关键词: 支气管哮喘, 指南解释, 诊断, 治疗

Abstract:

According to the Global Burden of Disease (GBD) data for 2021, the global age-standardized prevalence of asthma is 3 340.1/100 000, with a total of about 260 million patients, a mortality rate of 5.2/100 000, and 436 000 deaths. A 2012-2015 survey conducted in China shows that the prevalence of wheezing-related asthma among people aged 20 and above is 4.2%, with a total of about 45.7 million patients. However, the diagnosis rate is only 28.8%, and the control rate is only 28.5%, far below the international level, highlighting the urgent need for better asthma management and intervention. In March 2024, the Chinese Thoracic Society (CTS) released the Guidelines for the Prevention and Management of Bronchial Asthma (2024 Edition) (hereinafter referred to as the "2024 Guidelines"). For diagnostic pathways, the 2024 Guidelines improve the diagnostic criteria for asthma, emphasizing the evidence for variable expiratory airflow (such as bronchodilator tests, provocation tests, etc.). A "presumptive diagnosis pathway" is proposed for primary care and resource-limited medical institutions to improve the diagnosis rate and avoid overtreatment. In terms of staging and classification, the concept of "clinical remission" is introduced, defined as being asymptomatic for ≥1 year without the need for systemic glucocorticoid therapy. The classification of "intermittent state" is eliminated, and asthma severity is now simplified into three levels—mild, moderate and severe—with a dynamic assessment model proposed. The assessment system newly includes a type 2 inflammatory phenotype assessment, recommending the measurement of biomarkers such as peripheral blood eosinophil count (EOS) and fractional exhaled nitric oxide (FeNO) to guide individualized treatment, while also emphasizing comorbidity screening and risk factor assessment. In terms of treatment strategies, a stepwise management approach is used for chronic persistent treatment, with inhaled corticosteroid (ICS)-formoterol recommended as the preferred reliever (Pathway 1) to reduce the risk of acute exacerbations. The management of severe asthma emphasizes the use of biological targeted drugs, such as anti-IgE and anti-interleukin (IL)-5 monoclonal antibodies, while the treatment of acute exacerbations is recommended based on the severity level. Despite the significant progress made in the 2024 Guidelines, challenges remain. Epidemiological data on asthma in China are outdated, highlighting the urgent need for nationwide surveys to reflect the latest disease burden. Diagnosis rates in primary care are low, and inflammation assessment and dynamic mana-gement are insufficient, requiring strengthened capacity building at the primary care level. Real-world data on biologics in China are limited, restricting their application in precision therapy. The application of information technology in asthma management is still at an exploratory stage, and technologies like 5G should be leveraged to enhance patient education and follow-up efficiency. In the future, asthma prevention and treatment in China need to further optimize strategies for early diagnosis and early treatment, dynamically identify inflammatory phenotypes, establish drug response prediction models, and promote AI-assisted diagnosis and treatment to achieve more precise management.

Key words: Bronchial asthma, Guideline interpretation, Diagnosis, Treatment