OCS在重症哮喘护理中的应用:
是时候结束过度依赖了

他之前经营着英国最大的严重哮喘诊所之一, I’m all too familiar with the complicated relationship many people with severe asthma have with systemic corticosteroids (SCS), 包括口服皮质类固醇(OCS).

Despite the introduction of updated treatment strategies and novel therapies for asthma, OCS的使用率仍然很高. Although OCS are an effective treatment for acute asthma attacks and improving symptom control, the increased risk of acute and chronic adverse effects from frequent acute OCS prescriptions is often underestimated.^1-4 因此, it is vital that we continue to encourage responsible prescribing habits with an aim to minimise chronic and cumulative OCS exposure whenever possible. 总是, 当病人第一次来找我时，他们最关心的是他们的OCS使用情况, 他们的首要问题是:“我怎样才能停药??”

是时候从根本上改变OCS在重症哮喘治疗中的作用了.

口服皮质类固醇治疗严重哮喘

Severe asthma is a heterogenous and complex disease, with multiple underlying drivers.^5,6 据估计，2019年全球有2600万人受到影响，^1,7 experiencing frequent exacerbations and significant limitations on their lung function and quality of life.^1-4

For over 60 years we have relied on OCS as a mainstay of severe asthma treatment to help people manage their exacerbations.⁸ 超过13个.5 million people worldwide with severe asthma currently rely on OCS to control exacerbations and prevent hospitalisations.^1-3,7,9 这种累积, long-term use of OCS is associated with debilitating side effects for patients and can place further burden on their quality of life.^2,3,10 长期使用OCS可能会带来严重的健康风险, 包括糖尿病, 骨质疏松和心脏病.^4,11,12 事实上, potential OCS-induced morbidities have been identified in 93 percent of people with severe asthma ¹¹, with recent studies indicating that long-term use is associated with a higher risk of mortality compared with non-use ¹³.

OCS reduction in other disease areas gives us hope to replicate this success in severe asthma

在其他疾病领域，澳门第一赌城在线娱乐看到OCS的使用最近有所下降, 比如风湿病学, OCS曾经是司空见惯的护理标准.^8,14 For decades, steroids were used to help control symptoms for people with rheumatoid arthritis. ^8,14 现在有了早期诊断, 伴随着新疗法的出现, rheumatologists have been able to revolutionise patient care and substantially reduce OCS use. ^8,14

We must embrace learnings from other disease areas like rheumatology where clinicians have found success in reducing OCS use.^8,14 再加上关于如何安全的明确证据, 在严重哮喘中有效实现, 澳门第一赌城在线娱乐有潜力极大地改善病人的治疗结果. OCS的逐渐减少是减少短期和长期不利影响的基础.

采纳建议改变指南的证据是关键的进展驱动因素

越来越多的证据表明, 包括其他慢性病的例子, is emerging that could further inform guidelines to drive greater adoption of OCS-sparing strategies and enable physicians to safely and effectively taper their patients from OCS.¹⁵

The medical community must embrace this emerging evidence and put it into practice as quickly and responsibly as possible. With recent scientific advancements and targeted therapies now an option for many patients who were previously reliant on OCS, 以及支持安全的ocs保留策略的证据, I’m incredibly hopeful that we can achieve an improved approach to severe asthma treatment.

共同努力实现变革

尽管严重哮喘的全球指导方针正在实施, multiple barriers against change still exist and recommendations need to be adapted on a country-by-country basis. A comprehensive and concerted effort is necessary to tackle the issues of reliance on OCS which is why it will be crucial to change national and local policies alike. 最近出版的 世界过敏组织杂志上关于哮喘全身性皮质类固醇的文章 therefore calls on the global respiratory community to work alongside clinical leaders, patient advocates and healthcare systems to transform standards of care and truly relegate OCS use to a last resort. 具体步骤, 包括定义OCS使用的阈值和提高对适当使用的认识, 是否确定了一个社区可以为之努力的目标, 确保重症哮喘患者常规得到及时护理, 在最合适的场合. 

此外,一个 OCS Charter to Fundamentally Change the Role of Oral Corticosteroids in the Management of Asthma was published to reframe the relationship that patients living with asthma and their healthcare team have with OCS. Shifting mindsets and implementing the latest guidelines could bring clinical practice closer to other disease areas who have had success, 并最终, 对严重哮喘患者的长期健康产生重大影响.