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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleSmallCaps">The Spanish Asthma Guidelines</span>&#44; better known by the acronym GEMA&#44; have been in existence for more than 20 years&#46; GEMA was the first SEPAR-led consensus to be produced in collaboration with other scientific societies&#46; At present&#44; given the number of participating scientific societies&#44; it is probably the most important consensus documents currently implemented in any one disease in Spain&#44; and has grown steadily to become the standard worldwide reference guideline on asthma in the Spanish language&#46; It has been evaluated using objective methodological parameters &#40;the AGREE tool&#41;&#44; and these studies have positioned it among the best because of its quality&#44; rigor&#44; and presentation&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Its objectives are to prevent asthma and to improve the clinical situation of affected individuals by giving the healthcare professionals who treat them further insight into this disease&#46; 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number of participants&#44; design&#44; and content&#44; this new GEMA<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> has the very best prospects&#46; A total of 108 asthma experts&#44; accredited representatives of the above-mentioned 21 societies&#44; scientific groups&#44; associations&#44; and foundations&#44; have participated in drafting and reviewing this document&#46; The sheer number of participants and societies involved in the consensus makes this new GEMA<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> the largest ever&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Changes include the reordering of sections and subsections&#46; Particular care has been taken regarding the quality of the wording and the proper use of the Spanish language&#44; given the guideline&#39;s wide international dissemination&#44; particularly in Latin America&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The most important modifications&#44; grouped by areas&#44; include in the section of diagnosis-classification a cut-off point for FE<span class="elsevierStyleInf">NO</span> that was reduced from 50 to 40<span class="elsevierStyleHsp" style=""></span>ppb&#46; These revised values are in line with other expert recommendations&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and are more balanced and useful for clinical practice&#44; while still retaining sufficient rigor&#46; The new criteria for intermittent asthma are now more demanding&#58; for example&#44; the use of relief medication has been set at a maximum of only twice a month&#44; in contrast to the previous limit of twice a week&#46; Severity will be classified after appropriate treatment and on the basis of the amount of inhaled glucocorticoid needed to achieve and maintain disease control&#44; while initial severity prior to treatment will no longer be taken into account&#46; A new simple and practical diagnostic algorithm is provided for asthma in children&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Significant changes have been made in the therapeutic area&#46; In the treatment of intermittent asthma&#44; the problems resulting from the abuse of short-acting &#946;<span class="elsevierStyleInf">2</span>-agonists &#40;SABA&#41; have been recognized&#44; and options for the combination of on-demand inhaled glucocorticoid&#47;formoterol or glucocorticoid&#47;salbutamol have been incorporated&#44; allowing the physician to choose one of these 3 options&#44; depending on the patient&#39;s characteristics&#46; In the case of mild persistent asthma&#44; the first option is still inhaled glucocorticoids at low daily doses&#44; although for patients with poor adherence to this option who do not improve after appropriate corrective educational intervention&#44; on-demand administration of inhaled glucocorticoid&#47;formoterol or glucocorticoid&#47;salbutamol may be considered&#46; In our view&#44; the evidence provided on the effectiveness of this second option<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> is neither superior nor equal to the first&#44; but it could be used in the scenario described&#46; Therefore&#44; the GEMA recommendation would fall somewhere between those of GINA<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> &#40;in favor of on-demand glucocorticoid&#47;formoterol&#41; and the European Medicines Agency &#40;against&#41; in mild asthma&#46; Another important modification has been the change in the concept and treatment of step 6 disease &#40;severe uncontrolled asthma&#41; in adults&#44; now especially reserved for the use of biological drugs &#40;omalizumab&#44; mepolizumab&#44; reslizumab&#44; benralizumab&#44; and dupilumab&#41;&#46; A table is provided with the aerodynamic properties of the drug deposit provided by the different inhalers&#44; while another novel addition is the recommendation of at least one minimal educational intervention with a short action plan in writing for all patients&#44; based on the study sponsored by the SEPAR Asthma group &#40;PROMETEO&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Some further therapeutic innovations have been introduced in the treatment of childhood asthma&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In the section on severe asthma&#44; which is discussed in a separate section&#44; phenotypes&#44; which are now reserved only for severe asthma&#44; have been simplified in 3 variants&#58; allergic T2 asthma&#44; eosinophilic T2 asthma&#44; and non-T2 asthma&#44; while the asthma phenotype associated with obesity has been set aside&#46; A notable addition has been the inclusion of an algorithm for the treatment of severe uncontrolled asthma&#44; based on the recent SEPAR consensus for severe asthma&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Furthermore&#44; new biologics have been included in the treatment of severe asthma in children&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">And finally&#44; among a wide miscellany of other significant changes&#44; we must highlight&#58; the inclusion of care circuits&#44; referrals between levels of care&#44; and recent proposals from some working groups for patients after discharge for exacerbation<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a>&#59; the characteristics&#44; activity&#44; and resources of asthma units accredited by SEPAR or SEAIC<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#59; the inclusion of nasal polyposis &#40;diagnosis and treatment&#41; in the asthma-associated rhinitis section&#59; a specific section on asthma and Covid-19&#44; which includes&#44; in particular&#44; a table of possible drug interactions between drugs used to treat infection and asthma&#59; new asthma prevalence data &#40;in Spain and Argentina&#41;&#59; and some basic considerations regarding telehealth and telemedicine applied to asthma&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">As was the case in previous GEMA editions&#44; this latest version takes a balanced attitude toward the most controversial aspects&#44; avoiding extreme positions&#46; Taking this middle ground is not in any way disingenuous&#58; we believe it is the result of the deliberation&#44; restraint&#44; and independent thinking employed by the GEMA Executive Committee in the face of controversy&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">We are confident that this new edition will earn the same recognition as its predecessors and achieve its objectives&#46; In the meantime&#44; we are already working on the GEMA 5&#46;1 for 2021&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Plaza V&#44; Blanco M&#44; Garc&#237;a G&#44; Korta J&#44; Molina J&#44; Quirce S&#44; et al&#46; Novedades y otros aspectos destacados de la Gu&#237;a Espa&#241;ola para el Manejo del Asma &#40;GEMA&#41;&#44; versi&#243;n 5&#46;0&#46; Arch Bronconeumol&#46; 2020&#59;57&#58;11&#8211;12&#46;</p>"
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Editorial
Highlights of the Spanish Asthma Guidelines (GEMA), Version 5.0
Novedades y otros aspectos destacados de la Guía Española para el Manejo del Asma (GEMA), versión 5.0
Vicente Plazaa,g,
Corresponding author
vplaza@santpau.cat

Corresponding author.
, Marina Blancob,h, Gabriel Garcíac,i, Javier Kortad,j, Jesús Molinae,k, Santiago Quircef,l, on behalf of the Comité Ejecutivo de GEMA
a Servicio de Neumología y Alergia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
b Servicio de Neumología, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
c Servicio de Neumonología, Hospital Rossi La Plata, Buenos Aires, Argentina
d Servicio de Neumología Pediátrica, Hospital Universitario Donostia, Donostia-San Sebastián, Guipúzcoa, Spain
e Centro de Salud Francia, Dirección Asistencial Oeste, Fuenlabrada, Madrid, Spain
f Servicio de Alergología, Hospital Universitario La Paz, Madrid, Spain
g Coordinador del Comité Ejecutivo GEMA, Spain
h Coordinadora representante de SEPAR, Spain
i Coordinador representante de ALAT, Argentina
j Coordinador representante de la SENP, Spain
k Coordinador representante de semFYC y GRAP, Spain
l Coordinador representante de SEAIC, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleSmallCaps">The Spanish Asthma Guidelines</span>&#44; better known by the acronym GEMA&#44; have been in existence for more than 20 years&#46; GEMA was the first SEPAR-led consensus to be produced in collaboration with other scientific societies&#46; At present&#44; given the number of participating scientific societies&#44; it is probably the most important consensus documents currently implemented in any one disease in Spain&#44; and has grown steadily to become the standard worldwide reference guideline on asthma in the Spanish language&#46; It has been evaluated using objective methodological parameters &#40;the AGREE tool&#41;&#44; and these studies have positioned it among the best because of its quality&#44; rigor&#44; and presentation&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Its objectives are to prevent asthma and to improve the clinical situation of affected individuals by giving the healthcare professionals who treat them further insight into this disease&#46; To this end&#44; a group of experts has drafted a set of preferably evidence-based recommendations that are clear&#44; concise&#44; and intelligible&#44; and easily implemented by treating physicians&#46; The reader&#44; however&#44; should not expect the guideline to provide an exposition of all the available knowledge on asthma&#46; It is not an expert monograph&#44; but is instead deliberately designed to be a brief&#44; practical document&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Although GEMA is updated briefly on an annual basis&#44; mainly to incorporate the most relevant literature citations&#44; the text is revised in depth every 5 years by a new editorial team&#46; Their task is to develop new guidelines and renew both structure and content&#46; It has been 5 years since the appearance of GEMA 4&#46;0&#44; so in 2020 it was time to produce the new version&#44; GEMA 5&#46;0&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Because of its size&#44; number of participants&#44; design&#44; and content&#44; this new GEMA<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> has the very best prospects&#46; A total of 108 asthma experts&#44; accredited representatives of the above-mentioned 21 societies&#44; scientific groups&#44; associations&#44; and foundations&#44; have participated in drafting and reviewing this document&#46; The sheer number of participants and societies involved in the consensus makes this new GEMA<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> the largest ever&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Changes include the reordering of sections and subsections&#46; Particular care has been taken regarding the quality of the wording and the proper use of the Spanish language&#44; given the guideline&#39;s wide international dissemination&#44; particularly in Latin America&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The most important modifications&#44; grouped by areas&#44; include in the section of diagnosis-classification a cut-off point for FE<span class="elsevierStyleInf">NO</span> that was reduced from 50 to 40<span class="elsevierStyleHsp" style=""></span>ppb&#46; These revised values are in line with other expert recommendations&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and are more balanced and useful for clinical practice&#44; while still retaining sufficient rigor&#46; The new criteria for intermittent asthma are now more demanding&#58; for example&#44; the use of relief medication has been set at a maximum of only twice a month&#44; in contrast to the previous limit of twice a week&#46; Severity will be classified after appropriate treatment and on the basis of the amount of inhaled glucocorticoid needed to achieve and maintain disease control&#44; while initial severity prior to treatment will no longer be taken into account&#46; A new simple and practical diagnostic algorithm is provided for asthma in children&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Significant changes have been made in the therapeutic area&#46; In the treatment of intermittent asthma&#44; the problems resulting from the abuse of short-acting &#946;<span class="elsevierStyleInf">2</span>-agonists &#40;SABA&#41; have been recognized&#44; and options for the combination of on-demand inhaled glucocorticoid&#47;formoterol or glucocorticoid&#47;salbutamol have been incorporated&#44; allowing the physician to choose one of these 3 options&#44; depending on the patient&#39;s characteristics&#46; In the case of mild persistent asthma&#44; the first option is still inhaled glucocorticoids at low daily doses&#44; although for patients with poor adherence to this option who do not improve after appropriate corrective educational intervention&#44; on-demand administration of inhaled glucocorticoid&#47;formoterol or glucocorticoid&#47;salbutamol may be considered&#46; In our view&#44; the evidence provided on the effectiveness of this second option<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> is neither superior nor equal to the first&#44; but it could be used in the scenario described&#46; Therefore&#44; the GEMA recommendation would fall somewhere between those of GINA<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> &#40;in favor of on-demand glucocorticoid&#47;formoterol&#41; and the European Medicines Agency &#40;against&#41; in mild asthma&#46; Another important modification has been the change in the concept and treatment of step 6 disease &#40;severe uncontrolled asthma&#41; in adults&#44; now especially reserved for the use of biological drugs &#40;omalizumab&#44; mepolizumab&#44; reslizumab&#44; benralizumab&#44; and dupilumab&#41;&#46; A table is provided with the aerodynamic properties of the drug deposit provided by the different inhalers&#44; while another novel addition is the recommendation of at least one minimal educational intervention with a short action plan in writing for all patients&#44; based on the study sponsored by the SEPAR Asthma group &#40;PROMETEO&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Some further therapeutic innovations have been introduced in the treatment of childhood asthma&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">In the section on severe asthma&#44; which is discussed in a separate section&#44; phenotypes&#44; which are now reserved only for severe asthma&#44; have been simplified in 3 variants&#58; allergic T2 asthma&#44; eosinophilic T2 asthma&#44; and non-T2 asthma&#44; while the asthma phenotype associated with obesity has been set aside&#46; A notable addition has been the inclusion of an algorithm for the treatment of severe uncontrolled asthma&#44; based on the recent SEPAR consensus for severe asthma&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Furthermore&#44; new biologics have been included in the treatment of severe asthma in children&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">And finally&#44; among a wide miscellany of other significant changes&#44; we must highlight&#58; the inclusion of care circuits&#44; referrals between levels of care&#44; and recent proposals from some working groups for patients after discharge for exacerbation<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a>&#59; the characteristics&#44; activity&#44; and resources of asthma units accredited by SEPAR or SEAIC<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#59; the inclusion of nasal polyposis &#40;diagnosis and treatment&#41; in the asthma-associated rhinitis section&#59; a specific section on asthma and Covid-19&#44; which includes&#44; in particular&#44; a table of possible drug interactions between drugs used to treat infection and asthma&#59; new asthma prevalence data &#40;in Spain and Argentina&#41;&#59; and some basic considerations regarding telehealth and telemedicine applied to asthma&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">As was the case in previous GEMA editions&#44; this latest version takes a balanced attitude toward the most controversial aspects&#44; avoiding extreme positions&#46; Taking this middle ground is not in any way disingenuous&#58; we believe it is the result of the deliberation&#44; restraint&#44; and independent thinking employed by the GEMA Executive Committee in the face of controversy&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">We are confident that this new edition will earn the same recognition as its predecessors and achieve its objectives&#46; In the meantime&#44; we are already working on the GEMA 5&#46;1 for 2021&#46;</p></span>"
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Article information
ISSN: 15792129
Original language: English
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