Recommendations for the prevention and diagnosis of asthma in children: Evidence from international guidelines adapted for Mexico

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

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El lenguaje de la disnea. Una visión desde el español de México / Descriptors of breathlessness in Mexican spanish

Objetivo: La disnea es el síntoma más frecuente en la enfermedad cardiovascular o pulmonar. Sin embargo, el término engloba un número variado de descriptores que suelen usar o identificar los pacientes. Identificar estos descriptores puede ser de utilidad semiológica y para la compresión de su patogenia. El objetivo del presente estudio ha sido caracterizar los descriptores de disnea utilizados en español mexicano y su asociación con diferentes estados de estrés respiratorio o enfermedad cardiovascular o pulmonar. Material y métodos: Se estructuró un cuestionario de disnea basado en 21 descriptores, algunos sin equivalentes en idioma inglés. Se estudió a 15 sujetos sanos durante una prueba de ejercicio cardiopulmonar, a 13 durante una prueba de hipercapnia y a 10 mujeres embarazadas. Asimismo, se incluyó a 16 pacientes estables con cardiopatía demostrada, a 15 pacientes con crisis asmática, a 20 con enfermedad pulmonar obstructiva crónica estable y a 15 con neumopatía intersticial difusa también estable. La agrupación de los diferentes descriptores de disnea se determinó por análisis de conglomerados. Resultados: Se encontraron 7 conglomerados o asociaciones de descriptores que pueden interpretarse como tipos de disnea. Estos grupos de frases descriptivas se pueden englobar bajo los siguientes conceptos: agitación, asfixia, sofocación, inhalación exhalación, jadeo y rapidez. Se encontraron algunas asociaciones entre tipos de disnea y los grupos estudiados sobre la base de la frecuencia de uso de los términos. Conclusiones: Existen al menos 7 conglomerados o asociaciones de descriptores de disnea que equivalen a 7 tipos de disnea; algunos de los descriptores carecen de equivalente en inglés. Los sujetos sanos en estrés respiratorio o algunos grupos de pacientes con enfermedad cardiovascular o pulmonar se asociaron a tipos específicos de disnea

Objective: Breathlessness is the most common symptom of cardiovascular or pulmonary disease. The term encompasses a wide range of descriptors used by patients, however. Identifying those descriptors can be useful for analyzing symptoms and understanding how they arise. The aim of this study was to characterize the descriptors of breathlessness used in Mexican Spanish and to consider their association with various states of respiratory distress and cardiovascular or pulmonary disease. Material and methods: A questionnaire was based on 21 descriptors of breathlessness, some of which had no equivalents in English. The subjects included 15 healthy individuals during a cardiopulmonary stress test, 13 healthy subjects after a carbon dioxide rebreathing procedure, and 10 healthy women during pregnancy. We also included 16 patients with confirmed heart disease in stable condition, 15 patients during exacerbation of asthma, 20 with stable chronic obstructive pulmonary disease, and 15 with diffuse interstitial lung disease also in stable condition. Descriptors of breathlessness were then grouped based on the results of cluster analysis. Results: Seven clusters of phrasal descriptors were identified as possibly representative of types of dyspnea. These clusters of descriptors were categorized as follows: agitation, suffocation, smothering, inhalation, exhalation, panting, and rapidity. Associations between types of dyspnea and the groups of participants were identified based on how frequently they used the terms. Conclusions: At least 7 clusters or groups of descriptors of breathlessness were identified as equivalent to 7 types of dyspnea; some items have no equivalent in English. Healthy subjects with respiratory distress or certain groups of patients with cardiovascular or pulmonary disease are associated with certain types of dyspnea