FACTORES DE RIESGO PARA MAL CONTROL DE ASMA EN ADULTOS

Guillermo Velázquez Sámano

Resumen


Antecedentes: estudios en niños han identificado factores asociados con el asma parcialmente controlado o no controlado. En adultos, los factores relacionados con el control del asma no estaban bien definidos.

Objetivo: encontrar factores relacionados con el asma parcialmente o no controlado en adultos.

Métodos: Incluimos adultos asmáticos, clasificados como controlados, parcialmente controlados y no controlados (GINA). Se compararon los factores de riesgo entre los grupos de pacientes con asma controlados y parcialmente controlados / no controlados.

Resultados: incluimos 200 pacientes (75.5% mujeres), 100 (50%) grupo control y 100 (50%) con asma no controlado y parcialmente controlado. Edad promedio de 38,4 ± 11,93 años. Para la gravedad del asma se encontraron: 35 (88,2%) persistencia leve, 14 (10%) persistencia moderada y 97 (1,8%) persistencia grave. La no presencia de estrés arrojó un OR 0.41 (IC95%0.23-0.75) p=0.03; tabaquismo activo OR de 4.23 (IC 95%1.35-13.2) p=0.007. Los pacientes que no tienen contacto con peluches ni alfombras OR 0.4 (IC95%0.2-0.79). Los pacientes que utilizan correctamente sus inhaladores OR 0.36 (IC95%0.13-0.97) p=0.031.

Conclusiones: se observó asociación como factor de riesgo al tabaquismo actual y activo y con la dermatitis atópica. Como factor de protección, a los niveles normales de eosinófilos en sangre, uso correcto de inhaladores, VEF1 mayor a 80%, la no presencia de estrés y la ausencia de contacto con alfombras y peluches.

Palabras clave


asma, adultos, control, GINA, factores de riesgo

Referencias


- Prosser R, Carleton B, Smith A. The comorbidity burden of the treated asthma patient population in British Columbia. Chronic Dis. Can. 2010. 30, 46–55

- Platts-Mills TAE, Erwin EA, Heymann PW, Woodfolk JA. Pro: the evidence for a causal role of dust mites in asthma. Am J Respir Crit Care Med. 2009;180:109–121

- Tovey E, Ferro A. Time for new methods for avoidance of house dust mite and other allergens. Curr Allergy Asthma Rep. 2012;12:465–477

- Gershon AS, Wang C, Guan J, To T. Burden of comorbidity in individuals with asthma. Thorax. 2010. 65, 612–618

- Global Initiative for Asthma (GINA) 2018. Global strategy for asthma management and prevention. Available from: http://www.ginasthma.org/. Revisado el 4 de Junio de 2018.

- National Asthma Education and Prevention Program. Expert Panel Report 3. Guidelines for the diagnosis and management of asthma. Bethesda (MD): Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute; 2007. Revisado el 4 de Junio de 2014.

- British Thoracic Society, Scottish Intercollegiate Guidelines Network (SIGN). British guideline on the management of asthma. SIGN Guideline No 101. Edinburgh: Revisado; 2014.

- Cazzola M, Calzetta L, Bettoncelli G et al. Asthma and comorbid medical illness. Eur Respir J. 2011 Jul;38(1):42-9

- Antunes J, Fernandes A, Miguel Borrego L, et al. Cystic fibrosis, atopy, asthma and ABPA. Allergol Immunopathol (Madr) 2010;38:278–84

- Vandenplas O, Dramaix M, Joos G et al. The impact of concomitant rhinitis on asthma-related quality of life and asthma control. Allergy. 2010. 65, 1290–1297

- Thilsing, T., Rasmussen, J., Lange, B., et al. 2012, Chronic rhinosinusitis and occupational risk factors among 20- to 75 year-old Danes—A GA2LEN-based study. Am. J. Ind. Med., 55: 1037–1043

- Jarvis D, et al. Asthma in adults and its association with chronic rhinosinusitis: The GA2LEN survey in Europe. Allergy 2012; 67: 91–98. Allergy, 67: 91–98

- Franco-Marina F, Fernandez-Plata R, Torre-Bouscoulet L, et al. Efficient screening for COPD using three steps: a cross-sectional study in Mexico City. NPJ Prim Care Respir Med. 2014 May 20;24:14002

- Abramson MJ, Puy RM, Weiner JM. Injection allergen immunotherapy for asthma. Cochrane Database Syst Rev. 2010;(8):CD001186

- Chipps BE, Zeiger RS, Borish L, et al. Key findings and clinical implications from the Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study. J Allergy Clin Immunol 2012;130:332-42.e10.

- Harris M, Lundien M, Finnie D, et al. Application of a novel socioeconomic measure using individual housing data in asthma research: an exploratory study. NPJ Prim Care Respir Med. 2014 Jun 26;24:14018

- Halimi L, Pry R, Pithon G, et al. Severe asthma and adherence to peak flow monitoring: longitudinal assessment of psychological aspects. J Psychosom Res 2010;69:331-40.

- Just J, Gouvis-Echraghi R, Couderc R, et al. Novel severe wheezy young children phenotypes: boys atopic multiple-trigger and girls nonatopic uncontrolled wheeze. J Allergy Clin Immunol 2012;130: 103-10.e8.

- Sánchez J, Diez S, Cardona R. Frequency of sensitization to animals in a tropical area. Rev Alerg Mex. 2014 Apr-Jun;61(2):81

- Brozek JL, Bousquet J, Baena-Cagnani CE, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010;126:466–476

- Bousquet J, Addis A, Adcock I, et al. Integrated care pathways for airway diseases (AIRWAYS-ICPs). Eur Respir J. 2014 Jun 12. pii: erj00146-2014

- Portelli MA, Hodge E, Sayers I. Genetic risk factors for the development of allergic disease identified by genome wide association. Clin Exp Allergy. 2015 Jan;45(1):21-31. doi: 10.1111/cea.12327.

- Haldar P, Pavord ID, Shaw DE, et al. Cluster analysis and clinical asthma phenotypes. Am J Respir Crit Care Med 2008;178:218-24.

- Amelink M, de Nijs SB, Berger M, et al. Nonatopic males with adult onset asthma are at risk of persistent airflow limitation. Clin Exp Allergy 2012;42:769-74.

- Reponen T, Levin L, Zheng S, et al. Family and home characteristics correlate with mold in homes. Environ Res. 2013 Jul;124:67-70

- Eichenfield LF, Tom WL, Chamlin SL, et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol 2014;70:338

- Lai, Beasley, Crane, et al. The ISAAC Study Group. Thorax 2009;64:476

- Koh YY, Kim CK. Desarrollo de asma en pacientes con rinitis alérgica. Curr Opin Allergy Clin Immunol. 2003 Jun;3(3):159-64

- Reddel HK, Taylor DR, Bateman ED, et al. An official American Thoracic Society/European Respiratory Society statement: asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practice. Am J Respir Crit Care Med 2009; 180:59-99.




DOI: http://dx.doi.org/10.29262/ram.v65i1.557

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