptoms on existing inhaled corticosteroid. Allen & Hanburys Limited UK Study Group. Lancet 1994, 344:219-224.
• [16]Pauwels RA, Lofdahl CG, Postma DS, Tattersfield AE, O'Byrne P, Barnes PJ, Ullman A: Effect of inhaled formoterol and budesonide on exacerbations of asthma. Formoterol and Corticosteroids Establishing Therapy (FACET) International Study Group. N Engl J Med 1997, 337:1405-1411.
• [17]O'Byrne PM, Bisgaard H, Godard PP, Pistolesi M, Palmqvist M, Zhu Y, Ekstrom T, Bateman ED: Budesonide/formoterol combination therapy as both maintenance and reliever medication in asthma. Am J Respir Crit Care Med 2005, 171:129-136.
• [18]Thomas M, von Zeigenweidt J, Lee AJ, Price D: High-dose inhaled corticosteroids versus add-on long-acting beta-agonists in asthma: an observational study. J Allergy Clin Immunol 2009, 123:116-121.
• [19]Sears MR: Step-up therapy in uncontrolled asthma: choices and outcomes. J Allergy Clin Immunol 2009, 123:122-123.
• [20]Green RH, Brightling CE, McKenna S, Hargadon B, Parker D, Bradding P, Wardlaw AJ, Pavord ID: Asthma exacerbations and sputum eosinophil counts: a randomized controlled trial. Lancet 2002, 360:1715-1721.