[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.

Variabilidad circadiana de la oximetría de pulso en niños sanos menores de 7 años / Circadian Variability of Pulse Oximetry in Healthy Children Under the Age of 7

Antecedentes: La saturación periférica de oxígeno (SpO2) medida por oximetría de pulso es ampliamente usada en la práctica clínica, pero sus fluctuaciones durante las 24h del día han sido poco exploradas. Recientemente describimos que niños hospitalizados por causas no cardiopulmonares tenían una variación circadiana de la SpO2. Este hallazgo necesitaba ser corroborado en niños sanos, lo que constituyó la finalidad del presente estudio. Población y método: Niños sanos residentes en una casa cuna gubernamental se estudiaron mediante oximetría de pulso cada 2h a lo largo de 24h.ResultadosSe incluyeron 82 niños de un mes a 6,5 años de edad (media ± error estándar: 3,06 ± 0,16 años), con peso para la talla en el percentil 65,5 ± 2,9. En 65 (79,3%) niños los valores de SpO2 siguieron una curva sinusoidal sugestiva de un ritmo circadiano. El conjunto de curvas sinusoidales en esta población tuvo un mesor de 95,10 ± 0,08%SpO2 y un período de 21,05 ± 0,54h (en el 53,8% de estos niños el período estuvo entre 20 y 28h). El valor máximo de SpO2 se alcanzó a las 3:14PM ± 16min, y el más bajo a las 5:16AM ± 48min. Al dividir las 24h en 4 períodos se demostró que los valores más altos de SpO2 se alcanzaban entre las 2PM y las 8PM.ConclusionesEn esta población de niños clínicamente sanos existió una variación circadiana en la oximetría de pulso, con valores máximos a media tarde y mínimos en la madrugada(AU)

Background: Peripheral oxygen saturation (SpO2) measured by pulse oximetry is widely used in clinical practice, but its fluctuations over the course of the 24h of a day have not been explored at length. Recently, we reported that children hospitalized due to non-cardiopulmonary causes had a circadian variation in SpO2. This finding needed to be corroborated in healthy children, which is the objective of the present study. Patients and methods: Healthy children residing in a state foster home were studied with pulse oximetry every 2h for 24h.ResultsEighty two children were included in the study, ranging in age from one month to 6.5 years (average ± standard error of 3.06 ± 0.16 years), with a weight-for-length/height percentile of 65.5 ± 2.9. In 65 (79.3%) children, the SpO2 levels followed a sinusoidal curve suggesting circadian rhythm. The total group of sinusoidal curves in this population had a mesor of 95.10 ± 0.08%SpO2, period of 21.05 ± 0.54h (in 53.8% of these children, the period was between 20 and 28h). The maximum SpO2 was reached at 3:14PM ± 16min, and the minimum at 5:16AM ± 48min. When the 24h were divided into four periods, it was demonstrated that the highest SpO2 levels were reached between 2PM and 8PM.ConclusionsIn this population of clinically healthy children, there was a circadian variation in pulse oximetry, with maximum values in the late afternoon and minimal values in the early morning(AU)

Circadian variability of pulse oximetry in healthy children under the age of 7.

BACKGROUND: Peripheral oxygen saturation (SpO(2)) measured by pulse oximetry is widely used in clinical practice, but its fluctuations over the course of the 24 h of a day have not been explored at length. Recently, we reported that children hospitalized due to non-cardiopulmonary causes had a circadian variation in SpO(2). This finding needed to be corroborated in healthy children, which is the objective of the present study. PATIENTS AND METHODS: Healthy children residing in a state foster home were studied with pulse oximetry every 2h for 24h. RESULTS: Eighty two children were included in the study, ranging in age from one month to 6.5 years (average ± standard error of 3.06 ± 0.16 years), with a weight-for-length/height percentile of 65.5 ± 2.9. In 65 (79.3%) children, the SpO(2) levels followed a sinusoidal curve suggesting circadian rhythm. The total group of sinusoidal curves in this population had a mesor of 95.10 ± 0.08% SpO(2), period of 21.05 ± 0.54 h (in 53.8% of these children, the period was between 20 and 28 h). The maximum SpO(2) was reached at 3:14 pm ± 16 min, and the minimum at 5:16 am ± 48 min. When the 24 h were divided into four periods, it was demonstrated that the highest SpO(2) levels were reached between 2 pm and 8 pm. CONCLUSIONS: In this population of clinically healthy children, there was a circadian variation in pulse oximetry, with maximum values in the late afternoon and minimal values in the early morning.