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Comparación de los enfoques de la guía de la Iniciativa Mundial para el Asma para el control del asma en adolescentes
Danish Abdul Aziz1, Werdah Viquar1
1Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi.
Resumen
Las directrices de la Iniciativa Global para el Asma (GINA) recomiendan la administración de corticosteroides inhalados en dosis bajas con formoterol (Pista 1) en lugar de estrategias alternativas (Pista 2) para el tratamiento del asma pediátrica. La vía 1 redujo significativamente las readmisiones, las visitas de emergencia y mejoró la función pulmonar en adolescentes.
Área de la Ciencia:
- Pulmonología pediátrica
- Medicina de las vías respiratorias
- Farmacología clínica
Sus antecedentes:
- El manejo del asma en adolescentes (12+ años) sigue dos vías de la Iniciativa Global para el Asma (GINA).
- Vía 1: corticosteroides inhalados en dosis bajas según sea necesario con formoterol.
- Vía 2: ICS según sea necesario con β-agonista de acción corta (etapa 1) y ICS de mantenimiento en dosis bajas (etapa 2).
Objetivo del estudio:
- Comparar la eficacia de la vía 1 de GINA frente a la vía 2 para el tratamiento del asma en pacientes pediátricos de 12 años o más.
- Evaluar los resultados clínicos y la función pulmonar siguiendo diferentes estrategias de tratamiento basadas en las directrices de la GINA.
Principales métodos:
- Estudio retrospectivo en el Hospital de la Universidad Aga Khan, Karachi, Pakistán (enero de 2022-diciembre de 2023).
- Se incluyeron 90 pacientes pediátricos con asma (mayores de 12 años) que habían sido dados de alta con terapia de alivio de GINA Pasos 1/ 2.
- Reingresos evaluados de 30 días, visitas a urgencias, ingresos anuales, cuidados intensivos y pruebas de función pulmonar (PFT) a la semana 1 y 3 meses.
Principales resultados:
- La vía 1 (n=43) mostró significativamente menos readmisiones (4,65% frente a 19,15%, p=0,036) y visitas a urgencias (1,69±1,31 frente a 2,8±1,37, p<0,001) en comparación con la vía 2 (n=47).
- La vía 1 requirió menos cuidados intensivos (9,3% frente a 27,66%, p=0,034) y menos hospitalizaciones (1,37±0,85 frente a 2,1±0,84, p<0,001).
- Mayor mejora en el FEV1 (p=0,026) y la relación FEV1/ FVC (p<0,001) observada en la vía 1 a los 3 meses después del alta.
Conclusiones:
- El ICS/formoterol según sea necesario (GINA Track 1) es más eficaz para el tratamiento del asma en adolescentes de 12 años o más.
- Esta estrategia conduce a mejores resultados clínicos y a una mejor función pulmonar en comparación con la vía 2.
- Apoya la adopción de GINA Track 1 como la opción de tratamiento preferida para este grupo de edad.
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