Asma intermitente y leve

Luis Manuel Entrenas Costa, Marta Entrenas Castillo, Cristina Villalba Moral

Resumen


Las guías del asma indican claramente el tratamiento a seguir en cada escalón de gravedad y proporcionan las herramientas para medir el control que ayude a variar la medicación según la evolución de la enfermedad.

Sin embargo, y pese a la difusión que han logrado, una gran mayoría de pacientes no alcanza la situación de control y el cumplimiento terapéutico no es el adecuado.

El mal control se relaciona con la gravedad y la complejidad del tratamiento utilizado, siendo sus causas diversas y atribuibles tanto a médicos como a pacientes.

Parece evidente que en los escalones superiores de gravedad haya un alto porcentaje de pacientes no controlados y que, con la introducción de los anticuerpos monoclonales, susciten el máximo interés.

Sin embargo, el mayor número de pacientes se sitúa en los escalones más bajos, donde tampoco son ajenos a la pérdida de control de la enfermedad ni se ven libres de padecer exacerbaciones. En ellos se incluyen los pacientes con síntomas intermitentes donde se debe tomar la decisión de cuando iniciar el tratamiento.

El objetivo del presente trabajo es revisar el estado actual del tratamiento en los escalones iniciales de gravedad del asma, donde también hay novedades en su manejo.


Texto completo:

PDF HTML

Referencias


Comité ejecutivo de GEMA. Guía Española para el Manejo el Asma GEMA 4.3. Disponible en www.gemasma.com. (Con acceso el 04/05/2018).

Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2018. Disponible en: www. ginasthma.org. (Con acceso el 22/04/2018).

Bateman ED, Boushey HA, Bousquet J, Busse WW, Clark TJ, Pauwels RA, et al.; GOAL Investigators Group. Can guideline-defined asthma control be achieved? The Gaining Optimal Asthma ControL study. Am J Respir Crit Care Med. 2004;170:836–44.

Demoly P, Paggiaro P, Plaza V, Bolge SC, Kannan H, Sohier B, et al. Prevalence of asthma control among adults in France, Germany, Italy, Spain and the UK. Eur Respir Rev. 2009;18:105–12.

Plaza V, López-Viña A, Entrenas LM, Fernández- Rodríguez C, Melero C, Pérez-Llano L, et al. Differences in Adherence and Non-Adherence Behaviour Patterns to Inhaler Devices Between COPD and Asthma Patients. COPD. 2016;13:547–54.

Pavord ID, Beasley R, Agustí A, Anderson GP, Bel E, Brusselle G, et al. After asthma: redefining airways diseases. Lancet. 2018;391:350–400.

Álvarez Gutiérrez FJ. Anticuerpos monoclonales en el asma. Posibilidad de tratamiento “a la carta”. Monogr Arch Bronconeumol. 2015;2:74–82.

Reddel HK, Bateman ED, Becker A, Boulet LP, Cruz AA, Drazen J. A summary of the new GINA strategy: a roadmap to asthma control. Eur Respir J. 2015;46:622–39.

Vignola AM, Chanez P, Campbell AM, Souques F, Lebel B, Enander I, et al. Airway inflammation in mild intermittent and in persistent asthma. Am J Respir Crit Care Med. 1998;157:403–9.

Suissa S, Ernst P, Benayoun S, Baltzan M, Cai B. Low-dose inhaled corticosteroids and the prevention of death from asthma. N Engl J Med. 2000;343:332–6.

Suissa S, Ernst P, Kezouh A. Regular use of inhaled corticosteroids and the long-term prevention of hospitalisation for asthma. Thorax. 2002;57:880–4.

Pauwels RA, Pedersen S, Busse WW, Tan WC, Chen YZ, Ohlsson SV, et al.; START Investigators Group. Early intervention with budesonide in mild persistent asthma: a randomised, double-blind trial. Lancet. 2003;361:1071–6.

Busse WW, Pedersen S, Pauwels RA, Tan WC, Chen YZ, Lamm CJ, et al.; START Investigators Group. The Inhaled Steroid Treatment As Regular Therapy in Early Asthma (START) study 5-year follow-up: effectiveness of early intervention with budesonide in mild persistent asthma. J Allergy Clin Immunol. 2008;121:1167–74.

Reddel HK, Busse WW, Pedersen S, Tan WC, Chen YZ,

Jorup C, et al. Should recommendations about starting

inhaled corticosteroid treatment for mild asthma be based

on symptom frequency: a post-hoc efficacy analysis of the

START study. Lancet. 2017;389:157–66.

Papi A, Fabbri LM. Management of patients with early mild

asthma and infrequent symptoms. Lancet. 2017;389:129–

Papi A, Canonica GW, Maestrelli P, Paggiaro P, Olivieri

D, Pozzi E, et al.; BEST Study Group. Rescue use of

beclomethasone and albuterol in a single inhaler for mild

asthma. N Engl J Med. 2007;356:2040–52.

Ko FD, Hui DS. Many patients labelled as having mild

asthma do not have well-controlled asthma. Respirology.

;23:348–9.

Camargos P, Affonso A, Calazans G, Ramalho L,

Ribeiro ML, Jentzsch N, et al. On-demand intermittent

beclomethasone is effective for mild asthma in Brazil. Clin

Transl Allergy. 2018;8:7.

Du W, Zhou L, Ni Y, Yu Y, Wu F, Shi G. Inhaled

corticosteroids improve lung function, airway hyperresponsiveness

and airway inflammation but not symptom

control in patients with mild intermittent asthma: A metaanalysis.

Exp Ther Med. 2017;14:1594–608.

Wang G, Zhang X, Zhang HP, Wang L, Kang Y, Barnes PJ,

et al. Corticosteroid plus β2-agonist in a single inhaler as

reliever therapy in intermittent and mild asthma: a proofof-

concept systematic review and meta-analysis. Respir

Res. 2017;18:203.

O’Byrne PM, FitzGerald JM, Zhong N, Bateman E, Barnes

PJ, Keen C, et al. The SYGMA programme of phase 3 trials

to evaluate the efficacy and safety of budesonide/formoterol

given ‘as needed’ in mild asthma: study protocols for two

randomised controlled trials. Trials. 2017;18:12.

Rabe KF, Vermeire PA, Soriano JB, Maier WC. Clinical

management of asthma in 1999: The Asthma Insights

and Reality in Europe (AIRE) study. Eur Respir J.

;16:802–7.

Olaguíbel JM, Quirce S, Juliá B, Fernández C, Fortuna

AM, Molina J, et al.; MAGIC Study Group. Measurement

of asthma control according to Global Initiative for

Asthma guidelines: a comparison with the Asthma Control

Questionnaire. Respir Res. 2012;13:50.

Vennera MC, Picado C, Herráez L, Galera J, Casafont J.

Factores asociados con el asma grave no controlada y con

la percepción del control por parte de médicos y pacientes.

Arch Bronconeumol. 2014;50:384–91.

Martínez-Moragón E, Entrenas LM, Plaza V, Quirce S.

Actitudes y barreras en el asma inicialmente no controlada

en España. Estudio Abanico. Rev Clin Esp. 2017;217:60–2.

Vega JM, Badia X, Badiola C, López-Viña A, Olaguíbel JM,

Picado C, et al.; Covalair Investigator Group. Validation of

the Spanish version of the Asthma Control Test (ACT). J

Asthma. 2007;44:867–72.

Kitch BT, Paltiel AD, Kuntz KM, Dockery DW, Schouten

JP, Weiss ST, et al. A single measure of FEV1 is associated

with risk of asthma attacks in long-term follow-up. Chest.

;126:1875–82.

López-Campos JL, Soriano JB, Calle M. Cambios

interregionales en la realización e interpretación de las

espirometrías en España: estudio 3E. Arch Bronconeumol.

;50:475–83.

Boulet LP, Vervloet D, Magar Y, Foster JM. Adherence: the

goal to control asthma. Clin Chest Med. 2012;33:405–17.

Wilson SR, Strub P, Buist AS, Knowles SB, Lavori PW,

Lapidus J, et al.; Better Outcomes of Asthma Treatment

(BOAT) Study Group. Shared treatment decision making

improves adherence and outcomes in poorly controlled

asthma. Am J Respir Crit Care Med. 2010;181:566–77.

Montnémery P, Hansson L, Lanke J, Lindholm LH,

Nyberg P, Löfdahl CG, et al. Accuracy of a first diagnosis of

asthma in primary health care. Fam Pract. 2002;19:365–8.

Bel EH. Clinical Practice. Mild asthma. N Engl J Med.

;369:549–57.

Cazzoletti L, Marcon A, Janson C, Corsico A, Jarvis D,

Pin I, et al.; Therapy and Health Economics Group of

the European Community Respiratory Health Survey.

Asthma control in Europe: a real-world evaluation based

on an international population-based study. J Allergy Clin

Immunol. 2007;120:1360–7.

Kauppi P, Peura S, Salimäki J, Järvenpää S, Linna M,

Haahtela T. Reduced severity and improved control of selfreported

asthma in Finland during 2001-2010. Asia Pac

Allergy. 2015;5:32–9.

Ding B, Small M. Disease Burden of Mild Asthma:

Findings from a Cross-Sectional Real-World Survey. Adv

Ther. 2017;34:1109–27.

Barnes PJ. Efficacy of inhaled corticosteroids in asthma. J

Allergy Clin Immunol. 1998;102:531–8.

Masoli M, Weatherall M, Holt S, Beasley R. Clinical doseresponse

relationship of fluticasone propionate in adults

with asthma. Thorax. 2004;59:16–20.

Boulet LP. Perception of the role and potential side effects

of inhaled corticosteroids among asthmatic patients. Chest.

;113:587–92.

Ducharme FM. Continuous versus intermittent inhaled

corticosteroids for mild persistent asthma in children: not

too much, not too little. Thorax. 2012;67:102–5.

Rodrigo GJ. Daily versus intermittent inhaled corticosteroid

treatment for mild persistent asthma. Curr Opin Allergy

Clin Immunol. 2014;14:186–91.

King V, Nettleton W. Intermittent Inhaled Corticosteroid

Therapy for Mild Persistent Asthma in Children and

Adults. Am Fam Physician. 2016;94:21–2.

Boushey HA, Sorkness CA, King TS, Sullivan SD, Fahy

JV, Lazarus SC, et al.; National Heart, Lung, and Blood

Institute’s Asthma Clinical Research Network. Daily

versus as-needed corticosteroids for mild persistent asthma.

N Engl J Med. 2005;352:1519–28.

Rodríguez-Martínez CE, Nino G, Castro-Rodríguez

JA. Cost-utility analysis of daily versus intermittent

inhaled corticosteroids in mild-persistent asthma. Pediatr

Pulmonol. 2015;50:735–46.

Montelukast Combix 10 mg comprimidos recubiertos con

película EFG. Ficha técnica o resumen de las características

del producto. Disponible en: https://www.aemps.gob.

es/cima/pdfs/es/ft/75786/75786_ft.pdf. (Con acceso el

/04/2018).

Accolate 20 mg comprimidos recubiertos. Ficha

técnica o resumen de las características del producto.

Disponible en: https://www.aemps.gob.es/cima/pdfs/es/

ft/62443/FichaTecnica_62443.html.pdf. (Con acceso el

/04/2018).

Chauhan BF, Ducharme FM. Anti-leukotriene agents

compared to inhaled corticosteroids in the management

of recurrent and/or chronic asthma in adults and children.

Cochrane Database Syst Rev. 2012;5:CD002314.

Price D, Musgrave SD, Shepstone L, Hillyer EV, Sims

EJ, Gilbert RF, et al. Leukotriene antagonists as firstline

or add-on asthma-controller therapy. N Engl J Med.

;364:1695–707.

Drazen JM, Israel E, Boushey HA, Chinchilli VM, Fahy

JV, Fish JE, et al. Comparison of regularly scheduled with

as-needed use of albuterol in mild asthma. N Engl J Med.

;335:841–7.

Atrovent 20 microgramos solución para inhalación

en envase a presión. Ficha técnica o resumen de las

características del producto. Disponible en: https://www.

aemps.gob.es/cima/pdfs/es/ft/54674/54674_ft.pdf. (Con

acceso el 22/04/2018).

Plaza V, López-Viña A, Entrenas LM, Fernández-

Rodríguez C, Melero C, Pérez-Llano L, et al. Differences

in Adherence and Non-Adherence Behaviour Patterns to

Inhaler Devices Between COPD and Asthma Patients.

COPD. 2016;13:547–54.

Johnson KM, FitzGerald JM, Tavakoli H, Chen W,

Sadatsafavi M. Stability of Asthma Symptom Control in

a Longitudinal Study of Mild-Moderate Asthmatics. J

Allergy Clin Immunol Pract. 2017;5:1663–70.

Partridge MR, Van der Molen T, Myrseth SE, Busse

WW. Attitudes and actions of asthma patients on regular

maintenance therapy: the INSPIRE study. BMC Pulm

Med. 2006;6:13.

Tattersfield AE, Postma DS, Barnes PJ, Svensson K,

Bauer CA, O’Byrne PM, et al. Exacerbations of asthma: a

descriptive study of 425 severe exacerbations. The FACET

International Study Group. Am J Respir Crit Care Med.

;160:594–9.

Patel M, Pilcher J, Hancox RJ, Sheahan D, Pritchard A,

Braithwaite I, et al.; SMART Study Group. The use of

β2-agonist therapy before hospital attendance for severe

asthma exacerbations: a post-hoc analysis. NPJ Prim Care

Respir Med. 2015;25:14099.

Ankerst J. Combination inhalers containing inhaled

corticosteroids and long-acting beta2-agonists: improved

clinical efficacy and dosing options in patients with asthma.

J Asthma. 2005;42:715–24.

Scicchitano R, Aalbers R, Ukena D, Manjra A, Fouquert

L, Centanni S, et al. Efficacy and safety of budesonide/

formoterol single inhaler therapy versus a higher dose of

budesonide in moderate to severe asthma. Curr Med Res

Opin. 2004;20:1403–18.

Devillier P, Fadel R, De Beaumont O. House dust mite

sublingual immunotherapy is safe in patients with mildto-

moderate, persistent asthma: a clinical trial. Allergy.

;71:249–57.

Lin SY, Erekosima N, Kim JM, Ramanathan M, Suárez-

Cuervo C, Chelladurai Y, et al. Sublingual immunotherapy

for the treatment of allergic rhinoconjunctivitis and asthma:

a systematic review. JAMA. 2013;309:1278–88.

Virchow JC, Backer V, Kuna P, Prieto L, Nolte H, Villesen

HH, et al. Efficacy of a house dust mite sublingual allergen

immunotherapy tablet in adults with allergic asthma: A

randomized clinical trial. JAMA. 2016;315:1715–25.


Enlaces refback

  • No hay ningún enlace refback.