{"id":411,"date":"2019-11-28T16:10:06","date_gmt":"2019-11-28T15:10:06","guid":{"rendered":"https:\/\/admsu.org\/?p=411"},"modified":"2019-11-29T10:39:03","modified_gmt":"2019-11-29T09:39:03","slug":"staff-biblio-n1","status":"publish","type":"post","link":"https:\/\/admsu.org\/w\/staff-biblio-n1\/","title":{"rendered":"Staff biblio n\u00b01"},"content":{"rendered":"\n

GINA 2019: a fundamental change in asthma management : Treatment of asthma with short-acting bronchodilators alone is no longer recommended for adults and adolescents<\/h3>\n\n\n\n
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Reddel HK, FitzGerald JM, Bateman ED, et al. GINA 2019: a fundamental change in asthma management. Eur Respir J 2019; 53: 1901046 [https:\/\/doi.org\/10.1183\/13993003.01046-2019<\/a>].<\/p>\n\n\n\n

Pr\u00e9sent\u00e9<\/strong> par Margot Frampas et Dr Camille Cochet<\/p>\n\n\n\n

PICO<\/strong> : Chez les patients adulte et les adolescents de plus de 12 ans ayant un asthme de stade 1, le traitement par cortico\u00efde inhal\u00e9 est il plus efficace que le traitement par b\u00e9ta2 bronchodilatateur de dur\u00e9e br\u00e8ve (BDCA) pour la pr\u00e9vention des exacerbations d’asthme.<\/p>\n\n\n\n

R\u00e9ponse des auteurs<\/strong> : Le traitement de l\u2019asthme chez l\u2019adulte et l\u2019adolescent ne doit plus reposer sur les BDCA seuls.
Ils doivent d\u00e9sormais recevoir un traitement par cortico\u00efdes inhal\u00e9s selon les sympt\u00f4mes et le stade de l\u2019asthme.<\/p>\n\n\n\n

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Pourquoi cette question<\/strong>
Epid\u00e9miologie<\/strong>
2 \u00e9pid\u00e9mies internationales de d\u00e9c\u00e8s li\u00e9es \u00e0 l\u2019asthme entre 1980 et 1990
 Crompton G. A brief history of inhaled asthma therapy over the last fifty years. Prim Care Respir J 2006; 15: 326\u2013331.<\/a>
Une \u00e9tude cas-t\u00e9moins : d\u00e9c\u00e8s li\u00e9s \u00e0 une sur-utilisation des BDCA
 Suissa S, Ernst P, Boivin JF, et al. A cohort analysis of excess mortality in asthma and the use of inhaled beta-agonists. Am J Respir Crit Care Med 1994; 149: 604\u2013610.<\/a>
Abramson MJ, Bailey MJ, Couper FJ, et al. Are asthma medications and management related to deaths from asthma? Am J Respir Crit Care Med 2001; 163: 12\u201318.<\/a>
Une \u00e9tude randomis\u00e9e: pas d\u2019avantage entre la prise quotidienne et la prise \u00e0 la demande des BDCA
Drazen JM, Israel E, Boushey HA, et al. Comparison of regularly scheduled with as-needed use of albuterolmild asthma. Asthma Clinical Research Network. N Engl J Med 1996; 335: 841\u2013847<\/a>.
 Dennis SM, Sharp SJ, Vickers MR, et al. Regular inhaled salbutamol and asthma control: the TRUST randomised trial. Therapy Working Group of the National Asthma Task Force and the MRC General Practice Research Framework. Lancet 2000; 355: 1675\u20131679.<\/a>
Un essai contr\u00f4l\u00e9 randomis\u00e9 : diminution des exacerbations de 50% avec un traitement par CSI faible dose dans l\u2019asthme l\u00e9ger
Les chiffres de la revue nationale des d\u00e9c\u00e8s dus \u00e0 l\u2019asthme
O\u2019Byrne PM, Barnes PJ, Rodriguez-Roisin R, et al. Low dose inhaled budesonide and formoterol in mild persistent asthma: the OPTIMA randomized trial. Am J Respir Crit Care Med 2001; 164: 1392\u20131397.<\/a>
Pauwels RA, Pedersen S, Busse WW, et al. Early intervention with budesonide in mild persistent asthma:randomised, double-blind trial. Lancet 2003; 361: 1071\u20131076.<\/a>
Effets ind\u00e9sirables li\u00e9s \u00e0 une utilisation de BDCA seuls mis en \u00e9vidence par diverses \u00e9tudes:<\/strong>
bronchoprotection r\u00e9duite
hypersensibilit\u00e9 accrue des voies a\u00e9riennes
bronchoconstriction induite par l’exercice et des r\u00e9ponses allergiques
augmentation de l’inflammation \u00e0 \u00e9osinophiles et une lib\u00e9ration de m\u00e9diateur mastocytaire
Taylor DR, Sears MR, Cockcroft DW. The beta-agonist controversy. Med Clin North Am 1996; 80: 719\u2013748.<\/a>
 Hancox RJ. Concluding remarks: can we explain the association of beta-agonists with asthma mortality?hypothesis. Clin Rev Allergy Immunol 2006; 31: 279\u2013288.<\/a><\/p>\n\n\n\n

<\/p>\n\n\n\n

Quels sont les r\u00e9sultats<\/strong>
Stade II : Etude SYGMA<\/strong>
Patients pr\u00e9sentant des sympt\u00f4mes au moins 2 fois\/mois ou ayant des FDR d\u2019exacerbations s\u00e9v\u00e8res
Faibles doses quotidiennes de CSI inhal\u00e9s VS BDCA diminuent le risque d\u2019exacerbations s\u00e9v\u00e8res
Faibles doses de CSI inhal\u00e9s \u00e0 la demande VS BDCA = diminution de 2\/3 le risque d\u2019exacerbation s\u00e9v\u00e8re
Faibles doses de CSI inhal\u00e9s \u00e0 la demande VS quotidiennes = non inf\u00e9rieur sur le risque d\u2019exacerbations s\u00e9v\u00e8res
Bateman ED, Reddel HK, O\u2019Byrne PM, et al. As-needed budesonide-formoterol versus maintenance budesonide in mild asthma. N Engl J Med 2018; 378: 1877\u20131887.<\/a>
O\u2019Byrne PM, FitzGerald JM, Bateman ED, et al. Inhaled combined budesonide-formoterol as needed in mild asthma. N Engl J Med 2018; 378: 1865\u20131876.<\/a>
<\/p>\n\n\n\n

Stade I de l\u2019asthme<\/strong>
Patients pr\u00e9sentant des sympt\u00f4mes moins de 2 fois\/mois et sans FDR d\u2019exacerbations s\u00e9v\u00e8res
Pas d\u2019\u00e9tude sp\u00e9cifique
Recommandations bas\u00e9es sur les r\u00e9sultats pour le stade II
Cortico\u00efdes inhal\u00e9s inhal\u00e9s \u00e0 la demande, pas en quotidien<\/p>\n\n\n\n

Limites<\/strong>
Pas d\u2019\u00e9tude sp\u00e9cifique pour l\u2019asthme l\u00e9ger stade I
Pas d\u2019\u00e9tude chez l\u2019enfant, la femme enceinte et l\u2019asthme allergique saisonnier
Probl\u00e8mes d\u2019observance
Probl\u00e8mes de co\u00fbt dans les pays en voie de d\u00e9veloppement
Identifier les patients \u00e0 risque d\u2019exacerbation s\u00e9v\u00e8re n\u00e9cessitant un traitement par CSI<\/p>\n\n\n\n

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Commentaire du groupe de lecture<\/strong>
Applicabilit\u00e9 \u00e0 la population du SAU non hospitalis\u00e9e pour les stades 1 & 2
Ordonnance de sortie
Premi\u00e8re ligne de traitement \u00e0 domicile par cortico\u00efde inhal\u00e9 plus ou moins compl\u00e9t\u00e9 par bronchodilatateur de longue dur\u00e9e d’action.<\/p>\n\n\n\n

2 \u00e9tudes en cours pour \u00e9valuer l\u2019observance dans la vie r\u00e9elle :
 Beasley R, Holliday M, Reddel HK, et al. Controlled trial of budesonide-formoterol as needed for mild asthma. N Engl J Med 2019; 380: 2020\u20132030<\/a>.
 Fingleton J, Hardy J, Baggott C, et al. Description of the protocol for the PRACTICAL study: a randomised controlled trial of the efficacy and safety of ICS\/LABA reliever therapy in asthma. BMJ Open Respir Res 2017; 4:e000217<\/a>.<\/p>\n\n\n\n

<\/p>\n","protected":false},"excerpt":{"rendered":"

GINA 2019: a fundamental change in asthma management : Treatment of asthma with short-acting bronchodilators alone is no longer recommended for adults and adolescents Reddel HK, FitzGerald JM, Bateman ED, et al. GINA 2019: a fundamental change in asthma management. Eur Respir J 2019; 53: 1901046 [https:\/\/doi.org\/10.1183\/13993003.01046-2019]. Pr\u00e9sent\u00e9 par Margot Frampas et Dr Camille Cochet … <\/p>\n

Continuer la lecture de « Staff biblio n\u00b01 »<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-411","post","type-post","status-publish","format-standard","hentry","category-non-classe"],"_links":{"self":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/411","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/comments?post=411"}],"version-history":[{"count":14,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/411\/revisions"}],"predecessor-version":[{"id":432,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/posts\/411\/revisions\/432"}],"wp:attachment":[{"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/media?parent=411"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/categories?post=411"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/admsu.org\/w\/wp-json\/wp\/v2\/tags?post=411"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}