Asma de control difícil: factores predisponentes y factores agravantes / Difficult to control asthma: predisposing and aggravating factors

RESUMEN

El concepto de asma de control difícil engloba a todos aquellos pacientes con asma insuficientemente o mal controlada, a pesar de seguir una estrategia terap¨¦utica apropiada, una vez se ha comprobado el cumplimiento de esta, se han descartado otras enfermedades y controlados los factores agravantes de la enfermedad. Los factores que contribuyen a que el asma sea refractaria al tratamiento no son bien conocidos. Algunos estudios establecen asociaciones d¨¦biles entre determinadas alteraciones gen¨¦ticas y varios factores ambientales. Se ha descrito que mutaciones del gen IL-4 y su receptor parecen tener relaci¨®n con la p¨¦rdida de funci¨®n pulmonar y con episodios de asma de riesgo vital. Tambi¨¦n se han relacionado con la gravedad del asma factores implicados en el remodelado de la v¨ªa a¨¦rea as¨ª como mutaciones de los receptores para los glucocorticoides y los ¦Â2-adren¨¦rgicos. Por otra parte se han asociado con la gravedad del asma diversos factores ambientales como la exposici¨®n continua a al¨¦rgenos, tabaquismo, intolerancia a antiinflamatorios no esteroideos (AINE) e infecciones. Estudios multic¨¦ntricos como el estudio ENFUMOSA y el estudio TENOR nos han ayudado a comprender en parte esta enfermedad (AU)

ABSTRACT

The concept of difficult-to-control asthma covers all those patients with insufficiently or poorly controlled asthma who, in spite of having followed an appropriate therapeutic strategy, and after having verified its compliance, other diseases have been ruled out and aggravating factors of the disease controlled. The factors that contribute to making asthma refractory to treatment are not well known. Some studies establish weak associations between certain genetic alterations and several environmental factors. It has been described that mutations of the IL-4 gene and its receptor seem to have a relationship with loss of pulmonary function and with life-threatening asthma episodes. They have also been related with the severity of the asthma factors involved in airway remodeling and mutations of glucocorticoids and beta 2-adrenergic receptors. On the other hand, different environmental factors such as continuing exposure to allergens, tobacco smoke, intolerance to NSAIDs and infections have been associated with the severity of asthma. Multicenter study such as the ENFUMOSA study and the TENOR study have partially helped us to understand this disease (AU)