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Vol. 45. Issue S1.
Pages 25-29 (February 2009)
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Vol. 45. Issue S1.
Pages 25-29 (February 2009)
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Guías de Práctica Clínica para el asma. Luces y sombras
Asthma Clinical Practice Guidelines: Advantages and Pitfalls
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9105
Vicente Plazaa,
Corresponding author
vplaza@santpau.es

Autor para correspondencia.
, Jesús Bellido-Casadoa, Pablo Alonso-Coellob,c, Gustavo Rodrigod
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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Resumen

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.

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).

Palabras clave:
Asma
Guías de práctica clínica
Implementación de las guías de práctica clínica
Medicina basada en la evidencia
Abstract

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.

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).

Keywords:
Asthma
Clinical practice guidelines
Implementation of clinical practice guidelines
Evidence-based medicine
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