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Manejo farmacológico del asma persistente leve o moderada
Paul M O'Byrne1, Krishnan Parameswaran
1Firestone Institute for Respiratory Health, St Joseph's Healthcare and Department of Medicine, McMaster University, Hamilton, Ontario, Canada. obyrnep@mcmaster.ca
Lancet (London, England)
|August 29, 2006
Resumen
El tratamiento regular con corticosteroides inhalados maneja eficazmente el asma persistente leve, evitando a menudo la necesidad de medicamentos adicionales. Para casos moderados, la combinación de corticosteroides inhalados con agonistas beta2 de acción prolongada mejora significativamente el control del asma y reduce las exacerbaciones.
Área de la Ciencia:
- Pulmonología Pulmonología.
- Alergia e Inmunología.
- Farmacología Farmacología.
Sus antecedentes:
- El asma persistente leve con frecuencia no recibe el tratamiento adecuado debido al contacto poco frecuente entre el paciente y el médico.
- Las directrices actuales de tratamiento sugieren corticosteroides inhalados como terapia primaria para el asma persistente leve.
Objetivo del estudio:
- Revisar la evidencia que apoya la terapia con corticosteroides inhalados para el asma persistente leve.
- Evaluar las estrategias de tratamiento para el asma moderada persistente, incluyendo terapias combinadas.
- Explorar guías avanzadas de tratamiento para casos de asma refractaria.
Principales métodos:
- Revisión de los hallazgos de grandes ensayos clínicos aleatorizados.
- Análisis comparativo de los corticosteroides inhalados, los modificadores de leucotrienos y las terapias combinadas.
- Discusión de budesonida y formoterol como tratamiento de mantenimiento y alivio.
- Consideración de la medición de la inflamación de las vías respiratorias en el esputo inducido para la orientación del tratamiento.
Principales resultados:
- Los corticosteroides inhalados en dosis bajas son beneficiosos para el asma persistente leve, y rara vez se necesitan medicamentos adicionales.
- Los modificadores de leucotrieno son menos efectivos que los corticosteroides inhalados.
- La terapia combinada de corticosteroides inhalados y agonistas beta2 de acción prolongada mejora el control en el asma moderada persistente en comparación con el aumento de las dosis de corticosteroides.
- La budesonida y el formoterol como tratamiento de mantenimiento y alivio reducen aún más las exacerbaciones graves.
Conclusiones:
- La mayoría de los pacientes con asma pueden lograr un buen control con las estrategias actuales basadas en la evidencia.
- La medición de la inflamación de las vías respiratorias en el esputo inducido puede guiar el tratamiento para los pacientes que no responden a las terapias estándar.
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