MIA 2021, Manejo Integral del Asma. Lineamientos para México

Abstract

Antecedentes: El asma sigue siendo una patología respiratoria crónica frecuente en México. Se han descrito nuevos métodos para el diagnóstico y tratamiento conforme se renuevan las guías internacionales. Objetivo: Crear la plataforma nacional Manejo Integral del Asma (MIA), para el desarrollo de lineamientos actualizados con base en evidencia. Métodos: Se utilizó el método ADAPTE. El grupo de desarrollo de MIA estuvo integrado por expertos en neumología, alergología y metodología y representantes de 13 instituciones y sociedades de especialidades que manejan asma. Las guías internacionales de referencia (seleccionadas con AGREE-II) fueron GINA 2020, GEMA 5.0, BTS/SIGN 2019 y consenso ATS/ERS 2014-2019. En MIA se aborda sospecha de asma, diagnóstico, tratamiento y grupos especiales. Se formularon preguntas clínicas clave sobre tratamiento en los pasos 1 a 3, biomarcadores y asma grave. Resultados: Con base en evidencia, seguridad, costo y realidad local, el grupo nuclear desarrolló respuestas. Mediante proceso Delphi, el grupo amplio de desarrollo sugirió ajustes hasta que se logró el consenso. Conclusión: El documento generado contiene múltiples figuras y algoritmos, está sólidamente basado en evidencia acerca del manejo del asma y fue ajustado para México con participación de diferentes sociedades para su desarrollo; no se incluyeron lineamientos para la crisis asmática. .

Impact of the GINA asthma guidelines 2019 revolution on local asthma guidelines and challenges: special attention to the GCC countries

“…Global and local guidelines [1][2][3][4][5][6][7][8][9][10] have been established to standardize asthma diagnosis and management. Among these guidelines, the GINA guideline has become one of the most influential and widely adopted international documents for asthma care.…”

“…This speaks of the importance of having a national unified asthma guideline and the proper application of these guidelines. Currently, at the level of the GCC countries, there are published nationwide asthma guidelines for only two Gulf countries, Saudi Arabia [6] and Qatar [5]. In 2008, as a subsidiary of the Saudi Thoracic Society (STS), the SINA group was founded to develop guidelines for diagnosing and managing asthma for adults and children.…”

Asthma Phenotypes in the Era of Personalized Medicine

“…Early-onset eosinophilic asthma is often linked with a family history of atopy and carries a clearly defined prognosis responsive to steroids [72]. Nevertheless, an allergic severe asthma phenotype that shows poor responsiveness to corticosteroids has been delineated and appears to be one of the most-prevalent severe asthma manifestations [75,76].…”

“…Standard anti-inflammatory drugs, primarily inhaled corticosteroids (ICSs) and bronchodilators, remain the primary methods for treating asthma. However, these approaches do not consider the diverse range of asthma traits and endotypes [11,116], as recommended by multiple guidelines [76,[139][140][141][142][143][144]. While this "one size fits all" strategy may be effective for the majority of patients, approximately 5-10% of individuals with asthma do not achieve clinical or functional control even with high doses of ICSs, along with other controllers and/or prolonged use of oral corticosteroids (OCSs).…”

“…To address these challenges, ongoing research is focused on refining patient selection criteria, identifying reliable biomarkers, developing combination therapies, and improving our understanding of asthma's molecular mechanisms. It is important for healthcare providers to closely monitor treatment response, assess any changes in disease phenotype, and consider adjustments to treatment strategies as needed to achieve optimal outcomes for patients with severe asthma [76,139,142].…”