Abordaje mutidisciplinar en las unidades de asma grave / Multidisciplinary approach in the severe asthma units

El asma es una enfermedad crónica muy prevalente que genera un consumo importante de recursos sanitarios. El mal manejo de estos enfermos conlleva a un inadecuado control de la enfermedad, a un mayor coste sanitario y a un aumento de la morbimortalidad. La creación de unidades multidisciplinares es muy recomendable, principalmente en las formas más graves y ha demostrado una mejoría asistencial (efectividad), reduciendo notablemente los costes económicos de la enfermedad (eficiencia). Dichas unidades precisan un coordinador (neumólogo) que sea conocedor de todos los aspectos del asma y que organice todo el cuidado, incluyendo al resto de las especialidades implicadas (alergólogos, otorrinolaringólogos, gastroenterólogos, endocrinos, psicólogos y psiquiatras)

Asthma is a very prevalent chronic disease that generates a significant consumption of health resources. The mismanagement of these patients leads to poor control of the disease, a higher health cost and an increase in morbidity and mortality. The creation of multidisciplinary units is highly recommended, mainly in the most severe forms. It requires a coordinator (pneumologist) who is knowledgeable about all aspects of asthma and who organizes all the care, including the rest of the specialties involved (allergists, otolaryngologists, gastroenterologists, endocrines, psychologists and psychiatrists). The creation of these units has shown a welfare improvement (effectiveness), significantly reducing the economic costs of the disease (efficiency)

Asma / No disponible

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Valoración de bronquiectasias en pacientes con asma / No disponible

Introducción: Las bronquiectasias (BQ) son la consecuencia final de muchas enfermedades, entre las que se encuentra el asma, sin embargo han sido poco estudiadas. El objetivo principal de este estudio fue evaluar la presencia de BQ mediante una tomografía computarizada de alta resolución (TCAR) en un subgrupo de pacientes con asma mediante el sistema de clasificación de Bhalla. Asimismo, se comparó si existían diferencias clínicas entre los asmáticos que presentaban o no BQ y si estas se relacionaban con las puntuaciones obtenidas en la escala de Bhalla modificada. Material y métodos: Una TCAR pulmonar se realizó a pacientes con asma, durante un periodo de reclutamiento de 2 años, que cumplían las siguientes condiciones: tres o más exacerbaciones respiratorias al año, historia de expectoración habitual o hemoptoica en alguna ocasión, o asma de larga evolución. Los escáneres fueron evaluados por 2 radiólogos siguiendo la puntuación de Bhalla modificada. Resultados: Se observaron BQ en 48 pacientes de los 65 estudios realizados; el 88% de las BQ fueron cilíndricas y el 62% bilaterales, siendo los lóbulos más afectos los lóbulos inferiores y el lóbulo medio. En todos los enfermos que padecían reflujo gastroesofágico (RGE) se evidenciaron BQ. Los enfermos con BQ mostraron peor FVC (p=0,04) y FEV1 (p=0,05) y mayor frecuencia de rinitis. La puntuación total obtenida por la puntuación de Bhalla modificada se relacionó con la media del porcentaje del valor FEV1/FVC (p=0,01), con el número de exacerbaciones (p=0,01), y con la presencia de colonización bacteriana (p=0,001). Conclusiones: Una alta proporción de pacientes asmáticos de control difícil muestran BQ, que suelen ser cilíndricas y bilaterales. Los enfermos con BQ presentan peor función pulmonar. La puntuación total mediante el sistema de Bhalla se relaciona con la presencia de colonización bacteriana y con el número de exacerbaciones

Introduction: Bronchiectasis (BQ) are the final consequence of many diseases, including asthma is, however this has been inconsiderate. The main objective was to evaluate the presence of BQ by high resolution computerized tomography (HRCT) in a subgroup of patients with asthma using a modified Bhalla score. We compared also whether there were clinical differences between asthmatics who presented or not BQ and clinical variables were associated with modified Bhalla scores. Material and methods: Pulmonary HRCT was performed in patients with asthma during a recruitment period of 2 years, who had the following conditions: three or more respiratory exacerbations per year history of coughing or hemoptysis usual on occasion, asthma longstanding and images suggestive of BQ in the chest radiograph. The HRCT were evaluated by 2 radiologists according to the modified Bhalla score. Results: We observed 48 patients with BQ in 65 studies, 88% were cylindrical and bilateral in 62%. The more affected were the lower and middle lobes. All patients suffering from gastroesophageal reflux had evident BQ. Patients with BQ showed worse FEV1 (p = 0.04), FVC (p=0.05) and rhinitis more often. The total modified Bhalla score was related to the average percentage of FEV1/FVC value (p=0.01), the number of exacerbations (p = 0.01), and the presence of bacterial colonization (p = 0.01). Conclusions: A high proportion of patients with difficult asthma clinic have BQ. Usually these BQ are bilateral and cylindrical and the patients with BQ present worse respiratory functional state. Bhalla total score correlated with the presence of bacterial colonization and the number of exacerbations

Reduced expression of galectin-1 and galectin-9 by leucocytes in asthma patients.

Accumulating evidence shows that galectins play roles in the initiation and resolution phases of inflammatory responses by promoting anti- or proinflammatory effects. This study investigated the presence of three members of the galectin family (galectin-1, -3 and -9) in induced sputum samples of asthma patients, as well as their possible implication in the immunopathogenesis of human asthma. Levels of interleukin (IL)-5, IL-13, and galectins were determined in leucocytes isolated from induced sputum samples by reverse transcription-polymerase chain reaction (RT-PCR) immunofluorescence and flow cytometry. High levels of IL-5 and IL-13 mRNA were detected in sputum cells from asthma patients. In parallel, immunoregulatory proteins galectin-1 and galectin-9 showed a reduced expression on macrophages from sputum samples compared with cells from healthy donors. In-vitro immunoassays showed that galectin-1 and galectin-9, but not galectin-3, are able to induce the production of IL-10 by peripheral blood mononuclear cells from healthy donors. These findings indicate that macrophages from sputum samples of asthma patients express low levels of galectin-1 and galectin-9, favouring the exacerbated immune response observed in this disease.

Mujer joven con infecciones respiratorias de repetición / Young woman with recurrent respiratory infections

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