<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2448-9190</journal-id>
<journal-title><![CDATA[Revista alergia México]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. alerg. Méx.]]></abbrev-journal-title>
<issn>2448-9190</issn>
<publisher>
<publisher-name><![CDATA[Colegio Mexicano de Inmunología Clínica y Alergia A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2448-91902025000400359</article-id>
<article-id pub-id-type="doi">10.29262/ram.v72i4.1536</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Necesidades, limitantes y oportunidades para crear un centro de excelencia de atención en asma grave en el sistema de atención pública en México]]></article-title>
<article-title xml:lang="en"><![CDATA[Needs, limitations and opportunities to create a center of excellence for severe asthma care in the public healthcare system in Mexico]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Chávez-García]]></surname>
<given-names><![CDATA[Aurora Alejandra]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Lemus-Rangel]]></surname>
<given-names><![CDATA[Ricardo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Juárez-León]]></surname>
<given-names><![CDATA[José Ernesto]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Aguilar-Hinojosa]]></surname>
<given-names><![CDATA[Nadia Karina]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[González-Tuyub]]></surname>
<given-names><![CDATA[Yair Humberto]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Flores-González]]></surname>
<given-names><![CDATA[José Valentín]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital General de Zona 11, IMSS  ]]></institution>
<addr-line><![CDATA[Xalapa Veracruz ]]></addr-line>
<country>México</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Hospital General, Centro Médico Nacional &#8220;La raza&#8221;, IMSS Departamento de Neumología ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>México</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Centro Médico Nacional 20 de Noviembre, ISSSTE  ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>México</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Hospital General Regional 1 Lic. Ignacio García Téllez, IMSS  ]]></institution>
<addr-line><![CDATA[Mérida, Yucatán ]]></addr-line>
<country>México</country>
</aff>
<aff id="Af5">
<institution><![CDATA[,Clínica de Especialidades y Centro de Apoyo Diagnostico Leonardo y Nicolas Bravo, ISSSTE  ]]></institution>
<addr-line><![CDATA[Ciudad de Mèxico ]]></addr-line>
<country>Mèxico</country>
</aff>
<aff id="Af6">
<institution><![CDATA[,Hospital Regional ISSSTE Puebla  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>México</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2025</year>
</pub-date>
<volume>72</volume>
<numero>4</numero>
<fpage>359</fpage>
<lpage>366</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S2448-91902025000400359&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S2448-91902025000400359&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S2448-91902025000400359&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Antecedentes: El asma es una enfermedad respiratoria crónica común que afecta del 1 al 18% de la población en todo el mundo. En México el 8% de la población padece de asma. El asma grave representa, incluso, un 10% del total de casos. La propuesta de un Centro de Excelencia de Asma tiene como meta principal desarrollar procesos clave, establecer una metodología y ampliar la experiencia clínica con base en tecnologías actualizadas y enfoque en procesos críticos que permitan a las instituciones de salud pública hacer eficientes sus procesos de atención.  Objetivo: Consensuar las necesidades y oportunidades identificadas en el sector público para crear un centro de excelencia de atención en asma grave.  Metodología: Se utilizó la metodología RAND/UCLA para generar consensos, a través de evidencias científicas y la opinión de un panel Delphi modificado, online de forma asincrónica conformado por 14 expertos, de diferentes instituciones públicas, con experiencia en el tratamiento del asma grave. Principales recomendaciones: Se emiten consideraciones y recomendaciones para el desarrollo de un Centro de Excelencia de atención en asma grave y recomendaciones para facilitar y homologar el diagnóstico, atención, tratamiento y seguimiento del paciente con asma grave, enfatizando la importancia del tratamiento de las comorbilidades, las consideraciones internacionales y estrategias para evaluar el apego al tratamiento, así como los recursos indispensables para el desarrollo del Centro de Excelencia.  Conclusión: El desarrollo de Centros de Excelencia de Asma permitiría acelerar la innovación científica y clínica, educación y abogacía, promoviendo la excelencia en educación, investigación, y entrenamiento en el tratamiento del asma.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Background: Asthma is a common chronic respiratory condition that affects from 1 to 18% of the world population. In Mexico, 8% of the population lives with asthma. Severe asthma represents up to 10% of cases. The proposal of an Asthma Center of Excellence has the main goal to develop key procedures, establishing methods and developing clinical experience based in modern technology and focused on critical procedures that allow institutions to build more efficient management procedures.  Objective: To bring to consensus the needs and opportunities identified in the public sector to create a center of excellence for severe asthma management.  Methodology: We used the RAND/UCLA method for consensus, through scientific evidence and the opinions of an asynchronous online modified Delphi panel of 14 experts from different institutions with experience in severe asthma management. Main recommendations: The panel provided considerations and recommendations to facilitate and standardize the diagnosis, management, treatment, and follow-up of patients with severe asthma, with particular emphasis on management of comorbidities, international considerations and strategies to evaluate treatment adherence and key resources for the development of a Center of Excellence.  Conclusion: The development of a Center of Excellence would allow to accelerate scientific innovation, education and advocacy, promoting excellence in education, research and training in the management of asthma.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Asma]]></kwd>
<kwd lng="es"><![CDATA[Enfermedad respiratoria crónica]]></kwd>
<kwd lng="es"><![CDATA[Asma grave]]></kwd>
<kwd lng="es"><![CDATA[Centros de excelencia]]></kwd>
<kwd lng="es"><![CDATA[México]]></kwd>
<kwd lng="es"><![CDATA[Sector public]]></kwd>
<kwd lng="es"><![CDATA[Adherencia al tratamiento]]></kwd>
<kwd lng="en"><![CDATA[Asthma]]></kwd>
<kwd lng="en"><![CDATA[Chronic respiratory condition]]></kwd>
<kwd lng="en"><![CDATA[Severe asthma]]></kwd>
<kwd lng="en"><![CDATA[Centers of excellence]]></kwd>
<kwd lng="en"><![CDATA[Mexico]]></kwd>
<kwd lng="en"><![CDATA[Public sector]]></kwd>
<kwd lng="en"><![CDATA[Treatment adherence]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Elrod]]></surname>
<given-names><![CDATA[JK]]></given-names>
</name>
<name>
<surname><![CDATA[Fortenberry Jr]]></surname>
<given-names><![CDATA[JL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Centers of excellence in healthcare institutions: what they are and how to assemble them]]></article-title>
<source><![CDATA[BMC Health Serv Res]]></source>
<year>2017</year>
<volume>17</volume>
<numero>Suppl 1</numero>
<issue>Suppl 1</issue>
<page-range>425</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Maltby]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Gibson]]></surname>
<given-names><![CDATA[PG]]></given-names>
</name>
<name>
<surname><![CDATA[Reddel]]></surname>
<given-names><![CDATA[HK]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Severe Asthma Toolkit: an online resource for multidisciplinary health professionals-needs assessment, development process and user analytics with survey feedback]]></article-title>
<source><![CDATA[BMJ Open]]></source>
<year>2020</year>
<volume>10</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>e032877</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3.</label><nlm-citation citation-type="">
<source><![CDATA[Organización Mundial de la Salud]]></source>
<year>2022</year>
</nlm-citation>
</ref>
<ref id="B4">
<label>4.</label><nlm-citation citation-type="">
<source><![CDATA[Gaceta UNAM]]></source>
<year>2024</year>
</nlm-citation>
</ref>
<ref id="B5">
<label>5.</label><nlm-citation citation-type="">
<source><![CDATA[Global Initiative for Asthma]]></source>
<year>2022</year>
</nlm-citation>
</ref>
<ref id="B6">
<label>6.</label><nlm-citation citation-type="">
<collab>Global Strategy for Asthma Management and Prevention</collab>
<source><![CDATA[Global Initiative for Asthma]]></source>
<year>2022</year>
</nlm-citation>
</ref>
<ref id="B7">
<label>7.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Gereda]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Arruda-Chaves]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Larco]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Matos]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Asma grave: fisiopatología,diagnóstico y tratamiento]]></article-title>
<source><![CDATA[Rev Alergia Méx]]></source>
<year>2024</year>
<volume>71</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>114-27</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Del-Río-Navarro]]></surname>
<given-names><![CDATA[BE]]></given-names>
</name>
<name>
<surname><![CDATA[Berber]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Reyes-Noriega]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Global Asthma Network Phase I study in Mexico: prevalence of asthma symptoms, risk factors and altitude associations-a cross-sectional study]]></article-title>
<source><![CDATA[BMJ Open Respir Res]]></source>
<year>2020</year>
<volume>7</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>e000658</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Kaplan]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Szefler]]></surname>
<given-names><![CDATA[SJ]]></given-names>
</name>
<name>
<surname><![CDATA[Halpin]]></surname>
<given-names><![CDATA[DMG]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Impact of comorbid conditions on asthmatic adults and children]]></article-title>
<source><![CDATA[NPJ Prim Care Respir Med]]></source>
<year>2020</year>
<volume>30</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>36</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Martínez-Sahuquillo]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Ruiz De Vargas]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Métodos de consenso. Uso adecuado de la evidencia en la toma de decisiones. «Método RAND/UCLA»]]></article-title>
<source><![CDATA[Rehabilitación]]></source>
<year>2001</year>
<volume>35</volume>
<numero>6</numero>
<issue>6</issue>
<page-range>388-92</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Nasa]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Jain]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Juneja]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Delphi methodology in healthcare research: How to decide its appropriateness]]></article-title>
<source><![CDATA[World J Methodol]]></source>
<year>2021</year>
<volume>11</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>116-29</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Sugerman]]></surname>
<given-names><![CDATA[DT]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Centers of Excellence]]></article-title>
<source><![CDATA[JAMA]]></source>
<year>2013</year>
<volume>310</volume>
<numero>9</numero>
<issue>9</issue>
<page-range>994</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Li]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Burson]]></surname>
<given-names><![CDATA[RC]]></given-names>
</name>
<name>
<surname><![CDATA[Clapp]]></surname>
<given-names><![CDATA[JT]]></given-names>
</name>
<name>
<surname><![CDATA[Fleisher]]></surname>
<given-names><![CDATA[LA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Centers of excellence: Are there standards?]]></article-title>
<source><![CDATA[Healthc (Amst)]]></source>
<year>2020</year>
<volume>8</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>100388</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>1.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Elrod]]></surname>
<given-names><![CDATA[JK]]></given-names>
</name>
<name>
<surname><![CDATA[Fortenberry Jr]]></surname>
<given-names><![CDATA[JL]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Centers of excellence in healthcare institutions: what they are and how to assemble them]]></article-title>
<source><![CDATA[BMC Health Serv Res]]></source>
<year>2017</year>
<volume>17</volume>
<numero>Suppl 1</numero>
<issue>Suppl 1</issue>
<page-range>425</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>2.</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Maltby]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Gibson]]></surname>
<given-names><![CDATA[PG]]></given-names>
</name>
<name>
<surname><![CDATA[Reddel]]></surname>
<given-names><![CDATA[HK]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Severe Asthma Toolkit: an online resource for multidisciplinary health professionals-needs assessment, development process and user analytics with survey feedback]]></article-title>
<source><![CDATA[BMJ Open]]></source>
<year>2020</year>
<volume>10</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>e032877</page-range></nlm-citation>
</ref>
<ref id="B16">
<label>3.</label><nlm-citation citation-type="">
<source><![CDATA[Organización Mundial de la Salud]]></source>
<year>2022</year>
</nlm-citation>
</ref>
<ref id="B17">
<label>4.</label><nlm-citation citation-type="">
<source><![CDATA[Gaceta UNAM]]></source>
<year>2024</year>
</nlm-citation>
</ref>
</ref-list>
</back>
</article>
