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The reference categories appear between parentheses. The odds ratios and their corresponding 95% confidence intervals are presented.</p>" ] ] ] "autores" => array:2 [ 0 => array:2 [ "autoresLista" => "M. Roman-Rodriguez, J. Molina-Paris, A. Fernandez Sanchez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Roman-Rodriguez" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Molina-Paris" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Fernandez Sanchez" ] 3 => array:1 [ "colaborador" => "grupo de investigación GAP-asma" ] ] ] 1 => array:2 [ "autoresLista" => "" "autores" => array:1 [ 0 => array:1 [ "colaborador" => "Study participants" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256520300278" "doi" => "10.1016/j.rce.2019.11.016" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256520300278?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887420300357?idApp=WRCEE" "url" => "/22548874/0000022100000004/v2_202104080754/S2254887420300357/v2_202104080754/en/main.assets" ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Asthma control and adherence to clinical practice guidelines: mission impossible?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "230" "paginaFinal" => "232" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "F.J. Alvarez-Gutiérrez" "autores" => array:1 [ 0 => array:3 [ "nombre" => "F.J." "apellidos" => "Alvarez-Gutiérrez" "email" => array:1 [ 0 => "Fjavieralvarez2008@gmail.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Asma, Unidad Médico-Quirúrgica de Enfermedades Respiratorias (UMQER), Hospital Universitario Virgen del Rocio, Sevilla, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Control del asma y seguimiento de las guías de práctica clínica: ¿misión imposible?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Most studies on the subject conducted in standard practice agree that the percentage of patients with well-controlled asthma is low. According to a number of studies, a lack of good control can affect almost 80% of patients.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> In addition to a poor quality of life, this lack of control entails a greater risk of exacerbations, increased asthma-related morbidity and mortality, and increased healthcare expenditures.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> To counter this situation, however, there is an increasing availability of more effective and easier-to-follow treatments. Therefore, it can be stated unequivocally that achieving good control in a significant number of patients (those with mild to moderate asthma and most of those with severe asthma) is in the hands of the practitioners who treat them. Another salient fact reported in a large portion of these studies is the low compliance with the clinical practice guidelines, a situation that occurs in most countries.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> This lack of compliance is directly associated with poorer asthma control, increased exacerbations and hospitalizations and greater overall asthma-related healthcare expenditures.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> It is also known that therapeutic noncompliance with these guidelines is greater in primary care than specialized care<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4,7</span></a> and can affect “frail” sectors of the population, such as elderly patients<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,5</span></a> and, paradoxically, patients with moderate to severe asthma.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a> With these patients with severe asthma, compliance with the guidelines should be more exhaustively recommended, due to the more harmful implications that not complying with the guidelines can have on the patients’ morbidity and mortality. The study by Roman-Rodriguez et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> highlights these circumstances And assesses the compliance with the recommendations of the Spanish asthma management guidelines (GEMA 2009 and GEMA 2015) by 314 primary care physicians who treated 2864 patients. The results indicate a low rate of compliance with the 2 guidelines (rates that were very similar for the two), and the rates did not exceed a quarter of the practitioners. There was, however, an increase in compliance compared with the 2003 guidelines. This study also confirmed that one of the factors related to achieving good asthma control was complying with the recommendations included in these guidelines. There was also a noteworthy discrepancy, which has been indicated in other studies,<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,11</span></a> between physician/patient-perceived control and the actual control, as well as a discrepancy between the practitioners’ perception of their understanding and compliance with the guidelines (high) and their actual compliance (low). A false perception of one’s understanding of and compliance with the guidelines is far worse than not knowing the recommendations. This “illusion” does not match the reality of clinical practice. If practitioners did possess a good understanding of these guidelines then the use of clinical control tests, the examinations required for diagnosing and following-up the disease and the education and treatment compliance strategies would be different. It is important not only to understand the guidelines but also to truly implement the recommendations and integrate them into standard practice.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Delving deeper into the question of what leads to this lack of compliance, perhaps there is a lack of training regarding the recommendations of the guidelines and perhaps there is a lack of time, training and means to perform examinations (such as forced spirometry) that are the basis for diagnosing and following-up patients with the disease. Another related factor is the lack of trained nursing staff to support the implementation of these tests and for conducting patient follow-up. Along with the physicians, these nurses can participate in implementing education and medication compliance programs, which are so important for achieving proper asthma control. Another factor could be the lack of interest in asthma, both by practitioners and healthcare administrations, which results in asthma not being included as a priority chronic disease in the control objectives of healthcare units. Primary care practitioners are under significant pressure to not only provide care but also provide care that is fast and of high-quality. There are factors such as the lack of provisions for human resources in primary care, the aging of practitioners (whose replacement is hindered by the lack of specialists in family and community medicine) and the precarious nature of employment, with its high rate of temporary contracts and low wages, which could be at the root of the lack of practitioners.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> In short, there is insufficient investment in primary care by most healthcare administrations of Spain’s autonomous communities. Spain also has on average fewer nursing professionals than neighboring countries, which complicates their effective involvement in asthma education and follow-up programs. In light of this problem, we need to call on the proven professionalism of healthcare agents and demand improvements from the government. Currently, there are numerous initiatives in Spain that have been launched by the scientific societies involved in improving the coordination among the various practitioners involved in treating asthma.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,15</span></a> These initiatives will hopefully enhance compliance with the asthma guidelines and thereby improve asthma control.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Many poorly controlled diseases urgently need new and effective therapies to be developed. It is regrettable that for a chronic disease such as asthma, for which good control can be achieved for most patients with the currently available therapies, the studies in standard practice still indicate negative results and that the morbidity and mortality of asthma in Spain are still increasing. Together, the government and healthcare practitioners can change these results by at least decidedly supporting the initiatives developed by professionals. As with the previous version (GEMA 4.4),<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> the new version of the GEMA guidelines (GEMA 5.0)<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> will include an ambitious dissemination, implementation and assessment program. It is hoped that all of these efforts underway will definitively improve the control of this disease.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Our professional ethics and especially our patients demand this of us, a mission that is definitely possible.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "?" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Alvarez-Gutiérrez FJ. Control del asma y seguimiento de las guías de práctica clínica: ¿misión imposible? 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