重症例からみた気管支喘息治療の現状と危機管理に関する検討

1998年よりステロイド剤規則的吸入療法を主体としたガイドライン療法が導入され喘息死は徐々に減少してきたが,2000年度の本邦における喘息死は4,473名を数える.標準的治療が確立されたにもかかわらずなぜ死亡例が多いのかを,救命救急センターに3次救急搬送された重症気管支喘息患者54例を対象に検討した.救急搬送前の投薬内容をみると,ガイドラインにそった治療は行われず,喘息発作時だけβ受容体刺激剤(スプレー)を使用していた症例が平均92.9%でCPA(cardio pulmonary arrest)症例では100%であった.それに対してステロイド剤規則的吸入療法は2例3.7%にしか行われていなかった.気管支喘息を専門とする呼吸器専門医やアレルギー専門医はガイドラインにそった治療を行っているが,一般臨床医には未だ浸透していない可能性が示唆された.気管支喘息死を減少させるには,一般臨床医による患者教育の徹底,ステロイド剤規則的吸入療法をベースにした適切な定期的通院・治療の厳守,発作急変時に備えた病歴カードの常時携帯,救急医療機関側は救急隊のオーバートリアージを容認するなど危機管理の徹底を図ることが重要と考えられた.Asthmatic deaths have been gradually reduced since 1998 when regular steroid inhalation therapy was proved effective and widely introduced as guideline therapy. There were, however, still as many as 4,473 Japanese people who died of asthma in 2000. We examined the reasons for this large number of deaths, despite establishment of the guideline therapy, by investigating emergency patients who were carried to our emergency care center by ambulance as tertiary emergency cases for treatment of serious asthma. The investigation of medications used before emergency arrival showed that patients were not treated according to the guideline therapy: 92.9% of all patients and 100% of CPA (cardio pulmonary arrest) patients were treated with β-receptor stimulators (spray) only when they had asthmatic fits, and regular steroid inhalation therapy was performed on only 2 patients (3.7%). Although respiratory and allergy experts specializing in bronchial asthma follow the guideline therapy, it may not be widespread among general clinicians. To reduce the deaths from bronchial asthma, it is important to fully manage the possible risks of bronchial asthma by making general practitioners give patients full information on the disease; making patients strictly follow the appropriate hospital visit and treatment schedule based on regular steroid inhalation therapy; instructing patients to always carry their medical history cards for sudden attacks of bronchial asthma; and persuading emergency care centers to permit over-triaging by ambulance teams

重症例からみた気管支喘息治療の現状と危機管理に関する検討

1998年よりステロイド剤規則的吸入療法を主体としたガイドライン療法が導入され喘息死は徐々に減少してきたが,2000年度の本邦における喘息死は4,473名を数える.標準的治療が確立されたにもかかわらずなぜ死亡例が多いのかを,救命救急センターに3次救急搬送された重症気管支喘息患者54例を対象に検討した.救急搬送前の投薬内容をみると,ガイドラインにそった治療は行われず,喘息発作時だけβ受容体刺激剤(スプレー)を使用していた症例が平均92.9%でCPA(cardio pulmonary arrest)症例では100%であった.それに対してステロイド剤規則的吸入療法は2例3.7%にしか行われていなかった.気管支喘息を専門とする呼吸器専門医やアレルギー専門医はガイドラインにそった治療を行っているが,一般臨床医には未だ浸透していない可能性が示唆された.気管支喘息死を減少させるには,一般臨床医による患者教育の徹底,ステロイド剤規則的吸入療法をベースにした適切な定期的通院・治療の厳守,発作急変時に備えた病歴カードの常時携帯,救急医療機関側は救急隊のオーバートリアージを容認するなど危機管理の徹底を図ることが重要と考えられた.Asthmatic deaths have been gradually reduced since 1998 when regular steroid inhalation therapy was proved effective and widely introduced as guideline therapy. There were, however, still as many as 4,473 Japanese people who died of asthma in 2000. We examined the reasons for this large number of deaths, despite establishment of the guideline therapy, by investigating emergency patients who were carried to our emergency care center by ambulance as tertiary emergency cases for treatment of serious asthma. The investigation of medications used before emergency arrival showed that patients were not treated according to the guideline therapy: 92.9% of all patients and 100% of CPA (cardio pulmonary arrest) patients were treated with β-receptor stimulators (spray) only when they had asthmatic fits, and regular steroid inhalation therapy was performed on only 2 patients (3.7%). Although respiratory and allergy experts specializing in bronchial asthma follow the guideline therapy, it may not be widespread among general clinicians. To reduce the deaths from bronchial asthma, it is important to fully manage the possible risks of bronchial asthma by making general practitioners give patients full information on the disease; making patients strictly follow the appropriate hospital visit and treatment schedule based on regular steroid inhalation therapy; instructing patients to always carry their medical history cards for sudden attacks of bronchial asthma; and persuading emergency care centers to permit over-triaging by ambulance teams

Effectiveness of primary series, first, and second booster vaccination of monovalent mRNA COVID-19 vaccines against symptomatic SARS-CoV-2 infections and severe diseases during the SARS-CoV-2 omicron BA.5 epidemic in Japan: vaccine effectiveness real-time surveillance for SARS-CoV-2 (VERSUS)

Background: This study aimed to evaluate VE of primary, first, and second booster ancestral-strain monovalent mRNA COVID-19 vaccination against symptomatic infections and severe diseases in Japan. Methods: We conducted a test-negative case-control study. We included medically attended episodes and hospitalizations involving individuals aged ≥ 16 with signs and symptoms from July to November 2022, when Omicron BA.5 was dominant nationwide. To evaluate VE, we calculated adjusted ORs of vaccination among test-positive versus test-negative individuals using a mixed-effects logistic regression. Results: For VE against symptomatic infections among individuals aged 16 to 59, VE of primary vaccination at > 180 days was 26.1% (95% CI: 10.6–38.8%); VE of the first booster was 58.5% (48.4–66.7%) at ≤ 90 days, decreasing to 41.1% (29.5–50.8%) at 91 to 180 days. For individuals aged ≥ 60, VE of the first booster was 42.8% (1.7–66.7%) at ≤ 90 days, dropping to 15.4% (−25.9–43.2%) at 91 to 180 days, and then increasing to 44.0% (16.4–62.5%) after the second booster. For VE against severe diseases, VE of the first and second booster was 77.3% (61.2–86.7%) at ≤ 90 days and 55.9% (23.4–74.6%) afterward. Conclusion: mRNA booster vaccination provided moderate protection against symptomatic infections and high-level protection against severe diseases during the BA.5 epidemic in Japan.Expert Review of Vaccines, 23(1), pp.213-225; 202

Effectiveness of primary series, first, and second booster vaccination of monovalent mRNA COVID-19 vaccines against symptomatic SARS-CoV-2 infections and severe diseases during the SARS-CoV-2 omicron BA.5 epidemic in Japan: vaccine effectiveness real-time surveillance for SARS-CoV-2 (VERSUS)

This study aimed to evaluate VE of primary, first, and second booster ancestral-strain monovalent mRNA COVID-19 vaccination against symptomatic infections and severe diseases in Japan. We conducted a test-negative case-control study. We included medically attended episodes and hospitalizations involving individuals aged ≥16 with signs and symptoms from July to November 2022, when Omicron BA.5 was dominant nationwide. To evaluate VE, we calculated adjusted ORs of vaccination among test-positive versus test-negative individuals using a mixed-effects logistic regression. For VE against symptomatic infections among individuals aged 16 to 59, VE of primary vaccination at > 180 days was 26.1% (95% CI: 10.6–38.8%); VE of the first booster was 58.5% (48.4–66.7%) at ≤90 days, decreasing to 41.1% (29.5–50.8%) at 91 to 180 days. For individuals aged ≥60, VE of the first booster was 42.8% (1.7–66.7%) at ≤90 days, dropping to 15.4% (−25.9–43.2%) at 91 to 180 days, and then increasing to 44.0% (16.4–62.5%) after the second booster. For VE against severe diseases, VE of the first and second booster was 77.3% (61.2–86.7%) at ≤90 days and 55.9% (23.4–74.6%) afterward. mRNA booster vaccination provided moderate protection against symptomatic infections and high-level protection against severe diseases during the BA.5 epidemic in Japan.</p