[Mexican Asthma Guidelines: GUIMA 2017]

Rev Alerg Mex. 2017;64 Suppl 1:s11-s128. doi: 10.29262/ram.v64i0.272.
[Article in Spanish]

Abstract

Background: The need for a national guideline, with a broad basis among specialists and primary care physicians was felt in Mexico, to try unifying asthma management. As several high-quality asthma guidelines exist worldwide, it was decided to select the best three for transculturation.

Methods: Following the internationally recommended methodology for guideline transculturation, ADAPTE, a literature search for asthma guidelines, published 1-1-2007 through 31-12-2015 was conducted. AGREE-II evaluations yielded 3/40 most suitable for transculturation. Their compound evidence was fused with local reality, patient preference, cost and safety considerations to draft the guideline document. Subsequently, this was adjusted by physicians from 12 national medical societies in several rounds of a Delphi process and 3 face-to-face meetings to reach the final version.

Results: Evidence was fused from British Thoracic Society Asthma Guideline 2014, Global Initiative on Asthma 2015, and Guía Española del Manejo del Asma 2015 (2016 updates included). After 3 Delphi-rounds we developed an evidence-based document taking into account patient characteristics, including age, treatment costs and safety and best locally available medication.

Conclusions: In cooperation pulmonologists, allergists, ENT physicians, paediatricians and GPs were able to develop an evidence-based document for the prevention, diagnosis and treatment of asthma and its exacerbations in Mexico.

Antecedentes: Con el objetivo de unificar el manejo del asma en México se estructuró una guía clínica que conjunta el conocimiento de diversas especialidades y la atención en el primer nivel de contacto. Se seleccionaron 3 guías publicadas en el ámbito internacional para su transculturación. Métodos: Conforme a la metodología ADAPTE se usó AGREE II después de la búsqueda bibliográfica de guías sobre asma publicadas entre 2007 y 2015. Se fusionó la realidad local con la evidencia de 3/40 mejores guías. El documento inicial fue sometido a la revisión de representantes de 12 sociedades médicas en varias rondas Delphi hasta llegar a la versión final. Resultados: Las guías base fueron la British Thoracic Society Asthma Guideline 2014, la Global Initiative on Asthma 2015 y la Guía Española del Manejo del Asma 2015. Después de 3 rondas Delphi se desarrolló un documento en el que se consideraron las características de los pacientes según edad, costos de los tratamientos y perfiles de seguridad de los fármacos disponibles en México. Conclusión: Con la cooperación de neumólogos, alergólogos, otorrinolaringólogos, pediatras y médicos generales se llegó a un consenso basado en evidencia, en el que se incluyeron recomendaciones sobre prevención, diagnóstico y tratamiento del asma y sus crisis.

Keywords: Asthma; Asthmatic exacerbation; Bronchodilator; Clinical practice guideline; Immunotherapy; Inhaled corticosteroid; Spirometry.

Publication types

  • Consensus Development Conference
  • Practice Guideline

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Airway Obstruction / etiology
  • Airway Obstruction / physiopathology
  • Anti-Asthmatic Agents / therapeutic use
  • Asthma / classification
  • Asthma / diagnosis
  • Asthma / physiopathology
  • Asthma / therapy*
  • Bronchial Thermoplasty
  • Child
  • Child, Preschool
  • Combined Modality Therapy
  • Diagnosis, Differential
  • Disease Management
  • Evidence-Based Medicine
  • Female
  • Humans
  • Infant
  • Mexico
  • Oxygen Inhalation Therapy
  • Patient Education as Topic
  • Pregnancy
  • Pregnancy Complications / therapy
  • Respiration, Artificial
  • Self Care
  • Spirometry
  • Status Asthmaticus / therapy

Substances

  • Anti-Asthmatic Agents