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Allergologia et Immunopathologia
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Inicio Allergologia et Immunopathologia Recommendations for the prevention and diagnosis of asthma in children: Evidence...
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DOI: 10.1016/j.aller.2017.05.011
Recommendations for the prevention and diagnosis of asthma in children: Evidence from international guidelines adapted for Mexico
Visits
13
D.E.S. Larenas Linnemanna,
Corresponding author
marlar1@prodigy.net.mx

Corresponding authors.
, B.E. del Río Navarrob,c, J.A. Luna Pechd, J. Romero Lombarde, J. Villaverde Rosasf, M.C. Cano Salasg, M. Fernández Vegah,i, J.A. Ortega Martellj, E.C. López Estradak, J.L. Mayorga Butrónc,f,l, J. Salas Hernándezm,
Corresponding author
jsalas@iner.gob.mx

Corresponding authors.
, J.C. Vázquez Garcíah, I. Ortiz Aldanan, M.H. Vargas Becerrao,p, M. Bedolla Barajasq, N. Rodríguez Pérezr, A. Aguilar Arandas, C.A. Jiménez Gonzálezt, C. García Bolañosu, C. Garrido Galindoo, D.A. Mendoza Hernándezv, E. Mendoza Lópezw, G. López Pérezv, G.H. Wakida Kuzonokix, H.H. Ruiz Gutiérrezy, H. León Molinaz, H. Martínez de la Lanzaaa, H. Stone Aguilarab, J. Gómez Veraac, J. Olvera Salinasz, J.J. Oyoqui Floresad, J.L. Gálvez Romeroae, J.S. Lozano Saenzaf, J.I. Salgado Gamaag, M.A. Jiménez Chobillono, M.A. García Avilésah, M.P. Guinto Balanzarz, M.A. Medina Ávalosai, R. Camargo Angelesah, R. García Torrenterao, S. Toral Freyreo, G. Montes Narvaezz, H. Solorio Gómezaj, J. Rosas Peñaak, S.J. Romero Tapiaal,am, A. Reyes Herreraan, F. Cuevas Schachtao, J. Esquer Floresap, J.A. Sacre Hazouriaf, L. Compean Martínezaq, P.J. Medina Sánchezar, S. Garza Salinasas, C. Baez Loyolaz, I. Romero Alvaradoat, J.L. Miguel Reyeso, L.E. Huerta Espinosaau, M.Á. Correa Floresav, R. Castro Martínezaw
a Investigational Unit, Hospital Médica Sur, Mexico City, Mexico
b Department of Allergy and Clinical Immunology, Pediatric Hospital of Mexico “Federico Gómez”, Mexico City, Mexico
c Postgraduate Department, Medical Faculty, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
d Department of Philosophical, Methodological and Instrumental Disciplines, University Center of Science in Health, Universidad de Guadalajara, Mexico
e ISSSTE Hospital Saltillo, Nuevo León, Mexico
f A2DAHT Iberoamerican Agency for Development & Assessment of Health Technologies, Mexico City, Mexico
g Department of Postgraduate Medicine of the Instituto Nacional de Enfermedades Respiratorias “Ismael Cosio Villegas”, Mexico City, Mexico
h Dean's Office, of the Instituto Nacional de Enfermedades Respiratorias “Ismael Cosio Villegas”, Mexico City, Mexico
i Pregraduate Pulmonology Department, Medical Faculty, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
j Department of Pre and Postgraduate Medicine, Universidad Autónoma de Hidalgo, Pachuca, Mexico
k Asthma Clinic, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosio Villegas”, Mexico
l ENT Department, Instituto Nacional de Pediatría, Mexico City, Mexico
m General Management Instituto Nacional de Enfermedades Respiratorias “Ismael Cosio Villegas”, Mexico City, Mexico
n Secretary of Health of the State of Guanajuato, Guanajuato (Gto), Mexico
o Instituto Nacional de Enfermedades Respiratorias “Ismael Cosio Villegas”, Mexico
p Unit of Medical Investigations in Respiratory Medicine, of the Instituto Mexicano del Seguro Social, Mexico
q Civil Hospital of Guadalajara “Dr. Juan I. Menchaca”, Guadalajara, Mexico
r Institute of Science and Superior Studies of Tamaulipas, Universidad Autónoma de Tamaulipas, Matamoros, Mexico
s Medical Unit of High-Level Specialization, of Hospital de Pediatría Centro Médico de Occidente, Mexico
t Medical Faculty of the Universidad Autónoma San Luis Potosí, Mexico
u General Hospital “Doctor Gaudencio González Garza” of the Centro Médico Nacional La Raza, Mexico City, Mexico
v Allergy Department, Instituto Nacional de Pediatría, Mexico City, Mexico
w Sistema Tec Salud, Hospital San José, Monterrey (NL), Mexico
x Hospital Central Sur de Alta Especialidad, Petróleos Mexicanos, Mexico
y Servicio de Neumología Pediátrica, Centro Médico Nacional de Occidente, IMSS, Guadalajara, Jalisco, Mexico
z Private Practice, Mexico City, Mexico
aa Private Practice, Oaxaca, Oaxaca, Mexico
ab Hospital San José de Hermosillo, Mexico
ac Allergy Department, Hospital Regional Lic. Adolfo López Mateos, ISSSTE, Mexico City, Mexico
ad Private Practice, Uruapan (Michoacan), Mexico
ae Instituto de Seguridad y de Servicios Sociales de los Trabajadores del Estado (ISSSTE), Regional, Puebla, Puebla, Mexico
af Private Practice, Jalapa, Veracruz, Mexico
ag Clínica del Niño y del Adolescente de Coatzacoalcos (Veracruz), Mexico
ah Secretary of Health, National Center for Preventive Programs for Disease Control (CENAPRECE), Mexico City, Mexico
ai Instituto de Seguridad y de Servicios Sociales de los Trabajadores del Estado (ISSSTE) of Veracruz, Mexico
aj Private Practice, Puebla, Puebla, Mexico
ak Private Practice, Guadalajara, Guadalajara, Mexico
al Unit of Education and Investigation, Hospital de Alta Especialidad del Niño “Dr. Rodolfo Nieto Padrón”, Villahermosa, Tabasco, Mexico
am Profesor Investigador de la División Académica de la Universidad Juárez Autónoma de Tabasco, Mexico
an National College of Nursing, Mexico
ao Department of Pulmonology and Thoracic Surgery, Instituto Nacional de Pediatría, Mexico City, Mexico
ap Hospital del ISSSSTE, ‘Fray Junipero Serra’, Tijuana, BC, Mexico
aq Servicio de Otorrinolaringología del Centenario Hospital Hidalgo de Aguascalientes, Mexico
ar Hospital Regional ISSSSTE, León, Guanajuato, Mexico
as Hospital San José del Tecnológico de Monterrey, Mexico
at Emergency Department, Hospital Infantil de México “Federico Gómez”, Mexico City, Mexico
au Pediatric Hospital of Legaria of the Secretary of Health, Mexico City, Mexico
av Centro Médico Nacional “La Raza”, Mexico City, Mexico
aw Private Practice, San Luis Potosí, San Luis Potosí, Mexico
This item has received
13
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Received 18 April 2017, Accepted 19 May 2017
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Tables (4)
Table 1. Clinical questions on the prevention of asthma, level of evidence and recommendation.
Table 2. Clinical questions on when to suspect the diagnosis of asthma, level of evidence and recommendation.
Table 3. Clinical questions on tests that confirm the diagnosis of asthma,a level of evidence and recommendation.
Table 4. Clinical questions on how to evaluate asthma severity and levels of asthma control, level of evidence and recommendation of Mother guidelines and conclusions of GUIMA.
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Figures (14)
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Abstract
Background

With the availability of high-quality asthma guidelines worldwide, one possible approach of developing a valid guideline, without re-working the evidence, already analysed by major guidelines, is the ADAPTE approach, as was used for the development of National Guidelines on asthma.

Methods

The guidelines development group (GDG) covered a broad range of experts from medical specialities, primary care physicians and methodologists. The core group of the GDG searched the literature for asthma guidelines 2005 onward, and analysed the 11 best guidelines with AGREE-II to select three mother guidelines. Key clinical questions were formulated covering each step of the asthma management.

Results

The selected mother guidelines are British Thoracic Society (BTS), GINA and GEMA 2015. Responses to the questions were formulated according to the evidence in the mother guidelines. Recommendations or suggestions were made for asthma treatment in Mexico by the core group, and adjusted during several rounds of a Delphi process, taking into account: 1. Evidence; 2. Safety; 3. Cost; 4. Patient preference – all these set against the background of the local reality. Here the detailed analysis of the evidence present in BTS/GINA/GEMA sections on prevention and diagnosis in paediatric asthma are presented for three age-groups: children with asthma ≤5 years, 6–11 years and ≥12 years.

Conclusions

For the prevention and diagnosis sections, applying the AGREE-II method is useful to develop a scientifically-sustained document, adjusted to the local reality per country, as is the Mexican Guideline on Asthma.

Keywords:
Asthma
Asthma prevention
Asthma diagnosis
Lung function test
Asthma guidelines
AGREE-II
ADAPTE
Wheezing
Paediatric

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