Nordic consensus report on asthma management. Nordic Asthma Consensus Group

The work with the Nordic consensus report on asthma management started some years ago. The Nordic countries have common socioeconomic conditions. We acknowledge the international as well as other European guidelines providing valuable recommendations. Nevertheless, we felt the need to combine the common Nordic experiences in order to have a local statement of asthma and asthma care, based upon Nordic clinical science and tradition. The work has been rewarding and we acknowledge many valuable contributions from paediatricians, allergologists and lung physicians in all Nordic countries. The response has so far been positive and we feel that the present material reflects the main opinion of Nordic physicians taking care of asthma patients of all ages. However, the asthma and allergy research field is rapidly developing. Thus, this document should merely be regarded as a time-limited contribution to the continuing scientific discussion of this fascinating field.     

Update of the Consensus Statement of the Spanish Society of Rheumatology on the management of biologic therapies in rheumatoid arthritis

ObjectiveTo provide a reference to rheumatologists and to those involved in the treatment of RA who are using, or about to use biologic therapy.MethodsRecommendations were developed following a nominal group methodology and based on systematic reviews. The level of evidence and grade of recommendation were classified according to the model proposed by the Center for Evidence Based Medicine at Oxford. The level of agreement was established through Delphi technique.ResultsWe have produced recommendations on the use of the seven biologic agents available for RA in our country. The objective of treatment is to achieve the remission of the disease as quickly as possible. Indications and nuances regarding the use of biologic therapy were reviewed as well as the evaluation that should be performed prior to administration and the follow up of patients undergoing this therapy.ConclusionsWe present an update on the SER recommendations for the use of biologic therapy in patients with RA.     

妊娠期支气管哮喘管理中的新认识

妊娠期支气管哮喘(简称哮喘)的发病率在增加.未控制的妊娠期哮喘可以增加胎儿先天性异常的风险.妊娠期哮喘的管理应该包括避免或控制哮喘的诱发因素、个体化的药物治疗、监测肺功能和患者教育.吸入激素是不同程度妊娠期哮喘患者首选的治疗药物.妊娠期间给予哮喘治疗药物对胎儿造成的风险小于妊娠期间出现哮喘症状和哮喘急性发作而对胎儿造成的风险.妊娠期哮喘管理的目标就是保证母亲和胎儿的健康.     

Asthma nurse practice--a resource-effective approach in asthma management.

The objective of this study was to evaluate the efficacy of an Asthma Nurse Practice (ANP) in primary health care. A 12-month (September 1994-August 1995) open, prospective intervention study with pre- and post-test comparisons was performed on patients with asthma treated at a primary care centre in Sweden. Sixty-three patients with mild or moderate asthma participated and medication, structured follow-up and education in self-management at an ANP were assessed over a 12-month period. The main outcome measures assessed were pulmonary function, eosinophil cationic protein (ECP) in serum, respiratory symptoms, patient knowledge of asthma and emergency visits. ANP in primary health care increased patient knowledge of asthma and medication. The number of patients with nocturnal symptoms decreased significantly. Pulmonary function was improved: vital capacity (VC) 98-106, forced expiratory volume in 1 sec (FEV1) 93-100 and peak expiratory flow (PEF) 98-115% of predicted (P < 0.001). Variation in PEF fell from 21 to 12% (P < 0.001). ECP was significantly reduced. Visits to the emergency room were 60% fewer during the year of intervention (P < 0.01). In conclusion, patients attending an Asthma Nurse Practice, comprising a structured programme for asthma management, improve their knowledge and asthma control.     

亚太地区胃食管反流病的处理共识：更新版

背景与目的：自从2004年亚太地区胃食管反流病（GERD）共识发表以来，更多关于GERD流行病学和处理的文献资料相继出现，有必要对这些资料进行循证综述．对共识作出更新。方法：由多学科专家组应用德尔菲（Delphi）法制定共识条文，提呈相关资料，并对证据质量、推荐力度和共识水平进行分级。结果：亚洲GERD发生率日益增加，其危险因素包括老年、男性、种族、家族史、社会经济地位高、体重指数增加和吸烟。对于有典型症状而无报警症状的患者，对质子泵抑制剂（PPI）试验有症状应答具有诊断意义。如PPI试验失败，停止治疗后pH监测结果阴性可排除GERD。窄带成像、胶囊内镜检查和无线pH监测的作用尚未明确。亚洲诊断策略的制定须考虑到并存的胃癌和消化性溃疡。减轻体质量和抬高床头可改善反流症状。PPIs是最有效的内科治疗手段。对于非糜烂性反流病（NERD）患者，按需治疗较为适宜。有慢性咳嗽、喉炎和典型GERD症状的患者在排除非GERD病因后，应予PPI每天两次治疗。如有经验丰富的外科医师，GERD患者可行胃底折叠术。除临床试验外，GERD不应采用内镜治疗。结论：新的诊断方法和内镜治疗的作用有待进一步研究阐明：亚洲GERD诊断策略的制定须考虑到并存的胃癌和消化性溃疡。PPIs仍为治疗的基石。     

Consensus statement on the management of the GH-treated adolescent in the transition to adult care

The European Society for Paediatric Endocrinology held a consensus workshop in Manchester, UK in December 2003 to discuss issues relating to the care of GH-treated patients in the transition from paediatric to adult life. Clinicians experienced in the care of paediatric and adult patients on GH treatment, from a wide range of countries, as well as medical representatives from the pharmaceutical manufacturers of GH participated.