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Anomalías de las vías respiratorias pequeñas en pacientes asmáticos con limitación persistente del flujo aéreo
Marco Contoli1,2, Federico Baraldi1, Luca Morandi2
1Respiratory Section, Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
Resumen
La disfunción de las vías respiratorias pequeñas es común en pacientes con asma y limitación persistente del flujo aéreo, lo que contribuye significativamente a sus síntomas. Esta afección es intermedia entre la EPOC y el asma reversible, lo que sugiere que los tratamientos dirigidos pueden ayudar.
Área de la Ciencia:
- Medicina Pulmonar; Investigación Respiratoria
Sus antecedentes:
- La limitación persistente del flujo aéreo (LPF) afecta a algunos pacientes con asma a pesar del tratamiento óptimo.; El papel de la disfunción de las vías respiratorias pequeñas (DVP) en la LPF y su vínculo con los síntomas no se comprende completamente.
Objetivo del estudio:
- Evaluar la función de las vías respiratorias pequeñas en pacientes con asma y LPF.; Comparar la función de las vías respiratorias pequeñas en pacientes con LPF con aquellos con asma completamente reversible y EPOC.; Explorar las correlaciones entre los índices de las vías respiratorias pequeñas y los resultados informados por los pacientes.
Principales métodos:
- Se inscribieron 60 pacientes: 20 con asma y LPF, 20 con asma completamente reversible y 20 con EPOC, emparejados por edad, sexo y VEF1.; Se evaluó la función de las vías respiratorias pequeñas utilizando oscilometría de impulso (IOS; R5-R20) y prueba de lavado de nitrógeno de una sola respiración (SBNWT; dN2).; Los pacientes completaron un diario diario de síntomas de 4 semanas.
Principales resultados:
- Los pacientes con asma y limitación persistente del flujo aéreo (LPF) exhibieron valores de dN2 y R5-R20 más altos que aquellos con asma reversible, pero más bajos que los pacientes con EPOC.; La disfunción de las vías respiratorias pequeñas (DVP) fue prevalente: 79% en LPF, 37% en asma reversible y 100% en EPOC.; En LPF, R5-R20 se correlacionó fuertemente con las puntuaciones de disnea; en el asma reversible, se correlacionó con la tos y el uso de medicación de rescate.
Conclusiones:
- La disfunción de las vías respiratorias pequeñas es muy prevalente en pacientes con asma y LPF y contribuye significativamente a su carga diaria de síntomas.; La gravedad intermedia de la DVP en pacientes con LPF sugiere un papel clave en el desarrollo de la obstrucción fija.; Estos hallazgos respaldan el potencial de estrategias diagnósticas y terapéuticas dirigidas para la DVP en el asma.
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