[MIA 2021, Comprehensive Asthma Management. Guidelines for Mexico]. / MIA 2021, Manejo Integral del Asma. Lineamientos para México.

BACKGROUND: Asthma continues to be one of the most frequent chronic respiratory diseases in our country. New methods for diagnosis and treatment have been described; accordingly, the international guidelines were renewed. OBJECTIVE: To create a national platform for the development of updated guidelines, solidly based on evidence: Comprehensive Asthma Management (Spanish acronym: MIA). METHODS: MIA uses the ADAPTE method. The MIA development group consists of experts in pulmonology-allergology-methodology and representatives of 13 institutions and societies of specialties that manage asthma. The international reference guidelines (selected with AGREE-II): GINA 2020, GEMA 5.0, BTS/SIGN 2019 and ATS/ERS consensus document 2014-2019 on severe asthma. MIA covers suspected asthma, diagnosis, treatment, and special groups. Key clinical questions were formulated on treatment steps 1-3, biomarkers and severe asthma. RESULTS: Based on evidence, safety, cost and local reality, the core group developed responses. Through a Delphi process the broad MIA development group suggested adjustments until consensus was reached. CONCLUSION: A document was generated with multiple figures and algorithms, solidly based on evidence about asthma management, adjusted for Mexico with a broad base among different societies that participated in its development. It does not include guidelines for acute asthma.

Antecedentes: El asma sigue siendo una patología respiratoria crónica frecuente en México. Se han descrito nuevos métodos para el diagnóstico y tratamiento conforme se renuevan las guías internacionales. Objetivo: Crear la plataforma nacional Manejo Integral del Asma (MIA), para el desarrollo de lineamientos actualizados con base en evidencia. Métodos: Se utilizó el método ADAPTE. El grupo de desarrollo de MIA estuvo integrado por expertos en neumología, alergología y metodología y representantes de 13 instituciones y sociedades de especialidades que manejan asma. Las guías internacionales de referencia (seleccionadas con AGREE-II) fueron GINA 2020, GEMA 5.0, BTS/SIGN 2019 y consenso ATS/ERS 2014-2019. En MIA se aborda sospecha de asma, diagnóstico, tratamiento y grupos especiales. Se formularon preguntas clínicas clave sobre tratamiento en los pasos 1 a 3, biomarcadores y asma grave. Resultados: Con base en evidencia, seguridad, costo y realidad local, el grupo nuclear desarrolló respuestas. Mediante proceso Delphi, el grupo amplio de desarrollo sugirió ajustes hasta que se logró el consenso. Conclusión: El documento generado contiene múltiples figuras y algoritmos, está sólidamente basado en evidencia acerca del manejo del asma y fue ajustado para México con participación de diferentes sociedades para su desarrollo; no se incluyeron lineamientos para la crisis asmática.

Percepción emocional del COVID-19 en México: Estudio comparación entre la fase 1, fase 2 y medios de información

Introducción: Desde el registro de los primeros casos de COVID-19 en México, se han derivado una serie de respuestas emocionales caracterizadas por miedo y estrés. Dicho impacto emocional se debe en gran medida a la inundación de información paralela a las fases de la pandemia y la transición entre ellas y la percepción que los individuos tienen de la enfermedad. El objetivo del presente trabajo fue comparar la percepción del COVID-19 entre la fase 1 y 2 de la pandemia y entre los medios de información usados para informarse en población mexicana. Métodos: Considerando un muestreo en cadena, se realizó un estudio comparativo en el que se diseminó por medio de correo electrónico y redes sociales una batería de evaluación que respondieron 1560 participantes. Resultados: La preocupación por las consecuencias del COVID-19 y su impacto emocional incrementaron al pasar de la fase 1 a la fase 2 de la pandemia. Además, se identificó que el impacto emocional fue mayor en quienes se informaron a través de Facebook® y televisión. Conclusiones: La pandemia tendrá un impacto emocional progresivo en medida en que avancen sus fases y en la importancia de informarse en medios adecuados para prevenir consecuencias emocionales.

Background: Since the first COVID-19 cases in Mexico there have been a variety of emotional responses which have in common fear and stress. The emotional impact of COVID-19 is builded in some way because the information flooding parallel to the pandemic phases, the transition between them and illness perception. The aim of the present work was to compare the perception of COVID-19 between phase 1 and 2 of the pandemic and between the information media used to inform themselves in the Mexican population. Methods: Considering a chain sampling, a comparative study was carried out in which an evaluation battery was disseminated through email and social networks, which was answered by 1560 participants. Results The concern about the consequences of COVID-19 and its emotional impact increased when going from phase 1 to phase 2 of the pandemic. In addition, it was identified that the emotional impact was greater in those who reported through Facebook® and television. Conclusions: The pandemic will have a progressive emotional impact as its phases progress and the importance of informing oneself in adequate means to prevent emotional consequences.

COVID-19 perception and preventive behaviors: A descriptive, comparative study by severity and perceived risk / Percepción del COVID-19 y conductas de prevención: un estudio descriptivo y comparativo por gravedad y riesgo percibido

Abstract Introduction The prevention of COVID-19 infections involves the implementation of behaviors to reduce risk and protect health. However, engaging in these behaviors depends on the perception of the threat posed by the illness. Previous research shows the importance of illness perception in the case of communicable and non-communicable diseases, showing that they can change depending on the severity and risk attributed to them. Objective Compare the illness perception and the practice of preventive and exposure behavior based on the severity and the risk attributed to COVID-19 at the end of phase 1 and the beginning of phase 2 of the pandemic in Mexico. Method By means of a chain sampling, a comparative study was conducted in which an evaluation battery was disseminated through e-mail and social networks. Results It was found that evaluating COVID-19 as a serious disease and perceiving oneself as being at risk of contracting it had small and moderate effects on the perception of the consequences of the illness (r = .34; r = .26), emotional impact (r = .32; r = .25), personal control (r = .24) and engagement in preventive (r = .05), and exposure behaviors (r = .07; r = .07). Discussion and conclusion This article shows the relevance of the perceptual variables that impact concern due to the social and emotional consequences of COVID-19, as well as those that encourage preventive behaviors and the minimization of exposure behavior.

Resumen Introducción Si bien la prevención de contagios de COVID-19 supone la implementación de comportamientos para reducir el riesgo y proteger la salud, la práctica de estas conductas está en función de la percepción que se tenga sobre la amenaza de la enfermedad. Investigaciones previas evidencian la importancia de la percepción de enfermedad cuando se trata de padecimientos transmisibles y no transmisibles, señalando que ésta puede modificarse en función de la gravedad y el riesgo atribuido. Objetivo Comparar la percepción de enfermedad y la práctica de conductas de prevención y exposición con base en la gravedad y el riesgo atribuidos al COVID-19 al término de la fase 1 e inicio de la fase 2 de la pandemia en México. Método A partir de un muestreo en cadena, se realizó un estudio comparativo en el que se diseminó una batería de evaluación por medio de correo electrónico y redes sociales. Resultados Se encontró que evaluar el COVID-19 como una enfermedad grave y percibirse en riesgo de contraerla tiene efectos moderados y leves, respectivamente, sobre la percepción de las consecuencias de la enfermedad (r = .34; r = .26), el impacto emocional (r = .32; r = .25), el control personal (r = .24) y la práctica de conductas de prevención (r = .05) y exposición (r = .07; r = .07). Discusión y conclusión El presente estudio muestra la relevancia de las variables perceptuales que impactan en la preocupación por consecuencias sociales y emocionales del COVID-19, así como de aquellas que favorecen las conductas de prevención y la minimización de conducta de exposición.

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

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.

[Mexican Asthma Guidelines: GUIMA 2017]. / Guía Mexicana del Asma: GUIMA 2017.

BACKGROUND: The need for a national guideline, with a broad basis among specialists and primary care physicians was felt in Mexico, to try unifying asthma management. As several high-quality asthma guidelines exist worldwide, it was decided to select the best three for transculturation. METHODS: Following the internationally recommended methodology for guideline transculturation, ADAPTE, a literature search for asthma guidelines, published 1-1-2007 through 31-12-2015 was conducted. AGREE-II evaluations yielded 3/40 most suitable for transculturation. Their compound evidence was fused with local reality, patient preference, cost and safety considerations to draft the guideline document. Subsequently, this was adjusted by physicians from 12 national medical societies in several rounds of a Delphi process and 3 face-to-face meetings to reach the final version. RESULTS: Evidence was fused from British Thoracic Society Asthma Guideline 2014, Global Initiative on Asthma 2015, and Guía Española del Manejo del Asma 2015 (2016 updates included). After 3 Delphi-rounds we developed an evidence-based document taking into account patient characteristics, including age, treatment costs and safety and best locally available medication. CONCLUSIONS: In cooperation pulmonologists, allergists, ENT physicians, paediatricians and GPs were able to develop an evidence-based document for the prevention, diagnosis and treatment of asthma and its exacerbations in Mexico.

Antecedentes: Con el objetivo de unificar el manejo del asma en México se estructuró una guía clínica que conjunta el conocimiento de diversas especialidades y la atención en el primer nivel de contacto. Se seleccionaron 3 guías publicadas en el ámbito internacional para su transculturación. Métodos: Conforme a la metodología ADAPTE se usó AGREE II después de la búsqueda bibliográfica de guías sobre asma publicadas entre 2007 y 2015. Se fusionó la realidad local con la evidencia de 3/40 mejores guías. El documento inicial fue sometido a la revisión de representantes de 12 sociedades médicas en varias rondas Delphi hasta llegar a la versión final. Resultados: Las guías base fueron la British Thoracic Society Asthma Guideline 2014, la Global Initiative on Asthma 2015 y la Guía Española del Manejo del Asma 2015. Después de 3 rondas Delphi se desarrolló un documento en el que se consideraron las características de los pacientes según edad, costos de los tratamientos y perfiles de seguridad de los fármacos disponibles en México. Conclusión: Con la cooperación de neumólogos, alergólogos, otorrinolaringólogos, pediatras y médicos generales se llegó a un consenso basado en evidencia, en el que se incluyeron recomendaciones sobre prevención, diagnóstico y tratamiento del asma y sus crisis.

[ARIA Mexico 2014. Adaptation of the Clinical Practice Guide ARIA 2010 for Mexico. Methodology ADAPTE]. / ARIA México 2014. Adaptación de la Guía de Práctica Clínica ARIA 2010 para México. Metodología ADAPTE.

BACKGROUND: The global prevalence of allergic rhinitis is high. International Study of Asthma and Allergies in Childhood (ISAAC) Phase III reports a total estimated prevalence of 4.6% in Mexico. There is evidence based on allergic rhinitis Clinical Practice Guidelines (CPG), but its promotion, acceptance and application is not optimal or adequate in Mexico. OBJECTIVE: To generate a guideline for the treatment of allergic rhinitis and its impact on asthma by adaptating the 2010 ARIA Guideline to Mexican reality, through a transculturation process applying the ADAPTE methodology. PATIENTS AND METHOD: Using the ADAPTE Methodology, the original 2010 ARIA CPG recommendations were evaluated by the guideline development group (GDG) into which multiple medical specialities managing patients with allergic rhinitis were incoorporated. The GDG valorated the quality of 2010 ARIA, checked and translated key clinical questions. Moreover, the GDG adjusted recommendations, patient preferences and included comments in the context of the Mexican reality (safety, costs and cultural issues). To accomplish this, we ran Delphi panels with as many rounds as necessary to reach agreement. One extra question, not included in the original 2010 ARIA, on the use of Nasal Lavages for AR was created sustained by a systematic literature review. RESULTS: A total of 45 questions from the original 2010 ARIA were included and divided into six groups covering prevention, medical treatment, immunotherapy and alternative medicine to treat patients with allergic rhinitis with or without asthma. Most of the questions reached agreement in one or two rounds; one question required three rounds. CONCLUSIONS: An easy-to-use, adaptated, up-to-date and applicable allergic rhinitis guideline for Mexico is now available.

ANTECEDENTES: la prevalencia de rinitis alérgica en todo el mundo es alta. El Estudio Internacional de Asma y Alergias en la Niñez (ISAAC de International Study of Asthma and Allergies in Childhood) Fase III reporta una prevalencia estimada total en México de 4.6%. Existen guías de práctica clínica basadas en evidencia de rinitis alérgica, pero su promoción, aceptación y validez no son óptimas ni adecuadas para México. OBJETIVO: generar una guía de tratamiento de la rinitis alérgica y su repercusión en el asma adaptando la guía ARIA 2010 a la realidad mexicana mediante un proceso de transculturización, por medio de la metodología ADAPTE. MATERIAL Y MÉTODO: a través de la metodología ADAPTE un grupo de desarrollo de la guía, integrado por múltiples especialistas que tratan pacientes con rinitis alérgica, valoró la calidad de la guía ARIA 2010, revisó y tradujo las preguntas clínicas clave y ajustó las recomendaciones, preferencias del paciente y comentarios a la realidad mexicana (seguridad, costos y aspectos culturales). Para lograrlo se corrieron páneles Delphi, con tantas rondas como fuera necesario hasta lograr un acuerdo. Por medio de una revisión sistemática de la bibliografía se creó una pregunta especial no incluida en ARIA 2010 de la utilidad de realizar lavados nasales en pacientes con rinitis alérgica. RESULTADOS: se incluyeron 45 preguntas de la guía original ARIA 2010, divididas en seis bloques que abarcan prevención, tratamiento médico, inmunoterapia y terapias alternativas de pacientes con rinitis alérgica con o sin asma. La mayor parte de las preguntas alcanzaron acuerdo en una a dos rondas, sólo una requirió tres para ello. CONCLUSIONES: se cuenta ahora con una guía de rinitis alérgica de usosencillo, adaptada, actualizada y válida para México.

[Asthma diagnosis]. / Diagnóstico de asma.

The diagnosis of asthma is based primarily on patient history, conducting the interrogation to the search for risk factors for developing it and the triggers of their symptoms. This chapter will detail some laboratory tests and cabinet that can support this clinical diagnosis. Respiratory function tests help to show the degree of airway obstruction and its reversibility with treatment. Allergy tests help prove the existence of cells sensitized to a specific allergen and once identified, implement environmental control measures or if necessary to control this immunomodulation exaggerated immune response. The exhaled nitric oxide test has been most useful in assessing the course of asthma during treatment, rather than for diagnosis. Sometimes the confirmatory diagnosis of asthma is achieved after excluding other diseases that may present a similar clinical picture, and especially after knowing the response to standard treatment with bronchodilators and anti-inflammatory drugs.

[Asthma classification]. / Clasificación del asma.

Asthma, as chronic inflammatory disease, shows variations in clinical manifestations and the degree of airflow obstruction, so its severity may change over time in the same patient. The Global Initiative for Asthma (GINA) established a practical system of classification, considering clinical and functional aspects as frequency of diurnal and nocturnal respiratory symptoms and lung function, their combination allows for classifying asthma severity as intermittent and persistent ( mild, moderate and severe). Recently, it has been proposed to classify the asthma according to degree of control: controlled, partly controlled and uncontrolled. The parameters used in this system are: frequency of diurnal and nocturnal respiratory symptoms, activity limitation, use of rescue therapy, determining the forced expiratory volume in one second (FEV1) or peak expiratory flow (PEF) and the exacerbations. The patient's participation on the asthma classification has also been considered through the self application of asthma control questionnaire (ACT). Patients with high risk of death are classified in the group of difficult asthma control (ADC), requiring major and minor criteria to define it; the common denominator is the decontrol of the disease, high dose steroids and appropriate treatment previously established. Sort asthma with any of these systems, information about its impact on the patient's life and thus establish the recommended treatment schedule for each patient group.

[Asthma education]. / Educación en asma.

Education should be considered an integral part of asthma treatment; it must be individualized according to disease characteristics, age and socio-cultural condition of each person; the physicians, nurses, inhalation therapy technicians, psychologists and other specialists are responsible for this process. They must provide patients the information on the most important aspects of their disease and its association with triggers. The practical instruction in the use of inhaled medications and spacers or through a commercial spacer is essential for the use of inhaled therapy and an indication of the flowmeter in self-control and monitoring patients with asthma. The participation of the family and society is esential inthe control of asthma because it can alter the lifestyle and quality of life of patients. Recently diverse civil partnerships have been formed and are involved in patient education about asthma conducting some courses for patients and their families, these courses are a great support to the physician because they enhance the information provided to the patient in the medical office.

Correlación directa entre FEF25-75 y la actividad de la paraoxonasa plasmática en pacientes asmáticos adultos / Direct correlation between FEF25-75 and plasmatic paraoxonase activity in adult patients with asthma

Introducción: El incremento en la actividad de mieloperoxidasa (AAPO) (EC 1.11.1.7) plasmática ha sido relacionada con la evolución de diferentes patologías destacando las enfermedades crónico-degenerativas que tienen en común el cursar con un estado de estrés oxidativo (EO) concomitante a un proceso inflamatorio persistente. Este es el caso del asma. La enzima paraoxonasa (PON-1) (EC 3.1.1.2), es una arilesterasa que forma parte de la APO A-I de laa HDL. Su función catalítica le permite hidrolizar hidroperóxidos formados durante la lipoperoxídación de lipoproteínas y membranas como consecuencia de un EO. A la PON-1 se ha considerado como protectora de las lipoproteínas al interrumpir la oxidación de las LDL y disminuir el daño a estructuras celulares. Es una actividad enzimática que representa a la defensa antiestrés oxidativo. Objetivos: Demostrar que el estrés oxidativo del paciente asmático puede ser evaluado por el incremento de MPO como marcador de daño oxidante y que la función respiratoria adecuada puede ser relacionada con la capacidad de defensa antioxidante representada por la actividad de la PON-1. Métodos: La actividad de ambas enzimas fue determinada en el plasma de un grupo de pacientes con asma leve a moderada comparado con un grupo control formado por individuos clínicamente sanos. Resultados: En el grupo de pacientes con asma, la actividad de MPO se incrementó en un 42% (57.31 ± 7.2 U vs 33.34 ± 4.7 U p<0.05), mientras que se observó un decremento del 52% (0.09 ±0.1 nmol p-nitrofenol/mg prot vs 0.05 ± 0.01 nmol p-nitrofenol/mg prot p<0.01) en la actividad de la PON-1. La actividad de la MPO mostró una correlación inversamente proporcional con el FEV1 con una r de Spearman de -0.57 y la PON-1 mostró una correlación directamente proporcional con el FEF25-75 con una r de Spearman de 0.64. Conclusiones: Se demuestra por primera vez que los pacientes con asma, en los que se presenta un estado de estrés oxidativo que afecta ...

Introduction: Plasma myeloperoxidase activity (MPO) (EC 1.11.1.7) has been related to several chronic-degenerative diseases such as asthma, which have in common a chronic inflammatory process. Paraoxonase (PON-1) (EC 3.1.1.2), is an arylesterase enzyme that has a hydroperoxide catalytic function. This enzyme is a component of APO A-l located in HDL. PON1 is has been considered to protect lipoproteins, because it interrupts the oxidation process of LDL, conducive to the atherosclerotic process. Objectives: To demonstrate that, a) oxidative stress in asthmatic patients correlates with the MPO activity, and b) demonstrate the role of PON 1 activity as a biomarker of their pulmonary function. Methods: The activity of both enzymes was measured in plasma of patients with asthma and compared to a control group of healthy subjects. Results: In the group of patients with asthma, MPO activity increased 42% (57.31 ± 7.2 U vs 33.34 ± 4.7 U p<0.05), while PON-1 activity decreased 52% (0.09 ±0.1 nmol p-nitrophenol/mg prot vs 0.05 ± 0.01 nmol p-nitrophenol/mg prot p<0.01). MPO activity showed an inverse correlation with FEV, with a Spearman r of -0.57, while PON-1 activiy showed a direct correlation with FEF25-75, Spearman r of0.64. Conclusions: In this study we show, for the first time, that asthma patients, in whom there is a state of oxidative stress that affects the pulmonary function, PON-1 determination can be useful as a predictor of a better pulmonary function, whereas an increment in MPO activity could be associated to an acute inflammatory process, implicating cellular damage. * U = U/mg of protein'.

Incremento de la actividad de mieloperoxidasa plasmática en pacientes con asma asociada a diabetes mellitus tipo 2. Indicador de mayor desequilibrio homeostático / Increase of myeloperoxidase activity in patients with asthma associated to diabetes mellitus type 2. An indicator of homeostatic disequilibrium

Antecedentes: La actividad de mieloperoxidasa (MPO, EC 1.11.1.7) plasmática ha sido relacionada con diferentes enfermedades crónico-degenerativas, que tienen en común cursar con un proceso inflamatorio crónico, como son los casos de asma y diabetes mellitus. Durante el proceso inflamatorio se generan especies reactivas del oxígeno (ERO) incluyendo al ácido hipocloroso (HCIO-) que es el producto de la MPO. Objetivos: Demostrar que el asma y la diabetes mellitus, que cursan con estrés oxidante, presentan una respuesta metabólica acumulativa que puede ser evaluada por el incremento de MPO como marcador de daño oxidante. Métodos: La actividad de la enzima fue determinada en el plasma de un grupo control formado por 36 individuos clínicamente sanos y en tres grupos de pacientes: a) 13 asmáticos, b) 29 diabéticos y c) 6 con coexistencia de ambos padecimientos. Resultados: En los pacientes con ambos padecimientos, la actividad de MPO se incrementó significativamente (65.1 ± 11.2 U*; p < 0.05). El grupo control presentó una actividad similar (37.6 ±3.2 U*) a la de los pacientes con asma (35.9 ± 5.2 U*) y a los diabéticos (32.6 ± 3.3 U*). Conclusiones: Se demuestra que la coexistencia de dos padecimientos crónico-degenerativos incrementa la posibilidad de daño tisular debido a la generación de ERO, que supera a las defensas antioxidantes del organismo, incrementando el estrés oxidante con el consecuente daño tisular y desequilibrio homeostático. *U = U/mg de proteína:¹.

Background: The activity of the enzyme myeloperoxidase (MPO, EC 1.11.1.7), in plasma has been related to several chronic-degenerative diseases such as asthma and diabetes mellitus which have in common a chronic inflammatory condition. Several reactive species of oxygen are generated during inflammation, including hypochlorous acid, which is a product of MPO. Objective: To prove that asthma and diabetes mellitus, in which there is oxidative stress, present a cumulative metabolic response that can be measured by an increase of MPO, as a marker of oxidative damage. Methods: The activity of MPO was measured in the plasma of a control group of 31 healthy volunteers and in three groups of patients: a) 13 asthmatics, b) 29 diabetics, c) 6 asthmatics and diabetics. Results: In patients with both diseases, asthma and diabetes mellitus, there was a significant increase in the activity of the enzyme MPO (65.1 ± 11.2 U*; p < 0.05). The activity of MPO was similar in the control group (37.6 ± 3.2 U*), the asthma group (35.9 ± 5.2 U*) and the diabetics (32.6 ± 3.3 U*). Conclusions: The coexistence of asthma and diabetes mellitus, both chronic-degenerative diseases, increases the possibility of tissue damage due to the generation of oxygen reactive species that overwhelms the antioxidant defenses of the body, augmenting the oxidative stress and inducing secondary tissue damage and homeostatic disequilibrium. *U= U/mg of protein.

[Characteristics of Mexican asthmatic subjects attending an outpatient service]. / Características de pacientes asmáticos mexicanos atendidos en consulta externa.

BACKGROUND: Despite the high prevalence of asthma in Mexico, studies describing general characteristics of these patients are scarce. OBJECTIVE: To analyze the sociodemographic, clinical and respiratory functional profile of asthmatic patients attending for the first time the outpatient service of a tertiary-level hospital, as well as to investigate treatments already received and the abandonment rate. METHODS: Adolescent and adult asthmatic subjects seen from February 2000 to November 2002 in the outpatient service of the National Institute of Respiratory Diseases, in Mexico City, were prospectively studied. Sociodemographic information was gathered and clinical and spirometric evaluations were carried out. The severity of the disease was classified according to international criteria. RESULTS: A total of 1403 patients between 12 and 82 years of age, with predominance of the female gender, were included in the analysis. An 88.7% of patients had the mildest forms of the disease, 10% had moderate asthma, and 1.3% had severe asthma. While 21.4% had never received anti-asthma treatment, about one third of the remaining patients had received corticosteroids, independently of the asthma severity, indicating an over-treatment of the intermittent form of the disease and an under-treatment of persistent forms. A high abandonment rate (65.7%) was observed. A positive bronchodilator test was observed in 30.3% of patients with intermittent asthma, though this proportion increased to about 67% in those with moderate and severe asthma. CONCLUSION: Mildest forms of the disease predominate among asthmatic patients attending for the first time an outpatient service, with a still very high frequency of inadequate use of corticosteroids.

Características de pacientes asmáticos mexicanos atendidos en consulta externa / Characteristics of Mexican asthmatic subjects attending an outpatient service

Background. Despite the high prevalence of asthma in Mexico, studies describing general characteristics of these patients are scarce. Objective.To analyze the sociodemographic, clinical and respiratory functional profile of asthmatic patients attending for the first time the outpatient service of a tertiary-level hospital, as well as to investigate treatments already received and the abandonment rate. Methods.Adolescent and adult asthmatic subjects seen from February 2000 to November 2002 in the outpatient service of the National Institute of Respiratory Diseases, in Mexico City, were prospectively studied. Sociodemographic information was gathered and clinical and spirometric evaluations were carried out. The severity of the disease was classified according to international criteria. Results. A total of 1403 patients between 12 and 82 years of age, with predominance of the female gender, were included in the analysis. An 88.7% of patients had the mildest forms of the disease, 10% had moderate asthma, and 1.3% had severe asthma. While 21.4% had never received anti-asthma treatment, about one third of the remaining patients had received corticosteroids, independently of the asthma severity, indicating an over-treatment of the intermittent form of the disease and an under-treatment of persistent forms. A high abandonment rate (65.7%) was observed. A positive bronchodilator test was observed in 30.3% of patients with intermittent asthma, though this proportion increased to about 67% in those with moderate and severe asthma. Conclusion.Mildest forms of the disease predominate among asthmatic patients attending for the first time an outpatient service, with a still very high frequency of inadequate use of corticosteroids.

Antecedentes. A pesar de que en México existe una alta prevalencia de asma, hay pocos estudios que describan las características generales de estos pacientes. Objetivo. Conocer el perfil sociodemográfico, clínico y funcional respiratorio de pacientes asmáticos que acuden por primera vez a consulta externa de un hospital de tercer nivel de atención, así como los tratamientos recibidos y su tasa de abandono. Métodos. Se estudiaron, prospectivamente, sujetos asmáticos adolescentes y adultos, atendidos de febrero del 2000 a noviembre del 2002 en el servicio de consulta externa del Instituto Nacional de Enfermedades Respiratorias, de la ciudad de México. Se recabó información sociodemográfica y se realizó evaluación clínica y por espirometría. La gravedad del asma se clasificó de acuerdo con criterios internacionales. Resultados. Se incluyeron 1,403 pacientes de 12 a 82 años de edad, con predominio del sexo femenino. El 88.7% de los pacientes tenían formas leves de la enfermedad, 10% asma moderada, y 1.3% asma grave. El 21.4% no había recibido tratamiento antiasmático. Entre los demás, cerca de una tercera parte recibió corticosteroides, independientemente de la gravedad del asma, indicando sobretratamiento del asma intermitente y subtratamiento de las formas persistentes. Encontramos una alta tasa de deserción (65.7%). Una respuesta positiva a la prueba con broncodilatador se observó en 30.3% de los pacientes con asma intermitente, cifra que se elevó a cerca de 67% en las formas moderada y grave. Conclusión. Entre los pacientes asmáticos que acuden a consulta externa, predominan las formas leves, detectándose que todavía existe una alta frecuencia del uso inadecuado de los corticosteroides.