Este artículo debe citarse como: Larenas-Linnemann D, Salas-Hernández J, Vázquez-García JC, Ortiz-Aldana I, Fernández-Vega M, Del Río-Navarro BE, et al. Guía Mexicana del Asma 2017. Rev Alerg Mex. 2017;64 Supl 1:s11-s128. AbstractBackground: 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. Conclusion: 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.Keywords: Clinical practice guideline; Asthma; Asthmatic exacerbation; Bronchodilator; Inhaled corticosteroid; Spirometry; Immunotherapy. IntroducciónLa presentación de este documento muestra la importancia del asma en México por su alta prevalencia, pero también por su subdiagnóstico y tratamiento deficiente, que propician un mal control de los pacientes con asma, crisis más frecuentes y sintomatología activa. En consecuencia, el asma tiene un impacto socioeconómico considerable para el paciente y la sociedad en su conjunto, al igual que afecta la calidad de vida del paciente y su familia. En México, el paciente con asma puede recibir atención médica en los ámbitos pú-blico o privado, en los diferentes niveles de salud y por múltiples especialidades. Todas estas particularidades de la situación nacional indican la necesidad de un documento guía actualizado, con base amplia en múltiples gremios médicos, tanto de primer nivel de atención como de especialidad.El objetivo de la GUIMA 2017 es facilitar la reducción de la morbimortalidad por asma en México, no solo al mejorar el conocimiento acerca de esta patología, sino también al ayudar a la parte administrativa del Sector Salud a gestionar la selección y adquisición más precisa de los medicamentos necesarios para su tratamiento a nivel de la salud pública. Para tal fin se ofrecen lineamientos par...

RESUMEN.La telemedicina a nivel mundial y en México ha sido de gran utilidad durante la pandemia por COVID-19. Poder prestar servicios de atención médica donde la distancia es un factor crítico, en un momento en el que se encuentran saturados los servicios de salud, y donde la atención presencial implica un riesgo, tanto para el proveedor de atención en salud como para los pacientes, ha sido indispensable durante la pandemia. La rapidez con la que se han implementado servicios de telemedicina a nivel mundial ha sido muy diferente. Aún quedan grandes retos por resolver para poder brindar este tipo de atención a nivel mundial. Cabe resaltar que la telemedicina viene a complementar la atención del paciente, más que a sustituir la habitual atención presencial.

BackgroundIn April 2017 the Mexican Asthma Guidelines (GUIMA) were published. Before the launch, physicians’ knowledge was explored related to key issues of the guideline.MethodsA SurveyMonkey® survey was sent out to board-certified physicians of 5 medical specialties treating asthma. Replies were analyzed per specialty against the GUIMA evidence-based recommendations. We present the treatment part here.ResultsA total of 364 allergists (ALLERG), 161 pulmonologists (PULM), 34 ENTs, 239 pediatricians (PED) and 62 general practitioners (GPs) replied to the survey and 247-83-14-135-37 respectively finished it. Spirometry is not routinely indicated when asthma is very probable by ALLERG 54%, PULM 47%, ENT 39%, PED 65%, GP 64%. A fictitious case proposed to the physicians with intermittent asthma was erroneously treated with ICS by ALLERG 9%, PULM 11%, ENT 28%, PED 10%, GP 11%. The mild persistent case received mistakenly ICS-LABA by ALLERG 25%, PULM 26%, ENT 33%, PED 27%, GP 23%. The first-line option for moderate persistent asthma was ICS(median dose) instead of ICS(low)+LABA for ALLERG 29%, PULM 25%, ENT 17%, PED 27%, GP 23% and in severe asthma maintenance treatment PULM20%, ALLERG-ENT-PED-GP 22-34% failed to indicate LABA. Concerning the guidelines’ recommendation to use one inhaler for maintenance & rescue in moderate-to-severe asthma, PULM45%, ALLERG-ENT-PED-GP 56-80% (p < 0.00001), erroneously indicated ICS-salmeterol could be used, instead of ICS-formoterol. Oral β2 or theophylline are no longer recommended, but PULM 37% and ALLERG-ENT-PED-GP 42-62% (p < 0.01) still indicate their use. In severe asthma 61-73% of physicians consider adding LTRA to the treatment; only PULM38%, OTHERS12-25% consider adding tiotropium (p < 0.001) and 3-17% consider adding omalizumab, both guideline recommended add-ons. As for asthma in pregnancy, most surveyed are not aware budesonide is the 1st line option ICS. Finally, 81-97% of the group-members recognized allergen immunotherapy, as a viable add-on, in line with GINA/GEMA/GUIMA recommendations.ConclusionsAn online survey could detect knowledge-gaps related to asthma treatment. Interestingly, surveyed physicians tended to over-treat the milder asthma cases, thus clearly leaving room for cost-savings. Caution should be taken in the promotion of the SMART (single-maintenance-and-reliever-treatment) approach, which can only be done with ICS-formoterol. Many physicians opt for other combinations not apt for this approach. Among all surveyed specialties there is ample room for improvement in mild and severe asthma management.

www.medigraphic.com/neumología www.medigraphic.org.mx RESUMEN. Introducción: El informe de estrategias de GINA (del inglés Global Initiative for Asthma) 2019 presenta los cambios más relevantes en el manejo del asma en los últimos 30 años. Objetivo: El propósito de este artículo es la difusión de los cambios en GINA 2019 con respecto al tratamiento del asma leve, así como expresar la postura del grupo de Expertos para la Concientización del Asma en México (ECAM), y sus recomendaciones a toda la comunidad médica tras el estudio minucioso de los cambios y la evidencia científica que los sustenta. Metodología: Se reunió a un grupo de médicos especialistas, líderes de opinión y expertos en asma en México con la finalidad de revisar, analizar y discutir los estudios y la evidencia que sustentan los cambios en GINA 2019. Resultados: Se definieron posturas y estrategias para abordar los diferentes retos que podrían presentarse debido a los cambios. Conclusiones: La recomendación es que todo paciente asmático debe tener tratamiento antiinflamatorio. Una estrategia en pacientes con síntomas intermitentes es utilizar una dosis baja de corticosteroide inhalado/formoterol por razón necesaria (PRN) como medicamento preferido de rescate; y en pacientes con síntomas persistentes, utilizar dosis bajas diarias de corticosteroides inhalados/ formoterol como tratamiento de control y de rescate PRN. Los resultados de los estudios y su impacto en la práctica clínica son prometedores.

RATIONALE: Mites species are present throughout the world, the sensitization to these oscillate according to the region. However, little has been clarified in some ethnic. Intraepidermal tests and specific immunoglobulins for mites are lower in indigenous people compared to other predominant ethnic groups in the region. METHODS: An analytical study was carried out to compare ethnic groups in an Andean region of South America. The indigenous group selected with the Respondent-Driven Sampling technique (RDS) and the mestizos group was from a capital city, paired by sex and age group. Prick tests with extracts, with concentrations of 300mg/mL for B. tropicalis, 300mg/mL for D pteronyssinus, and 400mg/mL for D farinae; as well as an allergen-specific immunoglobulin E (IgE) measurement, were tested on individuals with allergic disease history. We used correlational effect sizes for comparing two groups using the Point-Biserial correlation. RESULTS: Diameters of the wheals showed large size effect, with lower diametral values in the indigenous group compared with the values of the mestizo group B tropicalis (rbis 5-0.50, 95% CI:-0.68 to-0.21), D pteronyssinus (rbis 5-0.54, 95% CI:-0.71 to-0.26) and D farinae(rbis 5-0.47, 95% CI:-0.66 to-0.17). The IgE reported medium effect sizes, with lower values in the indigenous ethnic group B tropicalis (rbis 5-0.29), D pteronyssinus (rbis 5-0.35) and D farinae (rbis 5-0.33, 95%). CONCLUSIONS: The environmental aspects and social determinants could be modifiable factors for the reaction of the indigenous population against Blomia tropicalis, Dermatophagoides pteronyssinus and Dermatophagoides farinae mites.