Asthma in Klinik und Praxis
Zeitschrift für Pneumologie - 2024
Tóm tắt
Asthma ist eine klinische Diagnose, wobei aktuelle Leitlinien ergänzend zur Beurteilung der Lungenfunktion die Berücksichtigung der Typ-2-Biomarker Eosinophile im Blut und Fraktion des exhalierten Stickstoffmonoxids („fraction of exhaled nitric oxide“, FeNO) empfehlen. Eine Phänotypisierung der Asthmaerkrankung auf Grundlage von Anamnese (u. a. Allergie), Biomarkern und Komorbiditäten ist Voraussetzung einer personalisierten Therapie. Inhalative Glukokortikoide (Inhaled corticosteroids, ICS) sind die in jeder Therapiestufe zu bevorzugende Basis der Therapie: Diese werden mit zunehmendem Asthmaschweregrad ergänzt durch lang wirksame Bronchodilatatoren und bei schwerem Asthma durch monoklonale Antikörper, die gegen Schlüsselmediatoren der asthmatischen Entzündung gerichtet sind (Biologika). Die enormen Fortschritte in der Therapie haben zu einer sehr guten Asthmakontrolle bei der sehr großen Mehrheit der Patientinnen und Patienten geführt, sodass die Asthmaerkrankung heute eine Domäne der ambulanten fachärztlichen Versorgung ist.
Từ khóa
Tài liệu tham khảo
Lommatzsch M, Buhl R, Korn S (2020) The treatment of mild and moderate asthma in adults. Dtsch Ärztebl Int 117:434–444. https://doi.org/10.3238/arztebl.2020.0434
Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) (2020) Nationale VersorgungsLeitlinie Asthma – Langfassung, 4. Auflage. Version 1. https://doi.org/10.6101/AZQ/000469. https://www.asthma.versorgungsleitlinien.de.
Lommatzsch M, Criee CP, de Jong CCM et al (2023) Diagnosis and treatment of asthma: a guideline for respiratory specialists 2023—published by the German Respiratory Society (DGP) e. V. Pneumologie 77:461–543. https://doi.org/10.1055/a-2070-2135
Aaron SD, Vandemheen KL, FitzGerald JM et al (2017) Reevaluation of diagnosis in adults with physician-diagnosed asthma. JAMA 317:269–279. https://doi.org/10.1001/jama.2016.19627
Louis R, Satia I, Ojanguren I et al (2022) European respiratory society guidelines for the diagnosis of asthma in adults. Eur Respir J. https://doi.org/10.1183/13993003.01585-2021
Kopp MV, Muche-Borowski C, Abou-Dakn M et al (2022) S3 guideline allergy prevention. Allergol Sel 6:61–97. https://doi.org/10.5414/ALX02303E
Pfaar O, Ankermann T, Augustin M et al (2022) Guideline on allergen immunotherapy in IgE-mediated allergic diseases: S2K Guideline of the German Society of Allergology and Clinical Immunology (DGAKI), Society of Pediatric Allergology and Environmental Medicine (GPA), Medical Association of German Allergologists (AeDA), Austrian Society of Allergology and Immunology (OGAI), Swiss Society for Allergology and Immunology (SSAI), German Dermatological Society (DDG), German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (DGHNO-KHC), German Society of Pediatrics and Adolescent Medicine (DGKJ), Society of Pediatric Pulmonology (GPP), German Respiratory Society (DGP), German Professional Association of Otolaryngologists (BVHNO), German Association of Paediatric and Adolescent Care Specialists (BVKJ), Federal Association of Pneumologists, Sleep and Respiratory Physicians (BdP), Professional Association of German Dermatologists (BVDD). Allergol Sel 6:167–232. https://doi.org/10.5414/ALX02331E
Lommatzsch M, Brusselle GG, Canonica GW et al (2022) Disease-modifying anti-asthmatic drugs. Lancet 399:1664–1668. https://doi.org/10.1016/S0140-6736(22)00331-2
Nathan et al (2004) Development of the Asthma Control Test: A survey for assessing asthma control. American Academy of Allergy, Asthma and Immunology. https://doi.org/10.1016/j.jaci.2003.09.008
Juniper EF, O’Byrne PM, Guyatt GH, Ferrie PJ, King DR (1999) Development and validation of a questionnaire to measure asthma control. Eur Respir J 14:902–907.
GINA, GIfA (2023) Global strategy for asthma management and prevention (www.ginasthma.org)
Nwaru BI, Ekstrom M, Hasvold P et al (2020) Overuse of short-acting beta(2)-agonists in asthma is associated with increased risk of exacerbation and mortality: a nationwide cohort study of the global SABINA programme. Eur Respir J. https://doi.org/10.1183/13993003.01872-2019
Beasley R, Holliday M, Reddel HK et al (2019) Controlled trial of budesonide-formoterol as needed for mild asthma. N Engl J Med 380:2020–2030. https://doi.org/10.1056/NEJMoa1901963
O’Byrne PM, FitzGerald JM, Bateman ED et al (2018) Inhaled combined budesonide-formoterol as needed in mild asthma. N Engl J Med 378:1865–1876. https://doi.org/10.1056/NEJMoa1715274
Reddel HK, FitzGerald JM, Bateman ED et al (2019) GINA 2019: a fundamental change in asthma management: treatment of asthma with short-acting bronchodilators alone is no longer recommended for adults and adolescents. Eur Respir J. https://doi.org/10.1183/13993003.01046-2019
Reddel HK, Busse WW, Pedersen S et al (2017) Should recommendations about starting inhaled corticosteroid treatment for mild asthma be based on symptom frequency: a post-hoc efficacy analysis of the START study. Lancet 389:157–166. https://doi.org/10.1016/S0140-6736(16)31399-X
Sobieraj DM, Weeda ER, Nguyen E et al (2018) Association of inhaled corticosteroids and long-acting beta-agonists as controller and quick relief therapy with exacerbations and symptom control in persistent asthma: a systematic review and meta-analysis. JAMA 319:1485–1496. https://doi.org/10.1001/jama.2018.2769
Beasley R, Harper J, Bird G et al (2019) Inhaled corticosteroid therapy in adult asthma. Time for a new therapeutic dose terminology. Am J Respir Crit Care Med 199:1471–1477. https://doi.org/10.1164/rccm.201810-1868CI
Lee LA, Bailes Z, Barnes N et al (2021) Efficacy and safety of once-daily single-inhaler triple therapy (FF/UMEC/VI) versus FF/VI in patients with inadequately controlled asthma (CAPTAIN): a double-blind, randomised, phase 3A trial. Lancet Respir Med 9:69–84. https://doi.org/10.1016/S2213-2600(20)30389-1
Jackson DJ, Heaney LG, Humbert M et al (2024) Reduction of daily maintenance inhaled corticosteroids in patients with severe eosinophilic asthma treated with benralizumab (SHAMAL): a randomised, multicentre, open-label, phase 4 study. Lancet 403:271–281. https://doi.org/10.1016/S0140-6736(23)02284-5