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Tratamiento del asma grave: necesidad de caracterizar a los pacientes
Liam G Heaney1, Douglas S Robinson
1Regional Respiratory Centre, Belfast City Hospital, Belfast, UK. l.heaney@qub.ac.uk
Lancet (London, England)
|March 16, 2005
Resumen
Muchos adultos con asma siguen siendo sintomáticos a pesar del tratamiento. Evaluar a los pacientes por las causas subyacentes es crucial antes de iniciar nuevas terapias como anti-IgE para el asma difícil de controlar.
Área de la Ciencia:
- Medicina Pulmonar La medicina pulmonar es el tratamiento de las enfermedades pulmonares.
- Alergia e Inmunología.
Sus antecedentes:
- El diagnóstico de asma suele ser sencillo y responde a los tratamientos estándar.
- Sin embargo, hasta el 40% de los adultos con asma experimentan síntomas persistentes, y el 5% tiene asma difícil de controlar.
- Nuevas terapias como la terapia anti-inmunoglobulina E (anti-IgE) están surgiendo para el asma alérgica grave.
Objetivo del estudio:
- Revisar el manejo del asma difícil de controlar.
- Para enfatizar la importancia de un diagnóstico preciso y la evaluación del paciente antes de nuevos tratamientos.
- Para explorar subgrupos potenciales dentro del asma difícil de controlar.
Principales métodos:
- Revisión de la literatura existente sobre el manejo del asma y la terapia anti-IgE.
- Discusión de las definiciones actuales y los enfoques de tratamiento para el asma grave.
- El énfasis en la evaluación sistemática del paciente.
Principales resultados:
- El omalizumab (terapia anti-IgE) ha demostrado ser prometedor para reducir las exacerbaciones y mejorar los síntomas en el asma alérgica grave.
- Los pacientes que reciben terapia anti-IgE han demostrado una menor necesidad de corticosteroides inhalados.
- Los estudios controlados con placebo indican la posibilidad de abstinencia de esteroides en algunos pacientes.
Conclusiones:
- La definición de asma grave (síntomas a pesar de las altas dosis de esteroides inhalados) puede abarcar diversos grupos de pacientes.
- La evaluación sistemática es esencial para identificar las causas no relacionadas con el asma de los síntomas persistentes y evitar tratamientos innecesarios.
- Los subgrupos de pacientes pueden tener procesos inflamatorios distintos, lo que influye en la respuesta al tratamiento.
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