Guía de práctica clínica sobre el diagnóstico, manejo y seguimiento de la enfermedad pulmonar obstructiva crónica en Colombia 2023

Clinical practice guideline on the diagnosis, management, and follow-up of chronic obstructive pulmonary disease in Colombia 2023

Publicado 2024-06-07

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Vol. 35 Núm. 2 Supl-1 (2023): Suplemento
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Guía de práctica clínica sobre el diagnóstico, manejo y seguimiento de la enfermedad pulmonar obstructiva crónica en Colombia 2023.
rev. colomb. neumol. [Internet]. 2024 Jun. 7 [cited 2024 Dec. 22];35(2 Supl-1). Disponible en: https://doi.org/10.30789/rcneumologia.v35.n2Supl-1.2023.984
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Olga Milena García Morales
Fundación Santa Fe de Bogotá image/svg+xml
    https://orcid.org/0000-0002-9921-883X
    Abraham Ali Munive
    Fundación Neumológica Colombiana image/svg+xml
      Carlos Andrés Celis-Preciado
      Hospital Universitario San Ignacio image/svg+xml
        https://orcid.org/0000-0001-8405-4513
        Darío Londoño Trujillo
        Fundación Santa Fe de Bogotá image/svg+xml
          Alejandro Casas
          Fundación Neumológica Colombiana image/svg+xml
            https://orcid.org/0000-0003-4700-9822
            Mostrar biografía de los autores

            Olga Milena García Morales,

            1. Sección de Neumología, Departamento de Medicina Interna, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá D.C., Colombia

            2. Facultad de Medicina, Universidad de los Andes, Bogotá D.C, Colombia

            Abraham Ali Munive,

            1. Fundación Neumológica Colombiana. Bogotá, Colombia
            2. Programas AIREPOC RespIRA y Rehabilitación Pulmonar, Fundación Neumológica Colombiana, Bogotá, Colombia

            Carlos Andrés Celis-Preciado,

            1. Unidad de Neumología, Departamento de Medicina Interna, Hospital Universitario San Ignacio, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá D.C, Colombia.

            Darío Londoño Trujillo,

            1. Sección de Neumología, Departamento de Medicina Interna, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá D.C., Colombia
            2. Salud Poblacional, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá D.C., Colombia

            Alejandro Casas,

            1. Fundación Neumológica Colombiana. Bogotá, Colombia
            2. Programas AIREPOC RespIRA y Rehabilitación Pulmonar, Fundación Neumológica Colombiana, Bogotá, Colombia

            Alirio Bastidas Goyes,

            1. Facultad de Medicina, Universidad de la Sabana

            Carlos Aguirre Franco,

            1. Fundación Neumológica Colombiana. Bogotá, Colombia
            2. Programas AIREPOC RespIRA y Rehabilitación Pulmonar, Fundación Neumológica Colombiana, Bogotá, Colombia

            Carlos Arturo Torres,

            1. Fundación Neumológica Colombiana. Bogotá, Colombia
            2. Programas AIREPOC RespIRA y Rehabilitación Pulmonar, Fundación Neumológica Colombiana, Bogotá, Colombia

            Iván De Jesús Baños Álvarez,

            1. Sección de Neumología, Departamento de Medicina Interna, Hospital Serena del Mar

            John Carlos Pedrozo Pupo,

            1. Facultad de Medicina, Universidad del Magdalena

            Luisa Manrique Acevedo,

            1. Unidad Neumología, Centro Médico Especializado en Medicina del Ejercicio (CEMDE), Medellín, Colombia

            Manuel Conrado Pacheco Gallego,

            1. Universidad Tecnológica de Pereira, Colombia
            2. Institución universitaria Visión de las Américas, Pereira, Colombia

            Rafael Acero,

            1. Sección de Neumología, Departamento de Medicina Interna, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá D.C., Colombia
            2. Facultad de Medicina, Universidad de los Andes, Bogotá D.C, Colombia

            Rubén Contreras Páez,

            Unidad de Neumología, Clínica los Nogales

            José Vicente Bohórquez,

            1. Fundación universitaria Juan N. Corpas. Asociación colombiana de Medicina Familiar

            Walter Chaves,

            1. Sociedad de Cirugía de Bogotá- Hospital de San José- Fundación Universitaria de Ciencias de la Salud- Asociación Colombiana de Medicina Interna ACMI

            Fernando Rivera,

            1. Clinica Los Rosales S.A, Pereira, Colombia;  IPS Virrey Solis, Sede Pereira, Colombia; Asociación Colombiana de Medicina Interna (ACMI).

            Jhonatan Betancourt Peña,

            1. Clínica Los Rosales S.A, Pereira, Colombia;  IPS Virrey Solis, Sede Pereira, Colombia; Asociación Colombiana de Medicina Interna (ACMI).

            Juan José Yepes-Núñez,

            1. Facultad de Medicina, Universidad de los Andes, Bogotá D.C, Colombia
            2. Instituto Universitario de Educación Física, Universidad de Antioquia. Medellín, Colombia.

            Andrés Felipe Loaiza-Betancur,

            1. Escuela de Rehabilitación Humana Facultad de Salud Universidad del Valle
            2. Instituto Universitario de Educación Física, Universidad de Antioquia. Medellín, Colombia.

            Andrés Mauricio García Sierra,

            1. Facultad de Medicina, Universidad de los Andes, Bogotá D.C, Colombia

            Carolina Ocampo Salgado,

            1. Facultad de Medicina, Universidad de los Andes, Bogotá D.C, Colombia

            José F. Meneses-Echavez ,

            1. Instituto Universitario de Educación Física, Universidad de Antioquia. Medellín, Colombia.
            2. Grupo de Investigación en Entrenamiento Deportivo y Actividad Física para la Salud (GIEDAF), Universidad Santo Tomás. Tunja, Colombia

            Hernando José González Coba,

            1. Unidad de Neumología, Departamento de Medicina Interna, Hospital Universitario San Ignacio, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá D.C, Colombia.

            Jenny Leandra Londoño,

            1. Grupo de Investigación en Entrenamiento Deportivo y Actividad Física para la Salud (GIEDAF), Universidad Santo Tomás. Tunja, Colombia

            María Angelica Moreno,

            1. Grupo de Investigación en Entrenamiento Deportivo y Actividad Física para la Salud (GIEDAF), Universidad Santo Tomás. Tunja, Colombia

            Diego Pérez Marmolejo,

            1. Unidad de Neumología, Departamento de Medicina Interna, Hospital Universitario San Ignacio, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá D.C, Colombia.

            María Carolina Torres,

            1. Grupo de Investigación en Entrenamiento Deportivo y Actividad Física para la Salud (GIEDAF), Universidad Santo Tomás. Tunja, Colombia

            Luis Eduardo Ramírez,

            1. Grupo de Investigación en Entrenamiento Deportivo y Actividad Física para la Salud (GIEDAF), Universidad Santo Tomás. Tunja, Colombia

            Natalia Remolina Murillo,

            1. Unidad de Neumología, Departamento de Medicina Interna, Hospital Universitario San Ignacio, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá D.C, Colombia.

            Introducción: La enfermedad pulmonar obstructiva crónica (EPOC) constituye un importante desafío tanto en el ámbito económico como en el de la salud pública, tanto a nivel mundial como en el contexto colombiano. Esta condición no solo repercute en los pacientes que la padecen, sino que también afecta a sus cuidadores y al sistema de salud en su conjunto. Se ha observado un incremento en el ausentismo laboral tanto por parte de los pacientes como de sus familiares, lo que resulta en pérdidas económicas y oportunidades laborales, agravando aún más el impacto adverso en el individuo y su entorno familiar. El propósito de esta guía clínica es establecer pautas basadas en la evidencia científica disponible para mejorar la atención médica y la gestión de recursos en el tratamiento de la EPOC en la población colombiana.

            Objetivo: Esta guía de práctica clínica (GPC) informada en evidencia de la Asociación Colombiana de Neumología y Cirugía de Tórax (Asoneumocito), Asociación Colombiana de Medicina Interna (ACMI) y Asociación colombiana de medicina familiar (SOCMEF) y Asociación Colombiana de Fisioterapia (ASCOFI), pretende apoyar a los pacientes, profesionales de la salud, y otros actores en la toma de decisiones sobre el diagnostico, enfoque, pronóstico y manejo de adultos con la EPOC en el contexto colombiano.

            Materiales y métodos: El Comité de la EPOC de Asoneumocito por delegación de la presidencia de esta, conformó un panel de expertos multidisciplinario para balancear y minimizar el potencial sesgo proveniente de los conflictos de intereses e invitó a las demás asociaciones que hicieron parte de esta guía. La Universidad de los Andes coordinó y desarrolló la actualización o realización de novo de revisiones sistemáticas de la literatura acorde a la metodología GRADE (Grading of Recommendations Assessment, Development and Evaluation). El comité de EPOC planteó una serie de preguntas que el panel de expertos priorizó, así como los desenlaces según su importancia para los profesionales de la salud y los pacientes. Se utilizaron los marcos de la Evidencia a la Decisión (EtD) desarrollados por el grupo de trabajo GRADE, los cuales estuvieron sujetos a comentarios públicos.

            Resultados: El panel elaboró 10 recomendaciones basadas en evidencia para el manejo de pacientes con la EPOC que recibieron alguna de las siguientes intervenciones: oxigenoterapia a largo plazo, vacunación contra virus de influenza, rehabilitación pulmonar, inhaloterapia con anticolinérgicos de acción prolongada, inhaloterapia con terapia triple, suplementos nutricionales, terapia complementaria con azitromicina, cesación tabáquica con vareniclina y reemplazo de alfa-1 antitripsina.

            Conclusiones: Las recomendaciones incluidas en esta guía se desarrollaron para el contexto colombiano. El panel consideró que hacen falta por desarrollar estudios de evaluaciones económicas, así como el impacto de las intervenciones evaluadas en áreas como la equidad, aceptabilidad y factibilidad de implementación en Colombia.

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