Asma y Bronquiectasias: Una relación aún no bien definida.
Resumen
El asma y las bronquiectasias (BQ) son patologías diferentes pero que pueden coexistir en muchos pacientes, con una alta prevalencia y morbilidad. Hemos realizado una revisión actualizada de los principales estudios que valoran la relación entre estas 2 entidades. La mayoría de los trabajos son estudios retrospectivos o transversales que tratan de determinar la prevalencia de BQ o algunas características de estos pacientes. Así, aunque los diferentes autores objetivan BQ en los pacientes asmáticos desde el 2% hasta el 80% de los casos (aunque con distintas metodologías y no siempre realizando tomografía computarizada a todos los pacientes), parece que los nuevos trabajos abogan por una prevalencia de BQ en asma grave sobre el 30-40%. Estas BQ suelen ser cilíndricas y encontrarse en las bases pulmonares y asocian en la mayoría de los casos un engrosamiento de la pared bronquial que revela la existencia de una inflamación bronquial no resuelta. La presencia de BQ, se ha relacionado con mayor gravedad del asma, generalmente junto a una inflamación de predominio neutrofílico, tabaquismo, mayor tiempo de evolución de la enfermedad y asmáticos no alérgicos, que precisan de una mayor carga terapéutica a pesar de lo cual presentan más exacerbaciones y mayor consumo de recursos. Sin embargo, serían necesarios estudios longitudinales que traten de establecer la relación entre ambas enfermedades y el posible impacto de las BQ en pacientes con asma dado que ello probablemente conlleve implicaciones pronósticas y terapéuticas.
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