Guía de Atención del Asma Bronquial

Objectives

Colombia’s asthma guidance frames asthma as a public-health and chronic-disease concern requiring early recognition, confirmation of reversible airway obstruction, risk-factor control, severity-based treatment and prompt management of exacerbations to reduce symptoms, complications, respiratory failure and deaths.[1][2][3][4]It applies to people diagnosed with bronchial asthma within the contributory and subsidised health-insurance regimes, and aims to preserve near-normal lung function, prevent exacerbations, improve adherence and support patient and family self-management.[2][3]

• Identify asthma through clinical history, objective demonstration of reversible airflow obstruction and exclusion of alternative diagnoses.[3][5]
• Classify asthma as intermittent, mild persistent, moderate persistent or severe persistent using symptom frequency, functional measures and medication needs.[6]
• Reduce exposure to allergens, tobacco smoke, occupational substances, irritants and relevant medicines or foods, while managing associated conditions such as rhinitis, sinusitis and gastro-oesophageal reflux.[3][7]
• Control airway inflammation through preventive, educational and pharmacological measures, prioritising inhaled treatment because of its direct action and lower adverse-effect burden.[6]
• Use controller treatment to prevent symptoms and reliever treatment for rapid relief during attacks, with inhaled corticosteroids identified as the preferred controller option across age groups and severity categories.[7][8]
• Improve education for people with asthma and their families on disease mechanisms, triggers, warning symptoms, inhaler use, peak-flow measurement, treatment adherence and self-management.[2][7][9]
• Address acute exacerbations according to severity by correcting airflow obstruction and gas-exchange abnormalities and preventing respiratory insufficiency, complications, adverse drug effects and death.[4]
• Use immunotherapy selectively to reduce allergic responsiveness where an unavoidable causative allergen is clearly linked to persistent or poorly controlled symptoms despite appropriate pharmacological treatment.[9]

Implementation

The guidance sets out a clinical continuum from primary assessment and functional diagnosis to long-term, stepwise treatment, education, specialist referral and escalation to hospital or intensive care where needed. General practitioners assess recurrent respiratory symptoms and their relationship to triggers, while spirometry is expected for suspected asthma and inconclusive cases are referred to a pulmonologist.[3][5]The Ministry of Health and its General Directorate of Promotion and Prevention are named institutional authorities, but the supplied text does not specify a wider governance structure, stakeholder responsibilities, budget or formal implementation plan.[10][11]

• Assess symptoms including cough, wheeze, breathlessness and chest tightness, and investigate trigger patterns, allergic manifestations and conditions that can resemble asthma.[3][5][12]
• Perform spirometry to establish obstruction and bronchodilator reversibility; repeat testing during symptoms where initial results are normal, assess peak expiratory flow variability if necessary, and refer unresolved cases to respiratory specialists.[5][13]
• Reserve bronchoprovocation, specialist lung-volume and diffusion testing, and allergen skin tests for specified clinical circumstances, including persistent diagnostic uncertainty, differential diagnosis and poorly controlled moderate or severe asthma.[13][12]
• Deliver long-term treatment stepwise according to severity, beginning at a level above the assessed category where indicated and reducing medicines gradually after sustained control.[14][15]
• Provide inhaled medicines through metered-dose or dry-powder inhalers, and teach correct inhaler and spacer technique alongside environmental management and differentiation between controller and reliever medicines.[7][15][9]
• Review clinical and functional response periodically, at intervals determined by medical judgement and no longer than six months; use spirometry or flow-volume assessment at baseline, after treatment begins, after normal or near-normal function is achieved, and every one or two years thereafter.[15][9]
• Manage exacerbations using severity criteria that include consciousness, dyspnoea, speech, accessory-muscle use, peak expiratory flow, forced expiratory volume in one second, vital signs and blood gases.[4]
• Provide oxygen, short-acting beta-2 agonists and corticosteroids as clinically indicated; add ipratropium, diagnostic investigations, aminophylline or admission for more serious crises, and reassess response after initial treatment.[16]
• Admit patients when there are life-threatening signs, inadequate response, very low post-treatment peak flow, recent or recurrent crises, prior intensive-care admission or relevant oral corticosteroid use.[16]
• Escalate to intensive care for intubation and ventilation needs, impaired consciousness, arrest, respiratory failure, deterioration despite treatment or muscular fatigue.[17]

Monitoring & Evaluation

Monitoring and evaluation are primarily clinical rather than programme-based. The material uses morbidity and hospital-discharge data to describe the burden of bronchitis, emphysema and asthma, and sets out repeated assessment of symptoms, lung function, treatment response and acute-crisis severity. A comprehensive national monitoring framework, routine reporting schedule, audit system, surveillance plan, performance targets or formal accountability mechanism is not specified.[1][2][3][5][13][6][7][15][9][4][16][17]

• Use 1997 outpatient consultation morbidity rates and hospital-discharge case counts as reported burden measures, drawing on the Ministry of Health Epidemiology Office and the SIS 103 information system. The overall reported morbidity rate for bronchitis, emphysema and asthma was 62.8 per 100,000 population, while 17,836 hospital discharges represented 1.4% of the total shown.[1][2]
• Confirm and follow asthma using spirometry, including forced vital capacity, forced expiratory volume in one second and their ratio. Identify obstruction where the forced expiratory volume in one second to forced vital capacity ratio is below the normal reference value.[5]
• Assess reversibility after a short-acting bronchodilator through an increase in forced expiratory volume in one second of at least 12% and 200 millilitres from baseline.[5]
• Repeat spirometry during symptoms when initially normal results are obtained during symptom-free periods in mild intermittent or mild persistent asthma. Measure peak expiratory flow variability if results remain non-diagnostic, and refer to a pulmonologist where findings remain inconclusive.[5]
• Use peak expiratory flow principally for follow-up. Daily variation above 20% between morning and evening readings over 15 days may support diagnosis, but the material does not establish this as a population-level indicator or reporting requirement.[13]
• Classify asthma severity using symptom frequency and type, medication need, and objective lung-function measures, including forced expiratory volume in one second and peak expiratory flow. Moderate persistent asthma is associated with values above 60% and below 80%, while severe persistent asthma is associated with values below 60%; intermittent and mild persistent asthma are associated with normal lung function.[6]
• Support patient self-management through education on peak-flow measurement, symptoms, inhaler and spacer use, controller and reliever medicines, and management of warning signs.[7][9]
• Review disease control periodically according to medical judgement and clinical and functional response, with reviews at intervals of no more than six months.[15]
• Assess pulmonary function by spirometry or a flow-volume curve at initial evaluation, after treatment begins, when normal or near-normal function is achieved, and every one or two years thereafter to document continued normal function.[9]
• Evaluate immunotherapy through periodic follow-up to establish whether treatment objectives are being achieved.[9]
• Reassess peak expiratory flow 30 minutes after initial treatment for mild and moderate exacerbations. Assess severe crises using peak flow where feasible or the clinical picture, and consider discharge from moderate crises after 60 minutes of observation when clinical and functional improvement is evident.[16]
• Use clinical severity and escalation criteria, including consciousness, dyspnoea, blood gases, speech, wheeze, accessory-muscle use, peak expiratory flow and forced expiratory volume in one second, to guide acute management, hospitalisation and intensive-care decisions.[4][16][17]

Costing & Financing

No quantified costs, budgets, financing sources, allocations, resource-mobilisation arrangements, funding gaps or economic assumptions are specified across the supplied material.[10][1][2][3][5][13][12][6][7][8][18][14][15][11][4][16][17][19][20][21][22][23]

• Recognise asthma education as cost-effective and as capable of reducing morbidity and mortality among adults and children, although no cost-effectiveness ratio, comparator, expenditure estimate, funding source or economic methodology is provided.[9]
• Note that the clinical guidance implies requirements for spirometry, peak-flow measurement, specialist respiratory assessment, emergency treatment, hospital admission and intensive care in specified circumstances, but it does not cost these services or assign financial responsibility for them.[5][13][16][17]
• Note that the guideline applies to people affiliated with Colombia’s contributory and subsidised health-insurance regimes, but it does not specify benefit coverage, reimbursement mechanisms, insurance allocations or differences in financing between those regimes.[3]
• Note that the Ministry of Health and its General Directorate of Promotion and Prevention are identified institutional authorities, but no budgetary role, resource allocation, financing mechanism or funding commitment is described.[10][11]