Asthma across the lifespan: Time for a paradigm shift - 06/09/18
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Abstract |
We have a unique opportunity to significantly reduce the worldwide burden of asthma in children and affect respiratory outcomes in adults. However, this will require a paradigm shift that is directed at altering the natural history of asthma, reducing asthma exacerbations, and preventing long-term adverse outcomes of childhood asthma. Attention should continue to be directed toward minimizing risk, as well as impairment, with a goal to achieve optimal control. Based on several National Institutes of Health studies conducted over the last 10 years, we now have the tools necessary to accomplish this goal. The tools include assessment of lung function over time or defining trajectories of lung growth, the Composite Asthma Severity Index score, a panel of useful biomarkers, the Seasonal Asthma Exacerbation Prediction Index score, and rapidly advancing technology that includes adherence monitoring. Future guideline revisions should consider incorporating recommendations to follow spirometry over time and defining trajectories of lung growth to assess risk for reduced lung growth and early decline, asthma burden by using biomarkers to select and monitor therapy, assessment of social determinants of health, evaluation of risk for seasonal exacerbations, and consideration of electronic adherence monitoring for difficult-to-manage asthma. Guidelines should continue to include a core dedicated to the diagnosis and treatment of intermittent and mild and moderate persistent asthma and include additional sections dedicated to the management of severe asthma.
Le texte complet de cet article est disponible en PDF.Key words : Asthma exacerbation, asthma guidelines, Composite Asthma Severity Index, Seasonal Asthma Exacerbation Prediction Index, trajectories of lung growth
Abbreviations used : CASI, COPD, EPR-3, GINA, ICAC, ICS, NAEPP, NHLBI, NIAID, NICE, NIH, SAEPI
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Disclosure of potential conflict of interest: S. J. Szefler has consulted for Aerocrine, AstraZeneca, Boehringer Ingelheim, Daiichi Sankyo, GlaxoSmithKline, Genentech, Novartis, Roche, and Teva and has received research support from the National Institutes of Health; the National Heart, Lung, and Blood Institute; GlaxoSmithKline; and the Colorado Cancer, Cardiovascular, and Pulmonary Disease Program. He is also a former member of the Global Initiative for Asthma Scientific Committee and the National Asthma Education and Prevention Program Expert Panel 3. |
Vol 142 - N° 3
P. 773-780 - septembre 2018 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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