Original Articles
Management According to the Global Initiative for Asthma Guidelines of Patients With Near-Fatal Asthma Reduces Morbidity and Mortality
Gema Rodríguez-Trigoa,
, Vicente Plazab, César Picadoc, Joaquín Sanchisb
Corresponding author
grodtri@canalejo.org
Correspondence: Dr G. Rodríguez-Trigo Servicio de Neumología, Complejo Hospitalario Universitario Juan Canalejo As Xubias, 84, 15006 A Coruña, Spain
Correspondence: Dr G. Rodríguez-Trigo Servicio de Neumología, Complejo Hospitalario Universitario Juan Canalejo As Xubias, 84, 15006 A Coruña, Spain
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Rodríguez-Trigo Servicio de Neumología, Complejo Hospitalario Universitario Juan Canalejo As Xubias, 84, 15006 A Coruña, Spain" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2007-01-24" "fechaAceptado" => "2007-10-31" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec155219" "palabras" => array:4 [ 0 => "<span class="elsevierStyleItalic">Near-fatal asthma</span>" 1 => "<span class="elsevierStyleItalic">Education and asthma</span>" 2 => "<span class="elsevierStyleItalic">Asthma guidelines</span>" 3 => "<span class="elsevierStyleItalic">Global Initiative for Asthma</span>" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec155218" "palabras" => array:4 [ 0 => "<span class="elsevierStyleItalic">Asma de riesgo vital</span>" 1 => "<span class="elsevierStyleItalic">Educación y asma</span>" 2 => "<span class="elsevierStyleItalic">Guías del asma</span>" 3 => "<span class="elsevierStyleItalic">Global Initiative for Asthma</span>" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">To assess the effect of adequate outpatient care as defined by guidelines of the Global Initiative for Asthma (GINA) on the long-term outcome of near-fatal asthma.</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">Fifty-three patients who had experienced a near-fatal attack of asthma were treated according to the GINA guidelines and followed for a mean of 49 months (intervention group). Clinical and spirometric measurements corresponding to the periods before the attack (obtained retrospectively) and after the attack (obtained prospectively) were compared to measurements from 40 near-fatal asthma patients who had not been managed according to the GINA guidelines and who were followed for a mean of 51 months (historic control group).</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">There were no deaths in the intervention group and 6 deaths (15%) in the control group (<span class="elsevierStyleItalic">P</span>=.005). The mean (SD) number of new near-fatal asthma attacks was significantly lower in the intervention group (0.17 [0.61]) than in the control group (1.6 [1]) (<span class="elsevierStyleItalic">P</span><.001). Emergency visits following a near-fatal asthma attack decreased from 0.9 (1.8) to 0.3 (0.6) in the intervention group and hospital admissions decreased from 3.4 (5.1) to 0.5 (1.4) (<span class="elsevierStyleItalic">P</span><.001). Eosinophil count decreased from 390 (411) × l0<span class="elsevierStyleSup">9</span> cells/L to 159 (121) × l0<span class="elsevierStyleSup">9</span> cells/L (<span class="elsevierStyleItalic">P</span>=.01) and forced expiratory volume in 1 second increased from 68% (23%) of predicted to 76% (20%) (<span class="elsevierStyleItalic">P</span>=.006).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Management according to the GINA guidelines of patients who had experienced a near-fatal asthma attack was associated with a decrease in asthma morbidity and mortality</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Valorar el efecto de un adecuado tratamiento ambulatorio, de acuerdo con las recomendaciones de la guía de la Global Initiative for Asthma (GINA), en la evolución a largo plazo del asma de riesgo vital (ARV).</p> <span class="elsevierStyleSectionTitle">Pacientes y métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Durante una media de 49 meses se realizó el seguimiento de 53 pacientes que habían sobrevivido a una crisis de ARV y que se trataron de acuerdo con las recomendaciones de la GINA (grupo de intervención). Se obtuvieron datos clínicos y espirométricos retrospectivos y prospectivos (antes y después del ataque de ARV, respectivamente) y se compararon con los de 40 pacientes con ARV que no fueron tratados según las recomendaciones de la GINA (grupo control histórico) y cuyo seguimiento medio fue de 51 meses.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">No se registraron fallecimientos en el grupo de intervención, mientras que en el grupo control murieron 6 pacientes (15%) (p = 0,005). Los nuevos ataques de ARV fueron significativamente menores (p < 0,001) en el grupo de intervención, con una media ± desviación estándar de 0,17 ± 0,61, frente a 1,6 ± 1 en el grupo control. En el grupo de intervención las visitas a urgencias descendieron de 0,9 ± 1,8 a 0,3 ± 0,6 después de la crisis de ARV (p = 0,03), y los ingresos hospitalarios pasaron de 3,4 ± 5,1 a 0,5 ± 1,4 (p < 0,001); el recuento de eosinófilos en sangre periférica descendió de 390 ± 411 a 159 ± 121 células × 10<span class="elsevierStyleSup">9</span>/l (p = 0,01) y el volumen espiratorio forzado en el primer segundo aumentó del 68 ± 23% al 76 ± 20% (p = 0,006).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">En los pacientes que han presentado una crisis de ARV el tratamiento siguiendo las recomendaciones de la GINA se asocia a un descenso de la morbilidad y la mortalidad del asma.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:35 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevención del asma mortal. ¿Cómo identificar al asmático de riesgo?" 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 1 | 6 | 7 |
| 2024 October | 44 | 14 | 58 |
| 2024 September | 42 | 15 | 57 |
| 2024 August | 46 | 37 | 83 |
| 2024 July | 31 | 23 | 54 |
| 2024 June | 41 | 32 | 73 |
| 2024 May | 48 | 42 | 90 |
| 2024 April | 22 | 20 | 42 |
| 2024 March | 28 | 14 | 42 |
| 2024 February | 13 | 13 | 26 |
| 2023 October | 0 | 4 | 4 |
| 2023 March | 5 | 4 | 9 |
| 2023 February | 18 | 19 | 37 |
| 2023 January | 16 | 33 | 49 |
| 2022 December | 27 | 25 | 52 |
| 2022 November | 19 | 13 | 32 |
| 2022 October | 20 | 30 | 50 |
| 2022 September | 21 | 28 | 49 |
| 2022 August | 22 | 44 | 66 |
| 2022 July | 28 | 38 | 66 |
| 2022 June | 25 | 25 | 50 |
| 2022 May | 21 | 33 | 54 |
| 2022 April | 24 | 27 | 51 |
| 2022 March | 25 | 29 | 54 |
| 2022 February | 19 | 22 | 41 |
| 2022 January | 22 | 42 | 64 |
| 2021 December | 24 | 46 | 70 |
| 2021 November | 20 | 52 | 72 |
| 2021 October | 27 | 50 | 77 |
| 2021 September | 19 | 66 | 85 |
| 2021 August | 20 | 34 | 54 |
| 2021 July | 44 | 27 | 71 |
| 2021 June | 19 | 30 | 49 |
| 2021 May | 16 | 24 | 40 |
| 2021 April | 35 | 52 | 87 |
| 2021 March | 16 | 19 | 35 |
| 2021 February | 12 | 25 | 37 |
| 2021 January | 10 | 16 | 26 |
| 2020 December | 14 | 10 | 24 |
| 2020 November | 11 | 15 | 26 |
| 2020 October | 8 | 10 | 18 |
| 2020 September | 3 | 4 | 7 |
| 2020 August | 12 | 20 | 32 |
| 2020 July | 11 | 13 | 24 |
| 2020 June | 15 | 10 | 25 |
| 2020 May | 13 | 18 | 31 |
| 2020 April | 16 | 21 | 37 |
| 2020 March | 18 | 12 | 30 |
| 2020 February | 14 | 13 | 27 |
| 2020 January | 13 | 18 | 31 |
| 2019 December | 15 | 15 | 30 |
| 2019 November | 9 | 11 | 20 |
| 2019 October | 17 | 8 | 25 |
| 2019 September | 6 | 13 | 19 |
| 2019 August | 9 | 8 | 17 |
| 2019 July | 15 | 16 | 31 |
| 2019 June | 10 | 7 | 17 |
| 2019 May | 10 | 5 | 15 |
| 2019 April | 5 | 10 | 15 |
| 2019 March | 7 | 13 | 20 |
| 2019 February | 4 | 5 | 9 |
| 2019 January | 3 | 9 | 12 |
| 2018 December | 12 | 10 | 22 |
| 2018 November | 11 | 10 | 21 |
| 2018 October | 6 | 13 | 19 |
| 2018 September | 10 | 6 | 16 |
| 2018 May | 2 | 0 | 2 |
| 2018 April | 7 | 6 | 13 |
| 2018 March | 3 | 4 | 7 |
| 2018 February | 5 | 6 | 11 |
| 2018 January | 2 | 6 | 8 |
| 2017 December | 6 | 8 | 14 |
| 2017 November | 1 | 5 | 6 |
| 2017 October | 3 | 5 | 8 |
| 2017 September | 3 | 5 | 8 |
| 2017 August | 4 | 10 | 14 |
| 2017 July | 2 | 5 | 7 |
| 2017 June | 9 | 20 | 29 |
| 2017 May | 4 | 5 | 9 |
| 2017 April | 2 | 4 | 6 |
| 2017 March | 3 | 4 | 7 |
| 2017 February | 0 | 2 | 2 |
| 2017 January | 3 | 5 | 8 |
| 2016 December | 6 | 5 | 11 |
| 2016 November | 5 | 7 | 12 |
| 2016 October | 17 | 8 | 25 |
| 2016 September | 9 | 7 | 16 |
| 2016 August | 14 | 2 | 16 |
| 2016 July | 15 | 4 | 19 |
| 2016 March | 2 | 0 | 2 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 42 | 6 | 48 |
| 2015 September | 43 | 6 | 49 |
| 2015 August | 25 | 8 | 33 |
| 2015 July | 36 | 5 | 41 |
| 2015 June | 26 | 3 | 29 |
| 2015 May | 47 | 11 | 58 |
| 2015 April | 24 | 8 | 32 |
| 2015 March | 31 | 4 | 35 |
| 2015 February | 21 | 7 | 28 |
| 2015 January | 30 | 6 | 36 |
| 2014 December | 32 | 2 | 34 |
| 2014 November | 33 | 6 | 39 |
| 2014 October | 37 | 8 | 45 |
| 2014 September | 32 | 6 | 38 |
| 2014 August | 38 | 8 | 46 |
| 2014 July | 38 | 5 | 43 |
| 2014 June | 32 | 9 | 41 |
| 2014 May | 44 | 8 | 52 |
| 2014 April | 59 | 7 | 66 |
| 2014 March | 55 | 12 | 67 |
| 2014 February | 46 | 5 | 51 |
| 2014 January | 38 | 7 | 45 |
| 2013 December | 43 | 8 | 51 |
| 2013 November | 34 | 11 | 45 |
| 2013 October | 52 | 8 | 60 |
| 2013 September | 43 | 8 | 51 |
| 2013 August | 41 | 6 | 47 |
| 2013 July | 48 | 10 | 58 |
| 2013 June | 31 | 8 | 39 |
| 2013 May | 36 | 6 | 42 |
| 2013 April | 26 | 3 | 29 |
| 2013 March | 8 | 3 | 11 |
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