El documento describe la fisiopatología y factores que contribuyen a la severidad del asma, así como opciones de tratamiento para exacerbaciones agudas. Explica que la inflamación en el asma severa involucra eosinófilos y células T, aunque también puede haber neutrofilia. Describe opciones de tratamiento inicial como oxígeno, beta-agonistas y corticoides, así como criterios para hospitalización.
SECTION III: TREATMENT OPTIONS FOR ACUTE ASTHMA EXACERBATIONS This section will review the treatment options available for managing acute asma exacerbations
IMPORTANCE OF EARLY TREATMENT OF ACUTE ASTHMA EXACERBATIONS Early treatment is vital in the management of acute asma episodes, including initiating treatment before the patient reaches the hospital. Patients may initiate management of an exacerbation at home to minimize treatment delay by inhaling short-acting beta agonists and, depending on the severity and response, adding an oral corticosteroid. This approach also reduces the attack’s severity. 1 When managing an acute exacerbation, the goals are to maintain adequate arterial oxygenation, relieve airflow obstruction, reduce airway inflammation, and prevent relapse. 2 National Asma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asma , 2007. Link at http://www.nhlbi.nih.gov/guidelines/asthma/index.htm 2. Rodrigo GJ , Rodrigo C , Hall JB . Acute asthma in adults: a review. Chest. 2004 Mar;125(3):1081-102. Comment in: Chest. 2005 May;127(5):1867. Departamento de Emergencia, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay. gurodrig@adinet.com.uy All patients with asthma are at risk of having exacerbations. Hospitalizations and emergency department (ED) visits account for a large proportion of the health-care cost burden of asthma, and avoidance or proper management of acute asthma (AA) episodes represent an area with the potential for large reductions in health-care costs. The severity of exacerbations may range from mild to life threatening, and mortality is most often associated with failure to appreciate the severity of the exacerbation, resulting in inadequate emergency treatment and delay in referring to hospital. This review describes the epidemiology, costs, pathophysiology, mortality, and management of adult AA in the ED and in the ICU. PMID: 15006973 [PubMed - indexed for MEDLINE] R1 , p 105, col 1, ¶1 R2 , p 1087, col 1, ¶2, li 2-9 NAEP, p 105, col 1, ¶1 NAEP, p 105, col 2, ¶4, li 5-6 Rodrigo, p 1087, col 1, ¶2, li 2-9 1. National Asma Education and Prevention Program Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asma . National Institutes of Health, National Heart, Lung, and Blood Institute; 1997. Publication 97-4051. 2. Rodrigo GJ, Rodrigo C, Hall JB. Acute asma in adults: a review. Chest. 2004;125:1081-1102.
GLOBAL INITIATIVE FOR ASTHMA RECOMMENDATIONS FOR MANAGING ASTHMA EXACERBATIONS IN ACUTE CARE SETTINGS: PART 1 Clinical guidelines have been developed for managing acute exacerbations, including these from the Iniciativa Global para el Asma. As shown in this slide, corticosteroids are recommended for all degrees of severity. GINA, p 67 top half of p. GINA, p. 67, top half of page Iniciativa Global para el Asma. Global Strategy for Asma Management and Prevention. Revisada en el 2006. Iniciativa Global para el Asma Web site. Available at: http://www.ginasthma.org/Guidelineitem.asp?l1=2&l2=1&intId=60. Accesado January 25, 2007.
GINA RECOMMENDATIONS: MANAGING ASTHMA EXACERBATIONS IN ACUTE CARE SETTINGS: PART 2 Corticosteroids should be included when the patient is admitted to the hospital and in the discharge regimen. GINA, p 67, Fig 4.4-2 lower half GINA, 67, fig. 4.4-2 Iniciativa Global para el Asma. Global Strategy for Asma Management and Prevention. Revisada en el 2006. Iniciativa Global para el Asma Web site. Available at: http://www.ginasthma.org/Guidelineitem.asp?l1=2&l2=1&intId=60. Accesado January 25, 2007.
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