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儿科哮喘治疗:国际指南推荐意见不一致时该怎么办。

Pediatric asthma treatment: What to do when international guideline recommendations do not agree.

机构信息

Investigational Unit, Hospital Médica Sur, Mexico City, Mexico.

Dean's Office, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosio Villegas", Mexico City, Mexico; Pregraduate Pulmonology Department, Medical Faculty, Universidad Nacional Autónoma de México, Mexico City, Mexico.

出版信息

Ann Allergy Asthma Immunol. 2018 Jul;121(1):7-13.e4. doi: 10.1016/j.anai.2018.03.008. Epub 2018 Mar 15.

Abstract

BACKGROUND

There was a need for a solid asthma guideline in Mexico to update and unify asthma management. Because high-quality asthma guidelines exist worldwide, in which the latest evidence on asthma management is summarized, the ADAPTE approach allows for the development of a national asthma guideline based on evidence from already existing guidelines, adapted to national needs.

OBJECTIVE

To fuse evidence from the best asthma guidelines and adapt it to local needs with the ADAPTE approach.

METHODS

The Appraisal of Guidelines for Research and Evaluation (AGREE) II asthma guidelines were evaluated by a core group to select 3 primary guidelines. For each step of asthma management, clinical questions were formulated and replied according to (1) evidence in the primary guidelines, (2) safety, (3) Cost, and (4) patient preference. The Guidelines Development Group, composed of a broad range of experts from medical specialties, primary care physicians, and methodologists, adjusted the draft questions and replies in several rounds of a Delphi process and 3 face-to-face meetings, taking into account the reality of the situation in Mexico. We present the results of the pediatric asthma treatment part.

RESULTS

Selected primary guidelines are from the British Thoracic Society and Scottish Intercollegiate Guidelines Network (BTS/SIGN), Global Initiative for Asthma (GINA), and Spanish Guidelines on the Management of Asthma (GEMA) 2015, with 2016 updates. Recommendations or suggestions were made for asthma treatment in Mexico. In this article, the detailed analysis of the evidence present in the BTS/SIGN, GINA, and GEMA sections on the (non) pharmacologic treatment of pediatric asthma, education, and devices are presented for 2 age groups: children 5 years or younger and children 6 to 11 years old with asthma.

CONCLUSION

For the pediatric treatment and patient education sections, applying the AGREE II and Delphi methods is useful to develop a scientifically sustained document, adjusted to the Mexican situation, as is the Mexican Guideline on Asthma.

摘要

背景

墨西哥需要一份可靠的哮喘指南来更新和统一哮喘管理。由于全球存在高质量的哮喘指南,其中总结了最新的哮喘管理证据,因此 ADAPTE 方法允许根据已经存在的指南中的证据制定基于国家需求的国家哮喘指南。

目的

通过 ADAPTE 方法融合最佳哮喘指南中的证据并使其适应本地需求。

方法

核心小组对 Appraisal of Guidelines for Research and Evaluation (AGREE) II 哮喘指南进行了评估,以选择 3 项主要指南。对于哮喘管理的每一步,根据(1)主要指南中的证据、(2)安全性、(3)成本和(4)患者偏好来制定临床问题并回答。指南制定小组由来自医学专业、初级保健医生和方法学家的广泛专家组成,他们通过几轮 Delphi 流程和 3 次面对面会议,根据墨西哥的实际情况调整了草案问题和回复。我们呈现儿科哮喘治疗部分的结果。

结果

选择的主要指南来自英国胸科协会和苏格兰校际指南网络(BTS/SIGN)、全球哮喘倡议(GINA)和 2016 年更新的西班牙哮喘管理指南(GEMA)。为墨西哥的哮喘治疗提出了建议。在本文中,详细分析了 BTS/SIGN、GINA 和 GEMA 部分关于儿科哮喘的非药物治疗、教育和设备的证据,针对 2 个年龄组:5 岁或以下的儿童和 6 至 11 岁患有哮喘的儿童。

结论

对于儿科治疗和患者教育部分,应用 AGREE II 和 Delphi 方法有助于制定科学持续的文件,适应墨西哥的情况,正如墨西哥哮喘指南一样。

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