Palabras clave
Enfermedad respiratoria exacerbada por asma
Aspirina
Desensibilización
Cómo citar
Plaudit
Resumen
Antecedentes: La enfermedad respiratoria exacerbada por aspirina (EREA) es un fenotipo de asma que conlleva un alto costo e importante carga para los sistemas de salud.
Objetivo: Determinar los conocimientos y actitudes hacia la EREA en médicos ecuatorianos.
Métodos: Estudio observacional descriptivo. Se elaboró un cuestionario acerca de los conocimientos sobre la enfermedad y la actitud hacia ella (confianza en el tratamiento e importancia de la EREA, medidas con una escala de Likert). Las respuestas sobre conocimiento se dicotomizaron en correctas e incorrectas; la actitud se calificó como alta o baja. Se obtuvo media y porcentaje; con c2 se compararon las respuestas de los médicos con o sin especialidad.
Resultados: Participaron 118 médicos. La edad fue de 41.3 ± 11.7 años; 48.3 % era especialista. Menos de 50 % contestó correctamente las preguntas sobre conocimiento. Los especialistas obtuvieron más respuestas correctas respecto a los primeros síntomas, prevalencia y sobreproducción de leucotrienos (67.9, 46.3 y 90.7 %), al compararlos con los médicos generales (45, 25 y 74.6 %) (p < 0.05). Más de 70 % de los médicos indicó alta confianza en la identificación de pacientes con EREA. No hubo diferencias significativas en las actitudes (p > 0.05).
Conclusión: Se deben desarrollar programas de educación médica para mejorar el conocimiento acerca de la EREA.
Referencias
Fahrenholz JM. Natural history and clinical features of aspirin-exacerbated respiratory disease. Clin Rev Allergy Immunol. 2003;24(2):113-124. DOI: http://dx.doi.org/10.1385/CRIAI:24:2:113
Garcia-Cruz ML, Jimenez-Chobillon MA, Teran LM. Rhinosinusitis and aspirin-exacerbated respiratory disease. J Allergy. 2012 [internet];2012:8 pages. DOI; http://dx.doi.org/10.1155/2012/27375
Stevenson D, Szczeklik A. Clinical and pathologic perspectives on aspirin sensitivity and asthma. J Allergy Clin Immunol. 2006;118(4):773-786. DOI: http://dx.doi.org/10.1016/j.jaci.2006.07.024
Varghese M, Lockey RF. Aspirin-exacerbated asthma. Allergy Asthma Clin Immunol. 2008;4(2):75-83. DOI: http://dx.doi.org/10.1186/1710-1492-4-2-75
Berges-Gimeno MP, Simon RA, Stevenson DD. The natural history and clinical characteristics of aspirin-exacerbated respiratory disease. Ann Allergy Asthma Immunol. 2002;89(5):474-478. DOI: http://dx.doi.org/10.1016/S1081-1206(10)62084-4
Szczeklik A, Nizankowska E, Duplaga M. Natural history of aspirin-induced asthma. AIANE Investigators. European Network on Aspirin-Induced Asthma. Eur Respir J. 2000;16(3):432-436. Disponible en: http://erj.ersjournals.com/content/16/3/432.long
Jenkins C, Costello J, Hodge L. Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice. BMC. 2004;328(7437):434. DOI: http://dx.doi.org/10.1136/bmj.328.7437.434
Mullol J, Picado C. Rhinosinusitis and nasal polyps in aspirin-exacerbated respiratory disease. Immunol Allergy Clin North Am. 2013;33(2):163-176. DOI: http://dx.doi.org/10.1016/j.iac.2012.11.002
Rajan JP, Wineinger NE, Stevenson DD, White AA. Prevalence of aspirin-exacerbated respiratory disease among asthmatic patients: A meta-analysis of the literature. J Allergy Clin Immunol. 2015;135(3):676-681.e1. DOI: http://dx.doi.org/10.1016/j.jaci.2014.08.020
Cahill KN, Boyce JA. Aspirin-exacerbated respiratory disease: Mediators and mechanisms of a clinical disease. J Allergy Clin Immunol. DOI: http://dx.doi.org/10.1016/j.jaci.2016.09.025
Steinke JW, Wilson JM. Aspirin-exacerbated respiratory disease: Pathophysiological insights and clinical advances. J Asthma Allergy. 2016;9:37-43. DOI https://doi.org/10.2147/JAA.S88739
Sakalar EG, Muluk NB, Kar M, Cingi C. Aspirin-exacerbated respiratory disease and current treatment modalities. Eur Arch Oto-Rhino-Laryngology. DOI: http://dx.doi.org/doi:10.1007/s00405-016-4273-1
Stevenson DD. Aspirin sensitivity and desensitization for asthma and sinusitis. Curr Allergy Asthma Rep. 2009;9(2):155-163. DOI: http://dx.doi.org/10.1007/s11882-009-0023-4
Nizankowska E, Bestyńska-Krypel A, Ćmiel A, Szczeklik A. Oral and bronchial provocation tests with aspirin for diagnosis of aspirin-induced asthma. Eur Respir J. 2000;15(5):863-869. Disponible en: http://erj.ersjournals.com/content/15/5/863.long
Parikh A, Scadding GK. Intranasal lysine-aspirin in aspirin-sensitive nasal polyposis: A controlled trial. Laryngoscope. 2005;115(8):1385-1390. DOI: http://dx.doi.org/10.1097/01.MLG.0000166702.38850.1B
Rolla G, Di Emanuele A, Dutto L, Marsico P, Nebiolo F, Corradi F, et al. Effect of inhalation aspirin challenge on exhaled nitric oxide in patients with aspirin-inducible asthma. Allergy Eur J Allergy Clin Immunol. 2004;59(8):827-832. DOI: http://dx.doi.org/10.1111/j.1398-9995.2004.00502.x
Lee-Sarwar K, Johns C, Laidlaw TM, Cahill KN. Tolerance of daily low-dose aspirin does not preclude aspirin-exacerbated respiratory disease. J Allergy Clin Immunol Pract. 2015;3(3):449-451. DOI: http://dx.doi.org/10.1016/j.jaip.2015.01.007
Le Pham D, Lee J-H, Park H-S. Aspirin-exacerbated respiratory disease: An update. Curr Opin Pulm Med. 2016;23(1):89-96. DOI: http://dx.doi.org/10.1097/MCP.0000000000000328
Buchheit K, Laidlaw T. Management of AERD. Allergy Asthma Immunol Res. 2016;8(4):298-304. DOI: http://dx.doi.org/10.4168/aair.2016.8.4.298 %5Cnhttp://e-aair.org
Szczeklik A, Nizankowska E. Clinical features and diagnosis of aspirin induced asthma. Thorax. 2000;55 Suppl 2:S42-S44. DOI: http://dx.doi.org/10.1136/thorax.55.suppl_2.S42
Heaney LG, Brightling CE, Menzies-Gow A, Stevenson M, Niven RM; British Thoracic Society Difficult Asthma Network. Refractory asthma in the UK: Cross-sectional findings from a UK multicentre registry. Thorax. 2010;65(9):787-794. DOI: http://dx.doi.org/10.1136/thx.2010.137414
Settipane R, Stevenson DD. Cross sensitivity aspirin-sensitive with acetaminophen in subjects with asthma. J Allergy Clin Immunol. 1989;84:26-33. DOI: http://dx.doi.org/10.1016/0091-6749(89)90174-7
Kong JSW, Teuber SS, Gershwin ME. Aspirin and nonsteroidal anti-inflammatory drug hypersensitivity. Clin Rev Allergy Immunol. 2007;32(1):97-110.
Barranco P, Bobolea I, Larco JI, Prior N, López-Serrano MC, Quirce S. Diagnosis of aspirin-induced asthma combining the bronchial and the oral challenge tests: A pilot study. J Investig Allergol Clin Immunol. 2009;19(6):446-452. Disponible en: http://www.jiaci.org/summary/vol19-issue6-num528
Schaper C, Noga O, Koch B, Ewert R, Felix SB, Glaser S, et al. Anti-inflammatory properties of montelukast, a leukotriene receptor antagonist in patients with asthma and nasal polyposis. J Investig Allergol. 2011;21(1):51-58. DOI: http://www.jiaci.org/summary/vol21-issue1-num690
Graefe H, Roebke C, Schäfer D, Meyer JE. Aspirin sensitivity and chronic rhinosinusitis with polyps: a fatal combination. J Allergy. 2012;2012:1-10. DOI: http://dx.doi.org/10.1155/2012/817910
Stevens WW, Peters AT, Suh L, Norton JE, Kern RC, Conley DB, et al. A retrospective, cross-sectional study reveals that women with CRSwNP have more severe disease than men. Immun Inflamm Dis. 2015;3(1):14-22. DOI: http://dx.doi.org/10.1002/iid3.46
Chipps BE, Zeiger RS, Dorenbaum A, Borish L, Wenzel SE, Miller DP, et al. Assessment of asthma control and asthma exacerbations in the epidemiology and natural history of asthma: outcomes and treatment regimens (TENOR) observational cohort. Curr Respir Care Rep. 2012;1(4):259-269. DOI: http://dx.doi.org/10.1007/s13665-012-0025-x
The ENFUMOSA cross-sectional European multicentre study of the clinical phenotype of chronic severe asthma. European Network for Understanding Mechanisms of Severe Asthma. Eur Respir J. 2003;22(3):470-477. DOI: http://dx.doi.org/10.1183/09031936.03.00261903
Chang JE, White A, Simon RA, Stevenson DD. Aspirin-exacerbated respiratory disease: Burden of disease. Allergy Asthma Proc. 2012;33(2):117-121. DOI: http://dx.doi.org/10.2500/aap.2012.33.3541.
Chipps BE, Zeiger RS, Borish L, Wenzel SE, Yegin A, Hayden M Lou, 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(2):332-342.e10. DOI: http://dx.doi.org/10.1016/j.jaci.2012.04.014
Erdogan T, Karakaya G, Kalyoncu AF. Comorbid diseases in aspirin-exacerbated respiratory disease, and asthma. Allergol Immunopathol (Madr). 2015;43(5):442-448. DOI: http://dx.doi.org/10.1016/j.aller.2014.07.008.
Bochenek G, Szafraniec K, Kuschill-Dziurda J, Nizankowska-Mogilnicka E. Factors associated with asthma control in patients with aspirin-exacerbated respiratory disease. Respir Med. 2015;109(5):588-595. DOI: http://dx.doi.org/10.1016/j.rmed.2015.02.015
Cherrez Ojeda I, Jeffe DB, Guerrero T, Mantilla R, Santoro I, Gabino G, et al. Attitudes and knowledge about obstructive sleep apnea among Latin American primary care physicians. Sleep Med. 2013;14(10):973-937. DOI: http://dx.doi.org/10.1016/j.sleep.2013.06.005.
Rolla G, Heffler E. Aspirin-exacerbated asthma: Avoiding challenge is still challenging. Int Arch Allergy Immunol. 2012;158(3):213-215. DOI: http://dx.doi.org/10.1159/000333096.
Simon RA, Dazy KM, Waldram JD. Update on aspirin desensitization for chronic rhinosinusitis with polyps in aspirin-exacerbated respiratory disease (AERD). Curr Allergy Asthma Rep. 2015;15(3):508. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/25663486
Ibrahim C, Singh K, Tsai G, Huang D, Mazza J, Rotenberg B, et al. A retrospective study of the clinical benefit from acetylsalicylic acid desensitization in patients with nasal polyposis and asthma. Allergy Asthma Clin Immunol. 2014;10(1):64. DOI: http://dx.doi.org/10.1186/s13223-014-0064-7
Klimek L, Dollner R, Pfaar O, Mullol J. Aspirin desensitization: Useful treatment for chronic rhinosinusitis with nasal polyps (CRSwNP) in aspirin-exacerbated respiratory disease (AERD)? Curr Allergy Asthma Rep. 2014;14(6):441. DOI: http://dx.doi.org/10.1007/s11882-014-0441-9
Fruth K, Pogorzelski B, Schmidtmann I, Springer J, Fennan N, Fraessdorf N, et al. Low-dose aspirin desensitization in individuals with aspirin-exacerbated respiratory disease. Allergy. 2013;68(5):659-665. DOI: http://dx.doi.org/10.1111/all.12131
Dahlén SE, Malmström K, Nizankowska EWA, Dahlén B, Kuna P, Kowalski M, et al. Improvement of aspirin-intolerant asthma by montelukast, a leukotriene antagonist: A randomized, double-blind, placebo-controlled trial. Am J Respir Crit Care Med. 2002;165(1):9-14. DOI: http://dx.doi.org/10.1164/ajrccm.165.1.2010080
Israel E, Fischer AR, Rosenberg MA, Lilly CM, Callery JC, Shapiro J, et al. The pivotal role of 5-lipoxygenase products in the reaction of aspirin-sensitive asthmatics to aspirin. Am Rev Respir Dis. 1993;148(6 Pt 1):1447-1451. DOI: http://dx.doi.org/10.1164/ajrccm/148.6_Pt_1.1447
Ta V, White AA. Survey-defined patient experiences with aspirin-exacerbated respiratory disease. J Allergy Clin Immunol Pract. 2015;3(5):711-718. DOI: http://dx.doi.org/10.1016/j.jaip.2015.03.001
Macy E, Bernstein JA, Castells MC, Gawchik SM, Lee TH, Settipane RA, et al. Aspirin challenge and desensitization for aspirin-exacerbated respiratory disease: A practice paper. Ann Allergy Asthma Immunol. 2007;98(2):172-174. DOI: http://dx.doi.org/10.1016/S1081-1206(10)60692-8
Sturm JM, Temprano J. A survey of physician practice and knowledge of drug allergy at a university medical center. J Allergy Clin Immunol Pract. 2014;2(4):461-464. DOI: http://dx.doi.org/10.1016/j.jaip.2014.02.004
Kenny SJ, Smith PJ, Goldschmid MG, Newman JM, Herman WH. Survey of physician practice behaviors related to diabetes mellitus in the U.S. Physician adherence to consensus recommendations. Diabetes Care. 1993;16(11):1507-1510.
Strohl KP. Sleep medicine training across the spectrum. Chest. 2011;139(5):1221-1231. DOI: http://dx.doi.org/10.1378/chest.10-0783
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