Tos crónica: viejos problemas, nuevas perspectivas

Christian Domingo Ribas, Ana Sogo Sagardía

Resumen


Durante la última década, la interpretación fisiopatológica de los mecanismos de la génesis de la tos crónica han evolucionado notablemente. A la conocida tríada clásica (reflujo gastroesofágico, drenaje o goteo nasal posterior y asma-hiperreactividad de la vía aérea) se han añadido los conceptos de reflujo laringofaríngeo y el de hipersensibilidad laríngea. La tos crónica hoy en día se explica en gran parte por un fenómeno neuropático que empieza en los receptores nerviosos sensitivos periféricos del nervio vago a nivel eminentemente de la laringe, que comporta una respuesta exagerada del centro de la tos en el sistema nervioso central. Pueden producirse fenónemos de hipertusia (reación exagerada ante estímulos mínimos) o alotusia (tos en ausencia de estímulos). Hipertusia o alotusia son estados clínicos que se agrupan ahora bajo el concepto de «síndrome de la hipersensibilidad de la tos crónica». El mecanismo neurológico de la tos humana se origina  pues en una estimulación de las terminaciones de las neuronas que convergen en el centro de la tos. Los mecanismos del aumento de la excitabilidad del centro de la tos localizado en el SNC son tres: hipersensibilidades periférica, central y secundaria. Este fenómeno de la convergencia de estímulos periféricos tiene evidentemente aplicaciones terapéuticas. En este artículo se revisan los conceptos clásicos así como la interpretación más novedosa y actualizada de los mecanismos generadores de tos crónica.

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