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2020 Brazilian Thoracic Association recommendations for the management of asthma.

ABSTRACT: The pharmacological management of asthma has changed considerably in recent decades, as it has come to be understood that it is a complex, heterogeneous disease with different phenotypes and endotypes. It is now clear that the goal of asthma treatment should be to achieve and maintain control of the disease, as well as to minimize the risks (of exacerbations, disease instability, accelerated loss of lung function, and adverse treatment effects). That requires an approach that is personalized in terms of the pharmacological treatment, patient education, written action plan, training in correct inhaler use, and review of the inhaler technique at each office visit. A panel of 22 pulmonologists was invited to perform a critical review of recent evidence of pharmacological treatment of asthma and to prepare this set of recommendations, a treatment guide tailored to use in Brazil. The topics or questions related to the most significant changes in concepts, and consequently in the management of asthma in clinical practice, were chosen by a panel of experts. To formulate these recommendations, we asked each expert to perform a critical review of a topic or to respond to a question, on the basis of evidence in the literature. In a second phase, three experts discussed and structured all texts submitted by the others. That was followed by a third phase, in which all of the experts reviewed and discussed each recommendation. These recommendations, which are intended for physicians involved in the treatment of asthma, apply to asthma patients of all ages.

SUBMITTER: Pizzichini MMM

PROVIDER: S-EPMC7462684 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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2020 Brazilian Thoracic Association recommendations for the management of asthma.

Pizzichini Marcia Margaret Menezes MMM Carvalho-Pinto Regina Maria de RM Cançado José Eduardo Delfini JED Rubin Adalberto Sperb AS Cerci Neto Alcindo A Cardoso Alexandre Pinto AP Cruz Alvaro Augusto AA Fernandes Ana Luisa Godoy ALG Blanco Daniella Cavalet DC Vianna Elcio Oliveira EO Cordeiro Junior Gediel G Rizzo José Angelo JA Fritscher Leandro Genehr LG Caetano Lilian Serrasqueiro Ballini LSB Pereira Luiz Fernando Ferreira LFF Rabahi Marcelo Fouad MF Oliveira Maria Alenita de MA Lima Marina Andrade MA Almeida Marina Buarque de MB Stelmach Rafael R Pitrez Paulo Márcio PM Cukier Alberto A

Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia 20200302 1

The pharmacological management of asthma has changed considerably in recent decades, as it has come to be understood that it is a complex, heterogeneous disease with different phenotypes and endotypes. It is now clear that the goal of asthma treatment should be to achieve and maintain control of the disease, as well as to minimize the risks (of exacerbations, disease instability, accelerated loss of lung function, and adverse treatment effects). That requires an approach that is personalized in ...[more]

PMID: 32130345

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Project description:BackgroundIn 2010, the Canadian Thoracic Society (CTS) published a Consensus Summary for the diagnosis and management of asthma in children six years of age and older, and adults, including an updated Asthma Management Continuum. The CTS Asthma Clinical Assembly subsequently began a formal clinical practice guideline update process, focusing, in this first iteration, on topics of controversy and⁄or gaps in the previous guidelines.MethodsFour clinical questions were identified as a focus for the updated guideline: the role of noninvasive measurements of airway inflammation for the adjustment of anti-inflammatory therapy; the initiation of adjunct therapy to inhaled corticosteroids (ICS) for uncontrolled asthma; the role of a single inhaler of an ICS⁄long-acting beta(2)-agonist combination as a reliever, and as a reliever and a controller; and the escalation of controller medication for acute loss of asthma control as part of a self-management action plan. The expert panel followed an adaptation process to identify and appraise existing guidelines on the specified topics. In addition, literature searches were performed to identify relevant systematic reviews and randomized controlled trials. The panel formally assessed and graded the evidence, and made 34 recommendations.ResultsThe updated guideline recommendations outline a role for inclusion of assessment of sputum eosinophils, in addition to standard measures of asthma control, to guide adjustment of controller therapy in adults with moderate to severe asthma. Appraisal of the evidence regarding which adjunct controller therapy to add to ICS and at what ICS dose to begin adjunct therapy in children and adults with poor asthma control supported the 2010 CTS Consensus Summary recommendations. New recommendations for the adjustment of controller medication within written action plans are provided. Finally, priority areas for future research were identified.ConclusionsThe present clinical practice guideline is the first update of the CTS Asthma Guidelines following the Canadian Respiratory Guidelines Committee's new guideline development process. Tools and strategies to support guideline implementation will be developed and the CTS will continue to regularly provide updates reflecting new evidence.

Dataset Information

2020 Brazilian Thoracic Association recommendations for the management of asthma.

Publications

2020 Brazilian Thoracic Association recommendations for the management of asthma.

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