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Síntomas, riesgo de exacerbaciones futuras y respuesta al tratamiento a largo plazo con macrolides en
Oriol Sibila1, Jamie Stobo2, Lidia Perea1
1Department of Respiratory, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBERES, Barcelona, Spain.
The Lancet. Respiratory medicine
|August 30, 2025
Resumen
Los síntomas diarios en las bronquiectasias son un factor de riesgo independiente para futuras exacerbaciones. Los pacientes altamente sintomáticos se benefician del tratamiento con macrolides de manera similar a los pacientes con exacerbaciones frecuentes.
Área de la Ciencia:
- Pulmonología
- Medicina de las vías respiratorias
- Investigación clínica
Sus antecedentes:
- Los síntomas diarios en la bronquiectasia se reconocen como indicadores de la actividad de la enfermedad y el riesgo potencial de exacerbación.
- Las directrices actuales recomiendan el tratamiento con macrolides a largo plazo para los pacientes que experimentan tres o más exacerbaciones al año.
- Este estudio investiga si la carga sintomática predice de forma independiente las exacerbaciones e identifica candidatos adicionales para el tratamiento con macrolides.
Objetivo del estudio:
- Determinar si los síntomas diarios en las bronquiectasias predicen de forma independiente las exacerbaciones futuras.
- Identificar si los pacientes altamente sintomáticos, independientemente de la frecuencia de la exacerbación, se benefician del tratamiento con macrolides a largo plazo.
- Informar las directrices de tratamiento con respecto al papel de la carga sintomática en el manejo de la bronquiectasia.
Principales métodos:
- Se utilizaron datos del registro EMBARC, una base de datos internacional de bronquiectasias multicéntrica.
- Se evaluaron los síntomas iniciales utilizando la puntuación de síntomas respiratorios del cuestionario de bronquiectasia de calidad de vida (QoL-B-RSS) y se rastrearon las exacerbaciones durante al menos un año.
- Se realizó un análisis post-hoc de tres ensayos controlados aleatorizados (BLESS, BAT, EMBRACE) para evaluar la asociación de los síntomas con la respuesta al tratamiento con macrolides.
Principales resultados:
- Tanto las exacerbaciones anteriores (RR 1.11) como las puntuaciones de síntomas (RR 1.10 por cada disminución de 10 puntos en QoL-B-RSS) fueron predictores independientes de exacerbaciones futuras.
- Los pacientes con puntuaciones altas de síntomas pero menos de tres exacerbaciones previas mostraron una tasa de exacerbaciones similar (RR 1,55) a la de aquellos con exacerbaciones frecuentes y síntomas promedio (RR 1,58).
- El número necesario para tratar con macrolides para prevenir las exacerbaciones fue comparable para los pacientes identificados por exacerbaciones frecuentes frente a los identificados por una alta carga de síntomas.
Conclusiones:
- Los síntomas diarios son un factor de riesgo independiente para futuras exacerbaciones en la bronquiectasia.
- Los pacientes con alta carga sintomática experimentan beneficios similares de la terapia con macrolides a largo plazo que aquellos con una alta frecuencia de exacerbación al inicio.
- La evaluación de los síntomas debe considerarse junto con el historial de exacerbaciones para optimizar la selección del tratamiento con macrolides en la bronquiectasia.
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