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...

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Introduction. The prevention of COVID-19 infections involves the implementation of behaviors to reduce risk and protect health. However, engaging in these behaviors depends on the perception of the threat posed by the illness. Previous research shows the importance of illness perception in the case of communicable and non-communicable diseases, showing that they can change depending on the severity and risk attributed to them. Objective. Compare the illness perception and the practice of preventive and exposure behavior based on the severity and the risk attributed to COVID-19 at the end of phase 1 and the beginning of phase 2 of the pandemic in Mexico. Method. By means of a chain sampling, a comparative study was conducted in which an evaluation battery was disseminated through e-mail and social networks. Results. It was found that evaluating COVID-19 as a serious disease and perceiving oneself as being at risk of contracting it had small and moderate effects on the perception of the consequences of the illness (r = .34; r = .26), emotional impact (r = .32; r = .25), personal control (r = .24) and engagement in preventive (r = .05), and exposure behaviors (r = .07; r = .07). Discussion and conclusion. This article shows the relevance of the perceptual variables that impact concern due to the social and emotional consequences of COVID-19, as well as those that encourage preventive behaviors and the minimization of exposure behavior.

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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.