RESUMEN
The Global Initiative for Asthma (GINA) Strategy Report provides clinicians with an annually updated evidence-based strategy for asthma management and prevention, which can be adapted for local circumstances (e.g., medication availability). This article summarizes key recommendations from GINA 2021, and the evidence underpinning recent changes. GINA recommends that asthma in adults and adolescents should not be treated solely with short-acting ß2-agonist (SABA), because of the risks of SABA-only treatment and SABA overuse, and evidence for benefit of inhaled corticosteroids (ICS). Large trials show that as-needed combination ICS-formoterol reduces severe exacerbations by ⩾60% in mild asthma compared with SABA alone, with similar exacerbation, symptom, lung function, and inflammatory outcomes as daily ICS plus as-needed SABA. Key changes in GINA 2021 include division of the treatment figure for adults and adolescents into two tracks. Track 1 (preferred) has low-dose ICS-formoterol as the reliever at all steps: as needed only in Steps 1-2 (mild asthma), and with daily maintenance ICS-formoterol (maintenance-and-reliever therapy, "MART") in Steps 3-5. Track 2 (alternative) has as-needed SABA across all steps, plus regular ICS (Step 2) or ICS-long-acting ß2-agonist (Steps 3-5). For adults with moderate-to-severe asthma, GINA makes additional recommendations in Step 5 for add-on long-acting muscarinic antagonists and azithromycin, with add-on biologic therapies for severe asthma. For children 6-11 years, new treatment options are added at Steps 3-4. Across all age groups and levels of severity, regular personalized assessment, treatment of modifiable risk factors, self-management education, skills training, appropriate medication adjustment, and review remain essential to optimize asthma outcomes.
Asunto(s)
Asma/diagnóstico , Asma/terapia , Adolescente , Adulto , Antiasmáticos/uso terapéutico , Asma/etiología , Niño , Preescolar , Terapia Combinada , Progresión de la Enfermedad , Quimioterapia Combinada , Humanos , Lactante , Gravedad del Paciente , Guías de Práctica Clínica como Asunto , Factores de Riesgo , AutocuidadoRESUMEN
The Global Initiative for Asthma (GINA) Strategy Report provides clinicians with an annually updated evidence-based strategy for asthma management and prevention, which can be adapted for local circumstances (e.g., medication availability). This article summarizes key recommendations from GINA 2021, and the evidence underpinning recent changes. GINA recommends that asthma in adults and adolescents should not be treated solely with short-acting ß2 -agonist (SABA), because of the risks of SABA-only treatment and SABA overuse, and evidence for benefit of inhaled corticosteroids (ICS). Large trials show that as-needed combination ICS-formoterol reduces severe exacerbations by ≥60% in mild asthma compared with SABA alone, with similar exacerbation, symptom, lung function, and inflammatory outcomes as daily ICS plus as-needed SABA. Key changes in GINA 2021 include division of the treatment figure for adults and adolescents into two tracks. Track 1 (preferred) has low-dose ICS-formoterol as the reliever at all steps: as needed only in Steps 1-2 (mild asthma), and with daily maintenance ICS-formoterol (maintenance-and-reliever therapy, "MART") in Steps 3-5. Track 2 (alternative) has as-needed SABA across all steps, plus regular ICS (Step 2) or ICS-long-acting ß2 -agonist (Steps 3-5). For adults with moderate-to-severe asthma, GINA makes additional recommendations in Step 5 for add-on long-acting muscarinic antagonists and azithromycin, with add-on biologic therapies for severe asthma. For children 6-11 years, new treatment options are added at Steps 3-4. Across all age groups and levels of severity, regular personalized assessment, treatment of modifiable risk factors, self-management education, skills training, appropriate medication adjustment, and review remain essential to optimize asthma outcomes.
Asunto(s)
Antiasmáticos , Asma , Administración por Inhalación , Adolescente , Corticoesteroides , Adulto , Asma/diagnóstico , Niño , Quimioterapia Combinada , Fumarato de Formoterol/uso terapéutico , HumanosAsunto(s)
Inteligencia Artificial , Medicina Clínica , Humanos , Aprendizaje Automático , AlgoritmosAsunto(s)
Inteligencia Artificial , Medicina Clínica , Humanos , Algoritmos , Aprendizaje AutomáticoRESUMEN
In keeping with the growing movement in scientific publishing toward transparency in data and methods, we propose changes to journal authorship policies and procedures to provide insight into which author is responsible for which contributions, better assurance that the list is complete, and clearly articulated standards to justify earning authorship credit. To accomplish these goals, we recommend that journals adopt common and transparent standards for authorship, outline responsibilities for corresponding authors, adopt the Contributor Roles Taxonomy (CRediT) (docs.casrai.org/CRediT) methodology for attributing contributions, include this information in article metadata, and require authors to use the ORCID persistent digital identifier (https://orcid.org). Additionally, we recommend that universities and research institutions articulate expectations about author roles and responsibilities to provide a point of common understanding for discussion of authorship across research teams. Furthermore, we propose that funding agencies adopt the ORCID identifier and accept the CRediT taxonomy. We encourage scientific societies to further authorship transparency by signing on to these recommendations and promoting them through their meetings and publications programs.
RESUMEN
The aerial view of the concept of data sharing is beautiful. What could be better than having high-quality information carefully reexamined for the possibility that new nuggets of useful data are lying there, previously unseen? The potential for leveraging existing results for even more benefit pays appropriate increased tribute to the patients who put themselves at risk to generate the data. The moral imperative to honor their collective sacrifice is the trump card that takes this trick. However, many of us who have actually conducted clinical research, managed clinical studies and data collection and analysis, and curated data sets have . . .
Asunto(s)
Antineoplásicos/uso terapéutico , Biomarcadores de Tumor/metabolismo , Neoplasias del Colon/genética , Expresión Génica , Proteínas de Homeodominio/metabolismo , Factor de Transcripción CDX2 , Femenino , Humanos , MasculinoAsunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Antihipertensivos/uso terapéutico , Asma/tratamiento farmacológico , Vacunas contra la COVID-19 , COVID-19/prevención & control , Epoprostenol/análogos & derivados , Hipertensión Pulmonar/tratamiento farmacológico , Oxígeno/administración & dosificación , Insuficiencia Respiratoria/terapia , Antiasmáticos/uso terapéutico , COVID-19/epidemiología , COVID-19/transmisión , Vacunas contra la COVID-19/administración & dosificación , Citocinas/antagonistas & inhibidores , Epoprostenol/uso terapéutico , Humanos , Hipertensión Pulmonar/etiología , Control de Infecciones , Inyecciones Subcutáneas , Unidades de Cuidados Intensivos , Enfermedades Pulmonares Intersticiales/complicaciones , Enfermedades Pulmonares Intersticiales/tratamiento farmacológico , Casas de Salud , Oxígeno/sangre , Terapia por Inhalación de Oxígeno , Insuficiencia Respiratoria/mortalidad , Brote de los Síntomas , Prueba de Paso , Linfopoyetina del Estroma TímicoRESUMEN
The U.S.-based Editors of ICMJE journals call for health-care professionals to act against the public health crisis of injury and death from guns.
Asunto(s)
Armas de Fuego , Personal de Salud , Incidentes con Víctimas en Masa , Rol Profesional , Heridas por Arma de Fuego/epidemiología , Humanos , Salud Pública , Estados Unidos/epidemiología , Heridas y Lesiones/epidemiología , Heridas y Lesiones/mortalidad , Heridas por Arma de Fuego/mortalidadRESUMEN
The International Committee of Medical Journal Editors announces requirements that a data sharing plan be prospectively registered, and a data sharing statement be included in submitted manuscripts, for clinical trials to be published in ICMJE journals.
Asunto(s)
Ensayos Clínicos como Asunto/organización & administración , Conjuntos de Datos como Asunto/normas , Políticas Editoriales , Difusión de la Información , Cooperación Internacional , Publicaciones Periódicas como Asunto/normas , Ensayos Clínicos como Asunto/normas , Humanos , Sociedades MédicasAsunto(s)
Antiasmáticos , Asma , Antiasmáticos/uso terapéutico , Asma/tratamiento farmacológico , HumanosRESUMEN
El Comité Internacional de Editores de Revista Médicas (ICMJE) ha tomado la posición que el compartir los datos generados por los ensayos clínicos es una obligación ética, por cuanto los participantes en esos estudios se colocaron en riesgo al aceptar su inclusión. En esta editorial el ICMJE expresa que requerirá desde Julio 2018 que los manuscritos enviados a sus revistas deben incluir una declaración sobre compartir datos. A su vez, los ensayos clínicos que comiencen a enrolar pacientes a partir de Enero 2019, deben incluir un plan sobre compartir datos en el registro de tales ensayos. Se dan en esta declaración cuatro ejemplos de declaraciones sobre compartir datos, referidos a qué datos se compartirán, cuándo estarán disponibles y qué criterios de acceso se establecerán. El ICMJE visualiza un futuro cercano en el cual el compartir los datos será la norma, con el fin de maximizar el conocimiento ganado por los esfuerzos y sacrificios de los participantes.
Asunto(s)
Ensayos Clínicos como Asunto/organización & administración , Conjuntos de Datos como Asunto/normas , Políticas Editoriales , Difusión de la Información , Publicaciones Periódicas como Asunto/normas , Ensayos Clínicos como Asunto/normas , Humanos , Cooperación Internacional , Sociedades MédicasRESUMEN
Asthma is characterized by chronic inflammation, airway hyperresponsiveness, and progressive airway remodeling. The airway epithelium is known to play a critical role in the initiation and perpetuation of these processes. Here, we review how excessive epithelial stress generated by bronchoconstriction is sufficient to induce airway remodeling, even in the absence of inflammatory cells.