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Practice Guideline
. 2020 Mar 2;46(1):e20190307.
doi: 10.1590/1806-3713/e20190307. eCollection 2020.

2020 Brazilian Thoracic Association recommendations for the management of asthma

[Article in English, Portuguese]
Marcia Margaret Menezes Pizzichini  1 , Regina Maria de Carvalho-Pinto  2 , José Eduardo Delfini Cançado  3 , Adalberto Sperb Rubin  4   5 , Alcindo Cerci Neto  6   7 , Alexandre Pinto Cardoso  8 , Alvaro Augusto Cruz  9   10 , Ana Luisa Godoy Fernandes  11 , Daniella Cavalet Blanco  12 , Elcio Oliveira Vianna  13 , Gediel Cordeiro Junior  14   15 , José Angelo Rizzo  16 , Leandro Genehr Fritscher  12 , Lilian Serrasqueiro Ballini Caetano  11 , Luiz Fernando Ferreira Pereira  17 , Marcelo Fouad Rabahi  18 , Maria Alenita de Oliveira  19 , Marina Andrade Lima  20 , Marina Buarque de Almeida  21 , Rafael Stelmach  2 , Paulo Márcio Pitrez  22 , Alberto Cukier  2
Affiliations
Practice Guideline

2020 Brazilian Thoracic Association recommendations for the management of asthma

[Article in English, Portuguese]
Marcia Margaret Menezes Pizzichini et al. J Bras Pneumol. .

Abstract
in English, Portuguese

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.

O manejo farmacológico da asma mudou consideravelmente nas últimas décadas, com base no entendimento de que a asma é uma doença heterogênea e complexa, com diferentes fenótipos e endótipos. Agora está claro que o objetivo do tratamento da asma deve ser alcançar e manter o controle da doença e evitar riscos futuros (exacerbações, instabilidade da doença, perda acelerada da função pulmonar e efeitos adversos do tratamento). Isso implica em uma abordagem personalizada, incluindo tratamento farmacológico, educação do paciente, plano de ação por escrito, treinamento para uso do dispositivo inalatório e revisão da técnica inalatória a cada visita ao consultório. Um painel de 22 pneumologistas brasileiros foi convidado a revisar criticamente evidências recentes de tratamento farmacológico da asma e a preparar esta recomendação, um guia de tratamento adaptado à nossa realidade. A escolha dos tópicos ou questões relacionadas às mudanças mais significativas nos conceitos e, consequentemente, no manejo da asma na prática clínica foi realizada por um painel de especialistas. Foi solicitado a cada especialista que revisasse criticamente um tópico ou respondesse a uma pergunta, com base em evidências, para estas recomendações. Numa segunda fase, três especialistas discutiram e estruturaram todos os textos submetidos pelos demais e, na última fase, todos revisaram e discutiram cada recomendação. As presentes recomendações se aplicam a adultos e crianças com asma e destinam-se a médicos envolvidos no tratamento da doença.

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Figures

Figure 1
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
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
Figure 3. Asthma management for children ≤ 5 years of age. ICS: inhaled corticosteroid(s); and SABA: short-acting β2 agonist.
See this image and copyright information in PMC

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