Anti ige na asma grave 'relato de caso' / Anti ige in severe asthma 'case report / Anti ige en el asma grave 'informe de un caso

A asma grave é uma doença respiratória crônica que afeta as vias aéreas, provocando inflamação e estreitamento dos brônquios. Esse estreitamento pode dificultar a respiração e causar sintomas como tosse, falta de ar, chiado no peito e aperto no peito. Quando a asma não é controlada adequadamente com medicamentos e outras medidas, ela pode evoluir para um quadro de asma grave. O presente artigo científico consiste em uma revisão literária sobre o tratamento da asma grave com elevados níveis de anticorpos IgE por meio do uso do anticorpo monoclonal Omalizumabe, além de apresentar o relato de caso observacional em um paciente pediátrico atendido em um consultório especializado da cidade de Mineiros no estado de Goiás. Os estudos revisados demonstraram que a terapia com Omalizumabe pode melhorar a função pulmonar, reduzir a necessidade de medicação de resgate e melhorar a qualidade de vida em pacientes com asma grave. No entanto, também foi observado que o benefício do Omalizumabe é mais pronunciado em pacientes com níveis mais elevados de IgE e em pacientes que apresentam sintomas asmáticos frequentes. A revisão literária apresentou evidências consistentes de que o Omalizumabe é uma opção terapêutica eficaz e segura para o tratamento de asma grave com elevados níveis de IgE em pacientes pediátricos. Por fim com objetivo de fornecer informações importantes para médicos e profissionais de saúde sobre o uso do Omalizumabe no tratamento da asma grave em crianças, além de destacar a necessidade de mais pesquisas para avaliar a eficácia e segurança do medicamento em populações maiores e com seguimento mais prolongado.

Severe asthma is a chronic respiratory disease that affects the airways, causing inflammation and narrowing of the bronchi. This narrowing can make breathing difficult and cause symptoms such as coughing, shortness of breath, wheezing, and chest tightness. When asthma is not properly controlled with medication and other measures, it can develop into severe asthma. The present scientific article consists of a literature review on the treatment of severe asthma with high IgE antibody levels by the use of the monoclonal antibody Omalizumab, besides presenting the report of an observational case in a pediatric patient seen at a specialized clinic in the city of Mineiros in the state of Goiás. The studies reviewed showed that Omalizumab therapy can improve lung function, reduce the need for rescue medication, and improve quality of life in patients with severe asthma. However, it was also noted that the benefit of Omalizumab is more pronounced in patients with higher IgE levels and in patients who have frequent asthmatic symptoms. The literature review presented consistent evidence that Omalizumab is an effective and safe therapeutic option for the treatment of severe asthma with high IgE levels in pediatric patients. Finally with aim to provide important information for physicians and health care professionals about the use of Omalizumab in the treatment of severe asthma in children, and to highlight the need for further research to evaluate the efficacy and safety of the drug in larger populations and with longer follow-up.

El asma grave es una enfermedad respiratoria crónica que afecta a las vías respiratorias, causando inflamación y estrechamiento de los bronquios. Este estrechamiento puede dificultar la respiración y causar síntomas como tos, falta de aire, sibilancias y opresión torácica. Cuando el asma no se controla adecuadamente con medicación y otras medidas, puede convertirse en asma grave. El presente artículo científico consiste en una revisión bibliográfica sobre el tratamiento del asma grave con niveles elevados de anticuerpos IgE mediante el uso del anticuerpo monoclonal Omalizumab, además de presentar el informe de un caso observacional en un paciente pediátrico atendido en una clínica especializada de la ciudad de Mineiros, en el estado de Goiás. Los estudios revisados demostraron que el tratamiento con omalizumab puede mejorar la función pulmonar, reducir la necesidad de medicación de rescate y mejorar la calidad de vida en pacientes con asma grave. Sin embargo, también se observó que el beneficio del omalizumab es más pronunciado en pacientes con niveles más altos de IgE y en pacientes que presentan síntomas asmáticos frecuentes. La revisión bibliográfica presentó pruebas consistentes de que omalizumab es una opción terapéutica eficaz y segura para el tratamiento del asma grave con niveles elevados de IgE en pacientes pediátricos. Finalmente con el objetivo de proporcionar información importante para los médicos y profesionales de la salud sobre el uso de Omalizumab en el tratamiento del asma grave en niños, así como destacar la necesidad de nuevas investigaciones para evaluar la eficacia y seguridad del fármaco en poblaciones más grandes y con un seguimiento más prolongado.

Optimal control of asthma improved eosinophilic otitis media

BACKGROUND: Eosinophilic otitis media (EOM) is often associated with comorbid asthma. The middle ear cavity is part of the upper airway. Therefore, EOM and asthma can be considered to be a crucial part of the “one airway, one disease” phenomenon. Based on the concept of one airway, one disease in the context of allergic rhinitis and asthma, optimal level of inhalation therapy for better asthma control leads to improvement in allergic rhinitis. OBJECTIVE: We conducted a pilot study to determine whether appropriate strengthening of inhalation therapy for asthma is effective for EOM. METHODS: Fifteen patients with EOM and comorbid asthma were enrolled in this study. Eight patients were randomly selected and administered appropriately strengthened inhalation therapy for asthma (strengthened group). The effect of the therapy on EOM was assessed by comparing a questionnaire for ear symptoms, clinical characteristic score, pure tone audiometry, blood tests and temporal bone computed tomography (CT) examination before and after the therapy. Seven other EOM + asthma patients without the above mentioned therapy were included as controls. RESULTS: In the strengthened group, the score of ear symptoms, clinical characteristics score, peripheral blood eosinophil count, CT score, and air conduction hearing level improved significantly after strengthening the inhalation therapy, but not in the control group. The lung function tests (forced vital capacity [%predicted], forced expiratory volume in 1 second [FEV₁] [L], and FEV₁ [%predicted]) significantly increased in the strengthened group after the therapy, but not in the control group. CONCLUSION: In this study we demonstrated that EOM improved along with improved lung function when appropriately optimal inhalation therapy was implemented in patients with EOM and asthma. Administration of optimizing therapy for asthma might be effective for concomitant EOM.

Crisis de asma en pediatría / Asthma crisis in pediatrics

La crisis de asma es el conjunto de síntomas, signos físicos y de laboratorio que apuntan a un aumento de la resistencia al flujo aéreo y como consecuencia la obstrucción bronquial. Es una causa frecuente de consulta y muchas veces la forma como se hace evidente la enfermedad en los pacientes y sus padres. En esta revisión entregamos algunas recomendaciones de cómo reconocer y responder rápidamente a esta situación. Los objetivos primarios al enfrentar una crisis son corregir la hipoxemia, obtener la bronco dilatación y disminuir el riesgo de recaídas. Para lograrlos, debe reconocer rápidamente la hipoxemia y aportar oxígenos suplementario, demostrar la obstrucción de la vía aérea (por clínica y/o laboratorio) y tratarla con broncodilatadores de acción rápida y corticoides sistémicos y una vez manejada la crisis dejar indicaciones suficientes para evitar que esto vuelva a ocurrir.

The asthma crisis is a group of symptoms, with physical and laboratory signs that show an increase in resistance to airflow because of the bronchial obstruction. It is a frequent cause of consultation and It is an often way that the disease becomes evident in patients and their parents. In this review we give some recommendations on how to recognize and have a quickly response to this situation. The primary objectives in facing a crisis are correcting hypoxemia, obtain broncho dilatation and decrease the risk of relapse. In order to achieve this, you should promptly recognize hypoxemia, provide supplemental oxygen, demonstrate airway obstruction (by clinic and / or laboratory) and treat it with rapid-acting bronchodilators and systemic corticosteroids and once the crisis is handled, leave sufficient indications to avoid this to happen again

Physician-prescribed Asthma Treatment Regimen does not differ Between Smoking and Non-smoking Patients With Asthma in Seoul and Gyunggi province of Korea

PURPOSE: Smoking has detrimental effects on asthma symptom control and response to treatment and is prevalent among asthma patients in South Korea. The aim of this study is to determine the prevalence of smoking among asthma patients in South Korea and to compare the medication regimens of asthma patients who do and do not smoke. METHODS: A cross-sectional survey was conducted from August 2010 to January 2011. Participating physicians (N=25) recorded demographic and clinical data on all asthma patients presenting during the study period (N=2,032), and then recruited a subset of patients (N=500) for the survey such that half were self-reported current smokers. Recruited patients were between the ages of 18 and 60. RESULTS: Among presenting asthma patients, 17.3% were current smokers, 19.2% were former smokers, and 63.5% had never smoked. Within the analyzable study population (N=471), 212 patients reported smoking currently, 79 smoking formerly, and 180 never smoking. Among current and former smokers, 79.7% and 81.0%, respectively, were men, while women represented 80.5% of patients who had never smoked. Agreement was strong between physician-determined smoking status and patient-reported smoking status (kappa=0.82; P<0.001). However, asthma medication regimens examined according to GINA treatment steps did not differ by smoking status. In addition, mean quality of life scores and level of asthma control did not differ by smoking status. CONCLUSIONS: In South Korea, physicians are well aware of the smoking status of their patients. However, smoking status did not affect the prescribed medication regimens of this population of asthma patients.

Fenotipos de sibilancias en el preescolar / Preschool wheezing phenotyping

Un tercio de los preescolares tienen sibilancias intermitentes, una condición que en muchos de ellos desaparecerá posteriormente en la vida. Estudios epidemiológicos han aclarado la historia natural, pero no tienen utilidad práctica en el diagnóstico, manejo ni en el pronóstico del caso individual, dado que se requiere de una evolución en el tiempo para clasificarlos. Los virus respiratorios son los desencadenantes más importantes a esta edad, produciendo sibilancias episódicas que se caracterizan por no presentar síntomas entre los episodios. Los niños con historia de atopia tienen un fenotipo diferente conocido como multigatillado, que se presentan con síntomas posteriores a la exposición de ejercicio, tabaco, alérgenos, aire frío o infecciones virales respiratorias, constituyendo los verdaderos asmáticos. El tratamiento recomendado se basa en la severidad de los síntomas, considerando que hasta un 50 por ciento de los fenotipos puede cambiar. Los esteroides inhalatorios pueden ser de utilidad en sibilancias multigatilladas y el montelukast en aquellas inducidas por virus.

One third of preschool children have intermittent wheezing, a condition that many of them outgrow. Epidemiological studies have taught us the natural history, but they are not useful in diagnosis, treatment and prognosis for the individual case, because time is needed to classify it. Respiratory viruses are the most common triggers at this age, leading to a pattern of episodic wheezing, with no symptoms between viral infections. Children with atopy, have a different phenotype known as “multitrigger” wheezing. This condition is characterized by wheezing after exposure to multiple triggers, such as exercise and exposure to smoke, allergens, cold air or viral infection. Treatment is based on disease severity; inhaled steroids may be useful in multitrigger wheezing and montelukast in viral induce children.

Características de pacientes asmáticos mexicanos atendidos en consulta externa / Characteristics of Mexican asthmatic subjects attending an outpatient service

Background. Despite the high prevalence of asthma in Mexico, studies describing general characteristics of these patients are scarce. Objective.To analyze the sociodemographic, clinical and respiratory functional profile of asthmatic patients attending for the first time the outpatient service of a tertiary-level hospital, as well as to investigate treatments already received and the abandonment rate. Methods.Adolescent and adult asthmatic subjects seen from February 2000 to November 2002 in the outpatient service of the National Institute of Respiratory Diseases, in Mexico City, were prospectively studied. Sociodemographic information was gathered and clinical and spirometric evaluations were carried out. The severity of the disease was classified according to international criteria. Results. A total of 1403 patients between 12 and 82 years of age, with predominance of the female gender, were included in the analysis. An 88.7% of patients had the mildest forms of the disease, 10% had moderate asthma, and 1.3% had severe asthma. While 21.4% had never received anti-asthma treatment, about one third of the remaining patients had received corticosteroids, independently of the asthma severity, indicating an over-treatment of the intermittent form of the disease and an under-treatment of persistent forms. A high abandonment rate (65.7%) was observed. A positive bronchodilator test was observed in 30.3% of patients with intermittent asthma, though this proportion increased to about 67% in those with moderate and severe asthma. Conclusion.Mildest forms of the disease predominate among asthmatic patients attending for the first time an outpatient service, with a still very high frequency of inadequate use of corticosteroids.

Antecedentes. A pesar de que en México existe una alta prevalencia de asma, hay pocos estudios que describan las características generales de estos pacientes. Objetivo. Conocer el perfil sociodemográfico, clínico y funcional respiratorio de pacientes asmáticos que acuden por primera vez a consulta externa de un hospital de tercer nivel de atención, así como los tratamientos recibidos y su tasa de abandono. Métodos. Se estudiaron, prospectivamente, sujetos asmáticos adolescentes y adultos, atendidos de febrero del 2000 a noviembre del 2002 en el servicio de consulta externa del Instituto Nacional de Enfermedades Respiratorias, de la ciudad de México. Se recabó información sociodemográfica y se realizó evaluación clínica y por espirometría. La gravedad del asma se clasificó de acuerdo con criterios internacionales. Resultados. Se incluyeron 1,403 pacientes de 12 a 82 años de edad, con predominio del sexo femenino. El 88.7% de los pacientes tenían formas leves de la enfermedad, 10% asma moderada, y 1.3% asma grave. El 21.4% no había recibido tratamiento antiasmático. Entre los demás, cerca de una tercera parte recibió corticosteroides, independientemente de la gravedad del asma, indicando sobretratamiento del asma intermitente y subtratamiento de las formas persistentes. Encontramos una alta tasa de deserción (65.7%). Una respuesta positiva a la prueba con broncodilatador se observó en 30.3% de los pacientes con asma intermitente, cifra que se elevó a cerca de 67% en las formas moderada y grave. Conclusión. Entre los pacientes asmáticos que acuden a consulta externa, predominan las formas leves, detectándose que todavía existe una alta frecuencia del uso inadecuado de los corticosteroides.