Procedimiento para la Detección y Diagnóstico de las Enfermedades Respiratorias Crónicas

Objectives

The procedure operationalises the Integrated Care Pathway for Chronic Respiratory Disease alongside clinical practice guidelines. Its central purpose is to enable timely, appropriate identification and diagnosis of people at risk of chronic respiratory disease or presenting compatible symptoms, after infectious causes have been excluded.[1]It covers clinical assessment, screening instruments, spirometry before and after bronchodilator use, methacholine bronchial provocation, and respiratory-specialist assessment.[1]

• Identify chronic respiratory disease among people with persistent compatible symptoms, with particular attention to asthma and chronic obstructive pulmonary disease.[1][2]
• Assess symptom patterns and relevant clinical risks, including personal and family history, tobacco use, second-hand smoke, biomass-smoke exposure, occupational exposure, obesity, oxygen use, dyspnoea, and previous tuberculosis where clinically relevant.[2]
• Confirm or exclude asthma and chronic obstructive pulmonary disease through a structured diagnostic process, using clinical probability, screening tools, lung-function testing and specialist review where required.[2][3]
• Provide people undergoing assessment, and their families or carers, with information on tobacco and second-hand smoke, continuing biomass exposure, environmental pollution, and respiratory health promotion.[4]
• Link people with confirmed chronic respiratory disease to the relevant care pathway while maintaining health-promotion and maintenance care.[4]
• Maintain people whose diagnosis is excluded within the health-promotion and maintenance pathway, emphasising healthy living, living conditions and lifestyles.[4]

The supplied material presents an operational diagnostic and care-routing framework rather than a broader strategic plan. It does not specify additional formal strategic goals, measurable objectives, priority populations beyond those with suspected disease, or targets for respiratory-health outcomes.[4]

Implementation

Delivery begins when a trained doctor or nurse applies screening instruments and diagnostic assessment, although a healthcare technician or another health professional may initially recognise clinical suspicion.[1]The approach is intended to use the competencies set out in the Integrated Health Care Pathway and applicable regulations, with diagnostic status determining subsequent referral, treatment-pathway linkage or continuing health-promotion care.[1][4]

• Assess suspected chronic obstructive pulmonary disease during a medical consultation using the Brief Questionnaire for Chronic Obstructive Pulmonary Disease.[2]
• Establish the clinical probability of asthma and confirm it through spirometry where appropriate, or use pharmacological treatment as a therapeutic trial according to the person's age and estimated probability of asthma.[2]
• Apply the Asthma Predictive Index for infants and preschool children who have a family history and wheezing episodes.[2]
• Perform spirometry before and after bronchodilator administration for all adults with clinical suspicion of asthma or chronic obstructive pulmonary disease, and for people under 18 years with intermediate probability of asthma.[2][3]
• Use methacholine bronchial provocation to confirm asthma when clinical suspicion remains despite inconclusive spirometry; where methacholine is unavailable, use other substances where appropriate.[3]
• Consider exercise testing individually using medical judgement, recognising its limited diagnostic performance.[3]
• Refer people with unresolved diagnostic uncertainty to an adult or paediatric respiratory specialist, who decides whether clinically relevant additional investigations, such as allergy tests, chest radiography or eosinophil measurement, are needed on the basis of available evidence.[3]
• Record relevant workplace exposures when occupational asthma is suspected and refer the presumptive diagnosis to the occupational medicine department of the Health Benefit Plan Administration Entity or the Occupational Risk Administrator.[3]
• Continue clinical asthma care through the asthma pathway while the relevant administrative entities manage occupational processes if occupational asthma is confirmed.[3]
• Provide information to all people receiving care for suspected chronic respiratory disease and to their families or carers, then direct confirmed and excluded cases to their respective care routes.[4]

The procedure identifies primary clinical staff, respiratory specialists and occupational-health entities as participants in delivery, but does not set out wider governance structures, named lead institutions, implementation timelines, workforce numbers, procurement plans or intersectoral coordination arrangements.[1][3][4]Methacholine access is described as constrained by lack of registration with the National Food and Drug Surveillance Institute and by procurement barriers, without specifying how these barriers are to be resolved.[3]

The supplied text does not specify implementation budgets, financing sources, resource allocations, indicators, reporting cycles, audit processes, accountability mechanisms or performance targets.[1][2][3][4]

Monitoring & Evaluation

The procedure sets out diagnostic and referral activities for suspected chronic respiratory disease, but does not establish a formal monitoring, evaluation, reporting, surveillance, audit, or accountability framework.[1][2][3][4]

• Use clinical assessment, screening instruments, spirometry, bronchial provocation where needed, and respiratory-specialist assessment to support timely detection and diagnosis.[1][2][3]
• Apply diagnostic routes according to clinical probability and test results, including specialist referral where diagnostic uncertainty remains.[2][3]
• Document workplace exposure for suspected occupational asthma and refer presumptive cases through the relevant occupational medicine or occupational-risk arrangements.[3]
• Route people with confirmed chronic respiratory disease to the relevant care pathway, while directing people whose diagnosis is excluded towards health-promotion and maintenance care.[4]
• Provide information to people receiving assessment and their families or carers on tobacco and second-hand smoke, biomass exposure, environmental pollution, and respiratory health promotion.[4]

No indicators, baselines, targets, data sources, reporting frequency, responsible reporting bodies, quality-assurance processes, outcome measures, or sanctions for non-performance are specified.[1][2][3][4]

Costing & Financing

No costs, budget allocations, financing sources, resource-mobilisation arrangements, funding gaps, or economic assumptions are specified in the supplied material.[1][2][3][4]

• Require trained doctors or nurses to initiate assessment using screening instruments, while allowing healthcare technicians or other health professionals to identify initial clinical suspicion.[1]
• Use spirometry for adults with suspected asthma or chronic obstructive pulmonary disease and for people under 18 years with intermediate asthma probability, without specifying equipment costs, service capacity, or reimbursement arrangements.[2][3]
• Use methacholine bronchial provocation when asthma suspicion persists after inconclusive spirometry; the material notes access barriers because methacholine lacked registration with the National Food and Drug Surveillance Institute and faced procurement barriers, but gives no monetary estimate.[3]
• Refer unresolved cases to adult or paediatric respiratory specialists and consider further clinically relevant testing, but no funding mechanism or cost estimate is provided.[3]

The material therefore identifies diagnostic-resource requirements and an access constraint affecting methacholine, but does not quantify required investment, recurrent expenditure, affordability, or financing needs.[1][2][3]