Publication: Estudio de fenotipos clínicos asociados a asma refractaria
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2017-08-24
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Universidad Complutense de Madrid
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Abstract
El asma persistente grave es aquella asma que necesita dosis altas de corticoides inhalados (CI), con o sin corticoides orales (CO), para conseguir y mantener su control (tanto de la clínica actual como del riesgo futuro de presentar exacerbaciones, inestabilidad, o disminución de la función pulmonar o efectos adversos del tratamiento). Lleva asociada otros tratamientos farmacológicos aconsejados por las guías, como el uso de adrenérgicos beta 2 de larga duración. Por otra parte, hablamos de asma de control difícil como aquella en la que no se han controlado las comorbilidades asociadas y/o los desencadenantes, o bien no se han excluido otras entidades que puedan cursar con asma, lo que dificulta su control diario y la prevención de las exacerbaciones. En más de un tercio de evaluaciones sistemáticas realizadas se manifestaron diagnósticos erróneos de procesos que simulan o agravan el asma .Por tanto, en personas con asma de control difícil, es primordial la identificación de estos factores que pueden causar síntomas similares, antes de aumentar el tratamiento. Se ha asociado con mayor frecuencia al sexo femenino, rinosinusitis, reflujo gastroesofágico, alérgenos ambientales, exposición ocupacional, intolerancia a aspirina, enfermedades sistémicas como por ejemplo la enfermedad tiroidea o la vasculitis y el tabaquismo entre muchos otros...
Severe persistent asthma is asthma that requires high doses of inhaled corticosteroids (IC), with or without oral corticosteroids (OC) to achieve and maintain control (both of current symptoms and future risk of exacerbations, instability, or decline in lung function, or adverse effects of treatment). It is associated with other drug treatments recommended by the guidelines, including the long-term use of beta-2 adrenergics. Moreover, we describe difficult-to-treat asthma as one in which associated comorbidities and/or triggers have not been controlled, or other entities that can present with asthma have not been excluded, making daily control and prevention of exacerbations difficult. In more than a third of systematic assessments there was demonstrably misdiagnosis of processes that mimic or exacerbate asthma. Therefore, before increasing treatment in people with poorly controlled asthma, it is essential to identify the factors that can cause similar symptoms. Most commonly associated with females are sinusitis, gastroesophageal reflux, environmental allergens, occupational exposure, aspirin intolerance, systemic diseases such as thyroid disease or vasculitis and smoking, among others. Until today, FEV1, although with certain limitations, is the only parameter whose measurement can be used to study the development of severe asthma objectively. Gelb et al. concluded that the persistent reduction of FEV1 (< 79% predicted) or FEV1/FVC < 75% and loss of elastic recoil with hyperinflation at total lung capacity (TLC) constituted a risk factor for near-fatal asthma...
Severe persistent asthma is asthma that requires high doses of inhaled corticosteroids (IC), with or without oral corticosteroids (OC) to achieve and maintain control (both of current symptoms and future risk of exacerbations, instability, or decline in lung function, or adverse effects of treatment). It is associated with other drug treatments recommended by the guidelines, including the long-term use of beta-2 adrenergics. Moreover, we describe difficult-to-treat asthma as one in which associated comorbidities and/or triggers have not been controlled, or other entities that can present with asthma have not been excluded, making daily control and prevention of exacerbations difficult. In more than a third of systematic assessments there was demonstrably misdiagnosis of processes that mimic or exacerbate asthma. Therefore, before increasing treatment in people with poorly controlled asthma, it is essential to identify the factors that can cause similar symptoms. Most commonly associated with females are sinusitis, gastroesophageal reflux, environmental allergens, occupational exposure, aspirin intolerance, systemic diseases such as thyroid disease or vasculitis and smoking, among others. Until today, FEV1, although with certain limitations, is the only parameter whose measurement can be used to study the development of severe asthma objectively. Gelb et al. concluded that the persistent reduction of FEV1 (< 79% predicted) or FEV1/FVC < 75% and loss of elastic recoil with hyperinflation at total lung capacity (TLC) constituted a risk factor for near-fatal asthma...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 27-01-2016