ABSTRACT
El asma es una de las enfermedades más prevalentes en España y, a pesar de los grandes avances diagnósticos y terapéuticos, los resultados en salud indican que hasta el 80% de los pacientes no tendrían su asma bien controlada. Aunque las causas de esta situación son diversas, existen algunas prácticas entre los profesionales que atienden el asma que no contribuyen a la mejora de los resultados en salud de esta enfermedad. Nuestro grupo de trabajo ha elaborado este documento para recordar una serie de pautas básicas, alineadas con las guías actuales y la literatura reciente, y consensuadas mediante metodología Delphi por un panel experto multidisciplinar. Estas recomendaciones sobre quéno se debe hacer en el manejo del asma en el adulto quedan articuladas en 4 ámbitos: el diagnóstico, el seguimiento, el tratamiento y la prevención de exacerbaciones.(AU)
Asthma is one of the most prevalent diseases in Spain, yet despite the great diagnostic and therapeutic advances made in this field, health outcomes suggest that up to 80% of patients do not have their asthma well controlled. Although the causes of this situation are diverse, there are some practices among the professionals who treat asthma that are not conducive to improving health outcomes in this disease. Our working group has prepared this document in order to remind clinicians of a series of basic guidelines, aligned with current guidelines and recent literature, and agreed by a multidisciplinary expert panel using Delphi methodology. These recommendations about what not to do in the management of asthma in the adult patient are structured into four areas: diagnosis, monitoring, treatment and prevention of exacerbations.(AU)
Subject(s)
Humans , Male , Female , Asthma/drug therapy , Asthma/therapy , Consensus , Health Knowledge, Attitudes, Practice , Practice Guidelines as Topic , Interdisciplinary Communication , Asthma/diagnosis , Asthma/prevention & control , Spain , Primary Health CareABSTRACT
Asthma is one of the most prevalent diseases in Spain, yet despite the great diagnostic and therapeutic advances made in this field, health outcomes suggest that up to 80% of patients do not have their asthma well controlled. Although the causes of this situation are diverse, there are some practices among the professionals who treat asthma that are not conducive to improving health outcomes in this disease. Our working group has prepared this document in order to remind clinicians of a series of basic guidelines, aligned with current guidelines and recent literature, and agreed by a multidisciplinary expert panel using Delphi methodology. These recommendations about what not to do in the management of asthma in the adult patient are structured into four areas: diagnosis, monitoring, treatment and prevention of exacerbations.
Subject(s)
Asthma , Physicians , Asthma/diagnosis , Asthma/drug therapy , Consensus , Delphi Technique , Humans , SpainABSTRACT
Las infecciones respiratorias representan la primera causa de morbilidad infecciosa tanto en adultos como en niños en atención primaria en España. Se tratan generalmente de infecciones autolimitadas, causadas principalmente por virus. Sin embargo, está documentado un alto porcentaje de prescripción antibiótica innecesaria. Las técnicas de diagnóstico rápido son pruebas biomédicas que puede ser utilizadas en la misma consulta con el paciente sin la necesidad de disponer de un laboratorio. El uso de estas pruebas, muchas de las cuales se han desarrollado recientemente, está aumentando rápidamente en atención primaria. No obstante, debemos reflexionar sobre si su uso contribuye siempre a que se realice un diagnóstico apropiado y de alta calidad por parte de los médicos de atención primaria. Presentamos un conjunto de criterios que pueden ser utilizados por los clínicos y se discuten las ventajas e inconvenientes de los instrumentos disponibles para el abordaje de las infecciones respiratorias y cómo utilizarlos (AU)
Respiratory tract infections rank first as causes of adult and paediatric infectious morbidity in primary care in Spain. These infections are usually self-limiting and are mainly caused by viruses. However, a high percentage of unnecessary antibiotic prescription is reported. Point-of-care tests are biomedical tests, which can be used near the patient, without interference of a laboratory. The use of these tests, many of which have been recently developed, is rapidly increasing in general practice. Notwithstanding, we must mull over whether they always contribute to an effective and high-quality diagnostic process by primary care clinicians. We present a set of criteria that can be used by clinicians and discuss the pros and cons of the instruments available for the management of respiratory tract infections and how to use them appropriately adecuadamente (AU)
Subject(s)
Humans , Child , Adult , Point-of-Care Testing , Respiratory Tract Infections/diagnosis , Risk Factors , Primary Health Care/methods , Practice Patterns, Physicians' , Specimen Handling/methodsABSTRACT
Respiratory tract infections rank first as causes of adult and paediatric infectious morbidity in primary care in Spain. These infections are usually self-limiting and are mainly caused by viruses. However, a high percentage of unnecessary antibiotic prescription is reported. Point-of-care tests are biomedical tests, which can be used near the patient, without interference of a laboratory. The use of these tests, many of which have been recently developed, is rapidly increasing in general practice. Notwithstanding, we must mull over whether they always contribute to an effective and high-quality diagnostic process by primary care clinicians. We present a set of criteria that can be used by clinicians and discuss the pros and cons of the instruments available for the management of respiratory tract infections and how to use them appropriately.
ABSTRACT
La faringoamigdalitis aguda (FAA) en el adulto es una de las enfermedades infecciosas más comunes en la consulta del médico de familia. La etiología más frecuente es viral. Dentro de la etiología bacteriana, el principal agente responsable es Streptococcus pyogenes o estreptococo β-hemolítico del grupo A (EBHGA), causante del 5-30% de los casos. En el manejo diagnóstico las escalas de valoración clínica, para predecir la posible etiología bacteriana, son una buena ayuda para seleccionar a qué pacientes se deben practicar las técnicas de detección rápida de antígeno estreptocócico. Es conocido que, en general, sin estas técnicas, se tiende al sobrediagnóstico de FAA estreptocócica, con la consiguiente prescripción innecesaria de antibióticos, muchas veces de amplio espectro. Así, con el manejo de las escalas y la técnica de diagnóstico rápido, elaboramos los algoritmos de manejo de la FAA. Los objetivos del tratamiento son acelerar la resolución de los síntomas, reducir el tiempo de contagio y prevenir las complicaciones supurativas locales y no supurativas. Los antibióticos de elección para el tratamiento de la FAA estreptocócica son penicilina y amoxicilina. La asociación de amoxicilina y clavulánico no está indicada en el tratamiento inicial en la infección aguda. Los macrólidos tampoco son un tratamiento de primera elección; su uso debe reservarse para pacientes con alergia a la penicilina. Es importante en nuestro país adecuar tanto el diagnóstico de la FAA bacteriana y la prescripción de antibióticos a la evidencia científica disponible. La implantación de protocolos de actuación en las farmacias comunitarias puede ser de utilidad para identificar y cribar los casos que no requieran tratamiento antibiótico (AU)
The acute pharyngotonsillitis (APT) in adults is one the most common infectious diseases in the family physicians surgery. The most frequent etiology is viral. Within the bacterial etiology, the main agent responsible is Streptococcus pyogenes or streptococcus β-GROUP A hemolytic (EBHGA), causing 5-30% of cases. In the diagnostic management, to predict the possible bacterial etiology, clinical evaluation scales are a good help for selecting which patients should undergo quick detection techniques for the streptococcic antigen. It is known that, in general, without these techniques streptococcic APT tends to be overdiagnosed, with the ensuing unnecessary prescription for antibiotics, often broad-spectrum. Thus, with the management of the steps and the quick diagnosis technique, we can draw up algorithms for managing APT. The objectives of the treatment are to accelerate the resolution of symptoms, reduce contagion time and prevent local suppurative and non-suppurative complications. The antibiotics of choice for treating streptococcic APT are penicillin and amoxicillin. The combination of amoxicillin and clavulanic acid is not indicated for the initial treatment of acute infection. Macrolides are not a first-choice treatment either; their use must be reserved for patients with allergy to penicillin. In our country it is important to adapt both the diagnosis of bacterial APT and the prescription of antibiotics to the scientific evidence available. The implementation of protocols of action in community pharmacies may be of use in identifying and screening cases that do not require antibiotic treatment (AU)
Subject(s)
Humans , Pharyngitis/drug therapy , Tonsillitis/drug therapy , Penicillins/therapeutic use , Streptococcal Infections/drug therapy , Acute Disease , Diagnosis, Differential , Anti-Bacterial Agents/therapeutic use , Colony Count, Microbial/methods , Virus Diseases/drug therapy , Streptococcus pyogenes/pathogenicityABSTRACT
No disponible
No disponible
