EPOC eosinofílico

Borja G Cosío

Resumen


La EPOC y el asma son dos enfermedades inflamatorias muy prevalentes caracterizadas por obstrucción al flujo aéreo que tienen diferentes mecanismos patogénicos y diferentes grados de respuesta al tratamiento antiinflamatorio. Sin embargo, en la práctica clínica aparecen con frecuencia presentaciones clínicas que solapan ambas enfermedades y que no están claramente representadas en los ensayos clínicos. Aunque estas presentaciones ya son reconocidas en las guías de práctica clínica, no existe consenso en como se deben identificar. Estos pacientes pueden tener una pérdida acelerada de la función pulmonar y peor pronóstico, por lo que su identificación precoz es importante. Por otro lado, su identificación implica una consecuencia terapéutica, ya que son el grupo de pacientes con EPOC que mas se beneficiarían del tratamiento con corticoides inhalados. Biomarcadores como la eosinofilia en sangre, la hiperreactividad bronquial o el óxido nítrico en aire exhalado  han mostrado resultados desiguales y hace necesario buscar nuevos biomarcadores de inflamación Th2 en estos pacientes, como puede ser la periostina. Su caracterización fenotípica nos permitiría individualizar y optimizar el tratamiento con corticoesteroides inhalados.


Texto completo:

PDF HTML

Referencias


Cosío BG, Fiorentino F, Scrimini S. Chronic obstructive pulmonary disease and asthma. Arch Bronconeumol. 2010;46 Suppl 8:2-7.

Global initiative for chronic obstructive lung disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. [Update December 2015]. Available from: http://www.goldcopd.org/.

Miravitlles M, Soler-Cataluna JJ, Calle M, Molina J, Almagro P, Quintano JA, et al. Spanish COPD Guidelines (GesEPOC): pharmacological treatment of stable COPD. Spanish Society of Pulmonology and Thoracic Surgery. Archivos de bronconeumologia. 2012;48(7):247-57.

Gibson PG, Simpson JL. The overlap syndrome of asthma and COPD: what are its features and how important is it? Thorax. 2009;64(8):728-35.

Hardin M, Silverman EK, Barr RG, Hansel NN, Schroeder JD, Make BJ, et al. The clinical features of the overlap between COPD and asthma. Respiratory research. 2011;12:127.

Vanfleteren LE, Kocks JW, Stone IS, Breyer-Kohansal R, Greulich T, Lacedonia D, et al. Moving from the Oslerian paradigm to the post-genomic era: are asthma and COPD outdated terms? Thorax. 2014;69(1):72-9.

Soler-Cataluna JJ, Cosio B, Izquierdo JL, Lopez-Campos JL, Marin JM, Aguero R, et al. Consensus document on the overlap phenotype COPD-asthma in COPD. Archivos de bronconeumologia. 2012;48(9):331-7.

Menezes AM, Montes de Oca M, Perez-Padilla R, Nadeau G, Wehrmeister FC, Lopez-Varela MV, et al. Increased risk of exacerbation and hospitalization in subjects with an overlap phenotype: COPD-asthma. Chest. 2014;145(2):297-304.

Cosio BG, Soriano JB, López-Campos JL, Calle-Rubio M, Soler-Cataluna JJ, de-Torres JP, et al. Defining the Asthma-COPD overlap syndrome in a COPD cohort. Chest. 2016;149(1):45-52.

Diagnosis of Diseases of Chronic Airflow Limitation: Asthma, COPD and Asthma-COPD Overlap Syndrome (ACOS). GINA reports are available at http://www.ginasthma.org. GOLD reports are available at http://www.goldcopd.org [December 30, 2015].

Brightling CE, McKenna S, Hargadon B, Birring S, Green R, Siva R, et al. Sputum eosinophilia and the short term response to inhaled mometasone in chronic obstructive pulmonary disease. Thorax. 2005;60(3):193-8.

Fujimoto K, Kubo K, Yamamoto H, Yamaguchi S, Matsuzawa Y. Eosinophilic inflammation in the airway is related to glucocorticoid reversibility in patients with pulmonary emphysema. Chest. 1999;115(3):697-702.

Kitaguchi Y, Komatsu Y, Fujimoto K, Hanaoka M, Kubo K. Sputum eosinophilia can predict responsiveness to inhaled corticosteroid treatment in patients with overlap syndrome of COPD and asthma. International journal of chronic obstructive pulmonary disease. 2012;7:283-9.

Pascoe S, Locantore N, Dransfield MT, Barnes NC, Pavord ID. Blood eosinophil counts, exacerbations, and response to the addition of inhaled fluticasone furoate to vilanterol in patients with chronic obstructive pulmonary disease: a secondary analysis of data from two parallel randomised controlled trials. Lancet Respir Med. 2015 Jun;3(6):435-42.

Moore WC, Hastie AT, Li X, Li H, Busse WW, Jarjour NN, et al. Sputum neutrophil counts are associated with more severe asthma phenotypes using cluster analysis. The Journal of allergy and clinical immunology. 2014;133(6):1557-63 e5.

Szabo SJ, Kim ST, Costa GL, Zhang X, Fathman CG, Glimcher LH. A novel transcription factor, T-bet, directs Th1 lineage commitment. Cell. 2000;100(6):655-69.

Woodruff PG, Modrek B, Choy DF, Jia G, Abbas AR, Ellwanger A, et al. T-helper type 2-driven inflammation defines major subphenotypes of asthma. American journal of respiratory and critical care medicine. 2009;180(5):388-95.

Woodruff PG, Boushey HA, Dolganov GM, Barker CS, Yang YH, Donnelly S, et al. Genome-wide profiling identifies epithelial cell genes associated with asthma and with treatment response to corticosteroids. Proceedings of the National Academy of Sciences of the United States of America. 2007;104(40):15858-63.

Haldar P, Brightling CE, Hargadon B, Gupta S, Monteiro W, Sousa A, et al. Mepolizumab and exacerbations of refractory eosinophilic asthma. N Engl J Med. 2009;360(10):973-84.

Jia G, Erickson RW, Choy DF, Mosesova S, Wu LC, Solberg OD, et al. Periostin is a systemic biomarker of eosinophilic airway inflammation in asthmatic patients. The Journal of allergy and clinical immunology. 2012;130(3):647-54 e10.

Wagener AH, de Nijs SB, Lutter R, Sousa AR, Weersink EJ, Bel EH, et al. External validation of blood eosinophils, FENO and serum periostin as surrogates for sputum eosinophils in asthma. Thorax. 2015;70(2):115-20.

Park HY, Lee H, Koh WJ, Kim S, Jeong I, Koo HK, et al. Association of blood eosinophils and plasma periostin with FEV1 response after 3-month inhaled corticosteroid and long-acting beta2-agonist treatment in stable COPD patients. Int J Chron Obstruct Pulmon Dis. 2015 Dec 22;11:23-30


Enlaces refback

  • No hay ningún enlace refback.