Guías de Práctica Clínica para el asma. Luces y sombras
Asthma Clinical Practice Guidelines: Advantages and Pitfalls
Vicente Plazaa,
, Jesús Bellido-Casadoa, Pablo Alonso-Coellob,c, Gustavo Rodrigod
Corresponding author
a Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona. España
b Centro Cochrane Iberoamericano, Servicio de Epidemiología y Salud Pública, Hospital de la Santa Creu i Sant Pau, Barcelona, España
c CIBER de Epidemiología y Salud Pública (CIBERESP), España
d Departamento de Emergencia, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay
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Luces y sombras" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "25" "paginaFinal" => "29" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Vicente Plaza, Jesús Bellido-Casado, Pablo Alonso-Coello, Gustavo Rodrigo" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Vicente" "apellidos" => "Plaza" "email" => array:1 [ 0 => "vplaza@santpau.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "Jesús" "apellidos" => "Bellido-Casado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 2 => array:3 [ "nombre" => "Pablo" "apellidos" => "Alonso-Coello" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] ] 3 => array:3 [ "nombre" => "Gustavo" "apellidos" => "Rodrigo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff4" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona. España" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Centro Cochrane Iberoamericano, Servicio de Epidemiología y Salud Pública, Hospital de la Santa Creu i Sant Pau, Barcelona, España" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "CIBER de Epidemiología y Salud Pública (CIBERESP), España" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] 3 => array:3 [ "entidad" => "Departamento de Emergencia, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay" "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff4" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Autor para correspondencia." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Asthma Clinical Practice Guidelines: Advantages and Pitfalls" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec240599" "palabras" => array:4 [ 0 => "Asma" 1 => "Guías de práctica clínica" 2 => "Implementación de las guías de práctica clínica" 3 => "Medicina basada en la evidencia" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec240598" "palabras" => array:4 [ 0 => "Asthma" 1 => "Clinical practice guidelines" 2 => "Implementation of clinical practice guidelines" 3 => "Evidence-based medicine" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">Las guías de práctica clínica sobre asma han contribuido a unificar conceptos y consensuar actuaciones entre grupos dispares de profesionales. Sin embargo, han fracasado en la mejora global del manejo del asma, objetivo último que persiguen. Todavía hoy, casi 20 años después de su aparición, la mayoría de los pacientes asmáticos continúa insuficientemente controlado, en parte debido a su escaso seguimiento por los médicos y el resto del personal sanitario que los debe atender. Esta falta de seguimiento de esas recomendaciones probablemente esté relacionada con la falta de una planificación bien estructurada en su difusión e implementación. Además, si bien las recomendaciones de esas guías coinciden en lo esencial, difieren en otros aspectos, que luego podrían ser determinantes en la práctica clínica.</p><p class="elsevierStyleSimplePara elsevierViewall">El objetivo del presente artículo ha sido constatar las principales diferencias en las recomendaciones que sobre el diagnóstico, la clasificación y el tratamiento del asma proponen las principales guías de práctica clínica sobre la enfermedad. Para ello se han comparado The British Guideline on the Management of Asthma 2007, The Global Strategy for Asthma Management and Prevention/Global Initiative for Asthma 2006 (GINA), el Programa Nacional de Prevención para la Educación del Asma (NAEPP), la Guía Española para el Manejo del Asma 2003 (GEMA) y la guía de ALAT y SEPAR, América Latina y España. Recomendaciones para la Prevención y el Tratamiento de la Exacerbación Asmática 2008 (ALERTA).</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">The Clinical Practice Guidelines on asthma have contributed towards unifying concepts and reaching a consensus on performances between different professional groups. However, they have failed in the overall improvement in the management of asthma, the final objective that they are meant to achieve. Today, almost 20 years after they appeared, the majority of asthmatic patients are still inadequately controlled, partly due to lack of follow up by doctors and the rest of health care staff who have to look after them. This lack of follow up of these recommendations is probably associated with a lack of well structured planning in their circulation and implementation. Also, although the recommendations of these guidelines agree in what is essential, they differ in other aspects, which in turn could be determining factors in clinical practice.</p><p class="elsevierStyleSimplePara elsevierViewall">The purpose of this article has been to establish the main differences in the recommendations that the principal clinical practice guidelines on the disease propose on the diagnosis, classification and treatment of asthma. To do this we have compared, The British Guideline on the Management of Asthma 2007, The Global Strategy for Asthma Management and Prevention/Global Initiative for Asthma 2006 (GINA), the National Prevention program for Education on Asthma (Programa Nacional de Prevención para la Educación del Asma) (NAEPP), the Spanish Guide for the Management of Asthma (Guía Española para el Manejo del Asma 2003) (GEMA) and the ALAT y SEPAR guides, Latin-America and Spain. Recommendations for the Prevention and Treatment of Asthma Exacerbation (América Latina y España. Recomendaciones para la Prevención y el Tratamiento de la Exacerbación Asmática 2008) (ALERTA).</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 12 | 4 | 16 |
| 2024 October | 48 | 24 | 72 |
| 2024 September | 66 | 19 | 85 |
| 2024 August | 98 | 51 | 149 |
| 2024 July | 55 | 21 | 76 |
| 2024 June | 62 | 32 | 94 |
| 2024 May | 61 | 31 | 92 |
| 2024 April | 57 | 35 | 92 |
| 2024 March | 63 | 29 | 92 |
| 2024 February | 43 | 31 | 74 |
| 2023 March | 12 | 2 | 14 |
| 2023 February | 64 | 22 | 86 |
| 2023 January | 47 | 35 | 82 |
| 2022 December | 56 | 35 | 91 |
| 2022 November | 55 | 45 | 100 |
| 2022 October | 74 | 35 | 109 |
| 2022 September | 59 | 30 | 89 |
| 2022 August | 64 | 42 | 106 |
| 2022 July | 82 | 52 | 134 |
| 2022 June | 73 | 40 | 113 |
| 2022 May | 77 | 48 | 125 |
| 2022 April | 74 | 76 | 150 |
| 2022 March | 87 | 47 | 134 |
| 2022 February | 105 | 31 | 136 |
| 2022 January | 61 | 36 | 97 |
| 2021 December | 80 | 48 | 128 |
| 2021 November | 64 | 67 | 131 |
| 2021 October | 64 | 54 | 118 |
| 2021 September | 47 | 76 | 123 |
| 2021 August | 28 | 48 | 76 |
| 2021 July | 35 | 37 | 72 |
| 2021 June | 36 | 39 | 75 |
| 2021 May | 37 | 34 | 71 |
| 2021 April | 55 | 73 | 128 |
| 2021 March | 41 | 39 | 80 |
| 2021 February | 47 | 19 | 66 |
| 2021 January | 48 | 28 | 76 |
| 2020 December | 29 | 28 | 57 |
| 2020 November | 26 | 35 | 61 |
| 2020 October | 19 | 43 | 62 |
| 2020 September | 14 | 18 | 32 |
| 2020 August | 28 | 27 | 55 |
| 2020 July | 29 | 38 | 67 |
| 2020 June | 14 | 11 | 25 |
| 2020 May | 27 | 18 | 45 |
| 2020 April | 26 | 21 | 47 |
| 2020 March | 41 | 26 | 67 |
| 2020 February | 48 | 27 | 75 |
| 2020 January | 41 | 28 | 69 |
| 2019 December | 30 | 31 | 61 |
| 2019 November | 19 | 27 | 46 |
| 2019 October | 15 | 21 | 36 |
| 2019 September | 14 | 18 | 32 |
| 2019 August | 31 | 25 | 56 |
| 2019 July | 34 | 25 | 59 |
| 2019 June | 23 | 8 | 31 |
| 2019 May | 47 | 59 | 106 |
| 2019 April | 51 | 31 | 82 |
| 2019 March | 30 | 33 | 63 |
| 2019 February | 22 | 20 | 42 |
| 2019 January | 17 | 19 | 36 |
| 2018 December | 20 | 23 | 43 |
| 2018 November | 37 | 24 | 61 |
| 2018 October | 55 | 16 | 71 |
| 2018 September | 29 | 10 | 39 |
| 2018 July | 0 | 1 | 1 |
| 2018 May | 7 | 1 | 8 |
| 2018 April | 22 | 7 | 29 |
| 2018 March | 9 | 7 | 16 |
| 2018 February | 13 | 9 | 22 |
| 2018 January | 8 | 12 | 20 |
| 2017 December | 14 | 18 | 32 |
| 2017 November | 8 | 19 | 27 |
| 2017 October | 14 | 22 | 36 |
| 2017 September | 12 | 13 | 25 |
| 2017 August | 12 | 24 | 36 |
| 2017 July | 13 | 14 | 27 |
| 2017 June | 18 | 27 | 45 |
| 2017 May | 16 | 12 | 28 |
| 2017 April | 21 | 29 | 50 |
| 2017 March | 8 | 12 | 20 |
| 2017 February | 13 | 20 | 33 |
| 2017 January | 11 | 9 | 20 |
| 2016 December | 27 | 19 | 46 |
| 2016 November | 57 | 28 | 85 |
| 2016 October | 79 | 49 | 128 |
| 2016 September | 54 | 22 | 76 |
| 2016 August | 32 | 12 | 44 |
| 2016 July | 43 | 11 | 54 |
| 2016 June | 40 | 12 | 52 |
| 2016 May | 50 | 11 | 61 |
| 2016 April | 23 | 2 | 25 |
| 2016 March | 30 | 2 | 32 |
| 2016 February | 30 | 3 | 33 |
| 2016 January | 46 | 19 | 65 |
| 2015 December | 53 | 16 | 69 |
| 2015 November | 47 | 17 | 64 |
| 2015 October | 41 | 1 | 42 |
| 2015 September | 49 | 0 | 49 |
| 2015 August | 38 | 0 | 38 |
| 2015 July | 31 | 0 | 31 |
| 2015 June | 24 | 0 | 24 |
| 2015 May | 47 | 0 | 47 |
| 2015 April | 29 | 0 | 29 |
| 2015 March | 41 | 0 | 41 |
| 2015 February | 17 | 0 | 17 |
| 2015 January | 31 | 0 | 31 |
| 2014 December | 41 | 0 | 41 |
| 2014 November | 28 | 0 | 28 |
| 2014 October | 48 | 0 | 48 |
| 2014 September | 49 | 0 | 49 |
| 2014 August | 39 | 0 | 39 |
| 2014 July | 29 | 0 | 29 |
| 2014 June | 50 | 0 | 50 |
| 2014 May | 39 | 0 | 39 |
| 2014 April | 46 | 0 | 46 |
| 2014 March | 36 | 0 | 36 |
| 2014 February | 42 | 0 | 42 |
| 2014 January | 22 | 0 | 22 |
| 2013 December | 25 | 0 | 25 |
| 2013 November | 26 | 0 | 26 |
| 2013 October | 41 | 0 | 41 |
| 2013 September | 38 | 0 | 38 |
| 2013 August | 63 | 0 | 63 |
| 2013 July | 74 | 0 | 74 |
| 2013 June | 27 | 0 | 27 |
| 2013 May | 33 | 0 | 33 |
| 2013 April | 15 | 0 | 15 |
| 2013 March | 7 | 0 | 7 |
| 2000 January | 1551 | 0 | 1551 |
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