Asma neutrofílica

Luis Alejandro Pérez de Llano

Resumen


Asma neutrofílica se puede definir como “asma -con demostración de hiperrespuesta bronquial- en no fumadores que en su esputo tienen un recuento de neutrófilos ≥ 76% o bien > 65% en dos ocasiones, o en fumadores sin obstrucción bronquial fija”. Las células Th17 parecen tener un importante rol en el asma grave, especialmente en el reclutamiento y expansión de neutrófilos. Los Th17 se caracterizan por la producción de IL-17A, IL-17F, IL-21 e IL-22 y se ha demostrado una correlación significativa entre la expresión bronquial de IL-17F y la presencia de neutrófilos. Se ha observado que el asma puede ser neutrofílica desde un inicio o puede suceder a un endotipo inflamatorio Th2 por la acción del tratamiento esteroideo, por inhalación de humo de tabaco o por cambios en la microbiota. Hasta el momento no existe un biomarcador que permita identificar el patrón neutrofílico, por lo que sólo el esputo inducido sirve para este propósito. La neutrofilia en el esputo se relaciona con mayor gravedad del asma, más obstrucción bronquial y peor respuesta al tratamiento. Hasta la fecha, los resultados de los fármacos dirigidos específicamente al asma neutrofílica (anti-TNFα, brodalumab, AZD5069) han sido negativos y el uso de la triple terapia inhalada y de macrólidos son las mejores opciones terapéuticas para estos pacientes.

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