2020 Brazilian Thoracic Association recommendations for the management of asthma

Marcia Margaret Menezes Pizzichini, Regina Maria de Carvalho-Pinto, José Eduardo Delfini Cançado, Adalberto Sperb Rubin, Alcindo Cerci Neto, Alexandre Pinto Cardoso, Alvaro Augusto Cruz, Ana Luisa Godoy Fernandes, Daniella Cavalet Blanco, Elcio Oliveira Vianna, Gediel Cordeiro Junior, José Angelo Rizzo, Leandro Genehr Fritscher, Lilian Serrasqueiro Ballini Caetano, Luiz Fernando Ferreira Pereira, Marcelo Fouad Rabahi, Maria Alenita de Oliveira, Marina Andrade Lima, Marina Buarque de Almeida, Rafael Stelmach, Paulo Márcio Pitrez, Alberto Cukier, Marcia Margaret Menezes Pizzichini, Regina Maria de Carvalho-Pinto, José Eduardo Delfini Cançado, Adalberto Sperb Rubin, Alcindo Cerci Neto, Alexandre Pinto Cardoso, Alvaro Augusto Cruz, Ana Luisa Godoy Fernandes, Daniella Cavalet Blanco, Elcio Oliveira Vianna, Gediel Cordeiro Junior, José Angelo Rizzo, Leandro Genehr Fritscher, Lilian Serrasqueiro Ballini Caetano, Luiz Fernando Ferreira Pereira, Marcelo Fouad Rabahi, Maria Alenita de Oliveira, Marina Andrade Lima, Marina Buarque de Almeida, Rafael Stelmach, Paulo Márcio Pitrez, Alberto Cukier

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.

Figures

Figure 1. Asthma management for patients ≥…
Figure 1. Asthma management for patients ≥ 12 years of age. ICS: inhaled corticosteroid(s); LABA: long-acting β2 agonist; OCS: oral corticosteroid(s); SABA: short-acting β2 agonist; and FORM: formoterol fumarate.
Figure 2. Asthma management in children between…
Figure 2. Asthma management in children between 6 and 11 years of age. OCS: oral corticosteroid(s); ICS: inhaled corticosteroid(s); LABA: long-acting β2 agonist; and SABA: short-acting β2 agonist.
Figure 3. Asthma management for children ≤…
Figure 3. Asthma management for children ≤ 5 years of age. ICS: inhaled corticosteroid(s); and SABA: short-acting β2 agonist.

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Source: PubMed

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