未控制哮喘中单吸入器三联疗法的合理使用：跨国改良德尔菲共识
该改良德尔菲共识纳入9国27名呼吸专家，经两轮在线调查和小组会议，使用59条声明问卷（52条共识、7条开放），共识阈值75%。专家就39/52条和3/13条声明在第一、二轮达成共识，认为中高剂量ICS/LABA控制不佳者可加用LAMA；对阿奇霉素、白三烯调节剂或生物制剂未达成共识。
要点
- 中高剂量ICS/LABA控制不佳的哮喘患者，加用LAMA是有效选择。
- 症状改善和急性发作减少被视为哮喘控制的关键指标。
- 对阿奇霉素、白三烯调节剂或生物制剂的使用未达成共识。
核心结论
- 国际呼吸专家达成共识：中高剂量ICS/LABA仍未控制的哮喘患者应加用LAMA。
- 对阿奇霉素、白三烯调节剂或生物制剂的使用存在分歧，需循证决策。
研究设计与样本
- 改良德尔菲共识，纳入9个国家27名呼吸专家。
- 经两轮在线调查和一次小组会议，使用59条声明问卷（52条共识、7条开放）。
- 采用9分制评分，共识阈值为75%。
主要发现
- 所有专家参与两轮调查，22/27名专家参加虚拟小组会议。
- 第一轮和第二轮调查分别对39/52条和3/13条声明达成共识。
- 15/27名专家估计其26-50%的哮喘患者疾病未控制。
- 96%专家同意症状改善和急性发作减少是哮喘控制的关键指标。
- 93%专家同意在中高剂量ICS/LABA基础上加用LAMA是未控制哮喘的有效选择。
关键数值与推荐
- 共识阈值定义为75%同意。
- 93%专家同意加用LAMA可改善症状、肺功能和减少急性发作。
- 96%专家同意症状改善和急性发作减少是哮喘控制的关键指标。
临床怎么用
- 对中高剂量ICS/LABA仍未控制的哮喘患者，可考虑加用LAMA。
- 阿奇霉素、白三烯调节剂或生物制剂的使用需个体化循证决策。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
J Asthma Allergy. 2026 May 25;19:590236. doi: 10.2147/JAA.S590236. eCollection 2026. ABSTRACT INTRODUCTION: Uncontrolled asthma is associated with impaired lung function, higher frequency of severe exacerbations, reduced quality of life, and increased healthcare costs. Although inhaled corticosteroids with long-acting β2-agonists (ICS/LABA) form the cornerstone of treatment, many patients continue to experience suboptimal disease control. Despite additional therapeutic strategies, their utilization is inconsistent. We conducted a modified Delphi consensus among expert clinicians to understand their perceptions of treatment strategies in uncontrolled asthma and evaluate their approaches beyond ICS/LABA therapy with a focus on single-inhaler triple therapy and other add-on options, including biologics. METHODS: The study consisted of two rounds of online surveys and a panel meeting involving 27 respiratory experts from nine countries. A 59-statement questionnaire (52 consensus statements, seven open) was developed following a literature review. Responses were recorded using a 9-point scale ranging from 1 (disagreement) to 9 (agreement) with a consensus threshold of 75%. RESULTS: All experts participated in both surveys, and 22/27 attended a virtual panelists' meeting. Consensus was reached on 39/52 and 3/13 statements in surveys-1 and -2, respectively. Most panelists (15/27) estimated that 26-50% of their patients with asthma have uncontrolled disease. Improvement in symptoms and reduction in exacerbations were perceived as key indicators of asthma control (96% agreement). Additionally, 93% agreed that adding a long-acting muscarinic antagonist (LAMA) to medium-high dose ICS/LABA is a valid option for patients with uncontrolled asthma, citing benefits in symptom relief, lung function, and exacerbation reduction. Consensus was not reached on the use of azithromycin, leukotriene modifiers or biologics in this population. CONCLUSION: In this modified Delphi consensus, international respiratory experts agreed on adding LAMA in patients who remain uncontrolled on medium-high dose ICS/LABA. Most consensus statements aligned with prevalent guidelines. However, divergent opinions on the use of azithromycin, leukotriene modifiers or biologics highlight the need for evidence-informed treatment decisions. PMID: 42222525 | PMC: PMC13221441 | DOI: 10.2147/JAA.S590236
引用
- 指南共识 · 哮喘：Appropriate Use of Single Inhaled Triple Therapy in Uncontrolled Asthma: A Multinational Modified Delphi Consensus
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。