RESUMO
The Global Initiative for Asthma (GINA) Strategy Report provides clinicians with an annually updated evidence-based strategy for asthma management and prevention, which can be adapted for local circumstances (e.g., medication availability). This article summarizes key recommendations from GINA 2021, and the evidence underpinning recent changes. GINA recommends that asthma in adults and adolescents should not be treated solely with short-acting ß2-agonist (SABA), because of the risks of SABA-only treatment and SABA overuse, and evidence for benefit of inhaled corticosteroids (ICS). Large trials show that as-needed combination ICS-formoterol reduces severe exacerbations by ⩾60% in mild asthma compared with SABA alone, with similar exacerbation, symptom, lung function, and inflammatory outcomes as daily ICS plus as-needed SABA. Key changes in GINA 2021 include division of the treatment figure for adults and adolescents into two tracks. Track 1 (preferred) has low-dose ICS-formoterol as the reliever at all steps: as needed only in Steps 1-2 (mild asthma), and with daily maintenance ICS-formoterol (maintenance-and-reliever therapy, "MART") in Steps 3-5. Track 2 (alternative) has as-needed SABA across all steps, plus regular ICS (Step 2) or ICS-long-acting ß2-agonist (Steps 3-5). For adults with moderate-to-severe asthma, GINA makes additional recommendations in Step 5 for add-on long-acting muscarinic antagonists and azithromycin, with add-on biologic therapies for severe asthma. For children 6-11 years, new treatment options are added at Steps 3-4. Across all age groups and levels of severity, regular personalized assessment, treatment of modifiable risk factors, self-management education, skills training, appropriate medication adjustment, and review remain essential to optimize asthma outcomes.
Assuntos
Asma/diagnóstico , Asma/terapia , Adolescente , Adulto , Antiasmáticos/uso terapêutico , Asma/etiologia , Criança , Pré-Escolar , Terapia Combinada , Progressão da Doença , Quimioterapia Combinada , Humanos , Lactente , Gravidade do Paciente , Guias de Prática Clínica como Assunto , Fatores de Risco , AutocuidadoAssuntos
Hipóxia , Oxigenoterapia , Doença Pulmonar Obstrutiva Crônica , Humanos , Ensaios Clínicos Fase IV como Assunto , Hipóxia/etiologia , Hipóxia/mortalidade , Hipóxia/terapia , Assistência de Longa Duração/métodos , Oxigênio/administração & dosagem , Oxigenoterapia/efeitos adversos , Oxigenoterapia/métodos , Oxigenoterapia/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/mortalidade , Doença Pulmonar Obstrutiva Crônica/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento , Duração da Terapia , Estudos Multicêntricos como AssuntoRESUMO
The Global Initiative for Asthma (GINA) Strategy Report provides clinicians with an annually updated evidence-based strategy for asthma management and prevention, which can be adapted for local circumstances (e.g., medication availability). This article summarizes key recommendations from GINA 2021, and the evidence underpinning recent changes. GINA recommends that asthma in adults and adolescents should not be treated solely with short-acting ß2 -agonist (SABA), because of the risks of SABA-only treatment and SABA overuse, and evidence for benefit of inhaled corticosteroids (ICS). Large trials show that as-needed combination ICS-formoterol reduces severe exacerbations by ≥60% in mild asthma compared with SABA alone, with similar exacerbation, symptom, lung function, and inflammatory outcomes as daily ICS plus as-needed SABA. Key changes in GINA 2021 include division of the treatment figure for adults and adolescents into two tracks. Track 1 (preferred) has low-dose ICS-formoterol as the reliever at all steps: as needed only in Steps 1-2 (mild asthma), and with daily maintenance ICS-formoterol (maintenance-and-reliever therapy, "MART") in Steps 3-5. Track 2 (alternative) has as-needed SABA across all steps, plus regular ICS (Step 2) or ICS-long-acting ß2 -agonist (Steps 3-5). For adults with moderate-to-severe asthma, GINA makes additional recommendations in Step 5 for add-on long-acting muscarinic antagonists and azithromycin, with add-on biologic therapies for severe asthma. For children 6-11 years, new treatment options are added at Steps 3-4. Across all age groups and levels of severity, regular personalized assessment, treatment of modifiable risk factors, self-management education, skills training, appropriate medication adjustment, and review remain essential to optimize asthma outcomes.
Assuntos
Antiasmáticos , Asma , Administração por Inalação , Adolescente , Corticosteroides , Adulto , Asma/diagnóstico , Criança , Quimioterapia Combinada , Fumarato de Formoterol/uso terapêutico , HumanosRESUMO
In keeping with the growing movement in scientific publishing toward transparency in data and methods, we propose changes to journal authorship policies and procedures to provide insight into which author is responsible for which contributions, better assurance that the list is complete, and clearly articulated standards to justify earning authorship credit. To accomplish these goals, we recommend that journals adopt common and transparent standards for authorship, outline responsibilities for corresponding authors, adopt the Contributor Roles Taxonomy (CRediT) (docs.casrai.org/CRediT) methodology for attributing contributions, include this information in article metadata, and require authors to use the ORCID persistent digital identifier (https://orcid.org). Additionally, we recommend that universities and research institutions articulate expectations about author roles and responsibilities to provide a point of common understanding for discussion of authorship across research teams. Furthermore, we propose that funding agencies adopt the ORCID identifier and accept the CRediT taxonomy. We encourage scientific societies to further authorship transparency by signing on to these recommendations and promoting them through their meetings and publications programs.
RESUMO
The aerial view of the concept of data sharing is beautiful. What could be better than having high-quality information carefully reexamined for the possibility that new nuggets of useful data are lying there, previously unseen? The potential for leveraging existing results for even more benefit pays appropriate increased tribute to the patients who put themselves at risk to generate the data. The moral imperative to honor their collective sacrifice is the trump card that takes this trick. However, many of us who have actually conducted clinical research, managed clinical studies and data collection and analysis, and curated data sets have . . .
Assuntos
Antineoplásicos/uso terapêutico , Biomarcadores Tumorais/metabolismo , Neoplasias do Colo/genética , Expressão Gênica , Proteínas de Homeodomínio/metabolismo , Fator de Transcrição CDX2 , Feminino , Humanos , MasculinoAssuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Asma/tratamento farmacológico , Vacinas contra COVID-19 , COVID-19/prevenção & controle , Epoprostenol/análogos & derivados , Hipertensão Pulmonar/tratamento farmacológico , Oxigênio/administração & dosagem , Insuficiência Respiratória/terapia , Antiasmáticos/uso terapêutico , COVID-19/epidemiologia , COVID-19/transmissão , Vacinas contra COVID-19/administração & dosagem , Citocinas/antagonistas & inibidores , Epoprostenol/uso terapêutico , Humanos , Hipertensão Pulmonar/etiologia , Controle de Infecções , Injeções Subcutâneas , Unidades de Terapia Intensiva , Doenças Pulmonares Intersticiais/complicações , Doenças Pulmonares Intersticiais/tratamento farmacológico , Casas de Saúde , Oxigênio/sangue , Oxigenoterapia , Insuficiência Respiratória/mortalidade , Exacerbação dos Sintomas , Teste de Caminhada , Linfopoietina do Estroma do TimoAssuntos
Sistemas Eletrônicos de Liberação de Nicotina , Pneumopatias , Vaping , Morte , Hospitalização , HumanosRESUMO
The U.S.-based Editors of ICMJE journals call for health-care professionals to act against the public health crisis of injury and death from guns.
Assuntos
Armas de Fogo , Pessoal de Saúde , Incidentes com Feridos em Massa , Papel Profissional , Ferimentos por Arma de Fogo/epidemiologia , Humanos , Saúde Pública , Estados Unidos/epidemiologia , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/mortalidade , Ferimentos por Arma de Fogo/mortalidadeRESUMO
The International Committee of Medical Journal Editors announces requirements that a data sharing plan be prospectively registered, and a data sharing statement be included in submitted manuscripts, for clinical trials to be published in ICMJE journals.
Assuntos
Ensaios Clínicos como Assunto/organização & administração , Conjuntos de Dados como Assunto/normas , Políticas Editoriais , Disseminação de Informação , Cooperação Internacional , Publicações Periódicas como Assunto/normas , Ensaios Clínicos como Assunto/normas , Humanos , Sociedades MédicasAssuntos
Doenças Cardiovasculares , Neoplasias , Terapia Nutricional , Humanos , Projetos de Pesquisa , Vitamina DAssuntos
Antiasmáticos , Asma , Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , HumanosRESUMO
El Comité Internacional de Editores de Revista Médicas (ICMJE) ha tomado la posición que el compartir los datos generados por los ensayos clínicos es una obligación ética, por cuanto los participantes en esos estudios se colocaron en riesgo al aceptar su inclusión. En esta editorial el ICMJE expresa que requerirá desde Julio 2018 que los manuscritos enviados a sus revistas deben incluir una declaración sobre compartir datos. A su vez, los ensayos clínicos que comiencen a enrolar pacientes a partir de Enero 2019, deben incluir un plan sobre compartir datos en el registro de tales ensayos. Se dan en esta declaración cuatro ejemplos de declaraciones sobre compartir datos, referidos a qué datos se compartirán, cuándo estarán disponibles y qué criterios de acceso se establecerán. El ICMJE visualiza un futuro cercano en el cual el compartir los datos será la norma, con el fin de maximizar el conocimiento ganado por los esfuerzos y sacrificios de los participantes.
Assuntos
Ensaios Clínicos como Assunto/organização & administração , Conjuntos de Dados como Assunto/normas , Políticas Editoriais , Disseminação de Informação , Publicações Periódicas como Assunto/normas , Ensaios Clínicos como Assunto/normas , Humanos , Cooperação Internacional , Sociedades MédicasRESUMO
Asthma is characterized by chronic inflammation, airway hyperresponsiveness, and progressive airway remodeling. The airway epithelium is known to play a critical role in the initiation and perpetuation of these processes. Here, we review how excessive epithelial stress generated by bronchoconstriction is sufficient to induce airway remodeling, even in the absence of inflammatory cells.