BRONCHIAL ASTHMA : Update on the Revised Guidelines for Diagnosis and Management - 08/09/11

Doi : 10.1016/S0095-4543(05)70092-0

J. Andrew Grant, MD ^{^{*
Allergy and Immunology Division, Department of Medicine, University of Texas Medical Branch–Galveston, Galveston, Texas}}

Resumen

Bronchial asthma can be defined in a number of ways, and these are summarized below.

Definition of bronchial asthma * * Adapted from Expert Panel Report 2: Guidelines for the diagnosis and management of asthma. Washington DC; 1997. National Institutes of Health Publication 97–4051

1	Cardinal symptoms (recurrent episodes of wheezing, dyspnea, chest tightness, or cough, especially at night or in the early morning).
2	Widespread but variable airflow obstruction that often is reversible either spontaneously or with treatment. The gold standard is increase in FEV1 of 12% and at least 200 mL with a bronchodilator or a short course of anti-inflammatory therapy.
3	Hyper-responsiveness to a variety of stimuli, both allergic and nonallergic. The diagnostic test for this parameter is an exaggerated bronchoconstrictive response to inhalation of increasing concentrations of methacholine or histamine. A positive response in a decrease in FEV₁ of at least 20% after inhalation of methacholine at a concentration of 8 mg/mL or less.
4	Chronic inflammatory disorder with infiltration by eosinophils, monocytes, lymphocytes, and basophils.

Clinically, bronchial asthma is a disorder characterized by recurrent symptoms of wheezing, cough, dyspnea, and chest tightness, especially at night or early in the morning. The patient may have one or more of these symptoms. From a physiologic viewpoint, asthma has been defined as reversible airways obstruction, with demonstration of improvement in forced expiratory volume in 1 second (FEV₁) of at least 12% and more than 200 mL spontaneously or with therapy. Asthmatics often complain of hyper-responsiveness to a variety of immunologic and nonimmunologic triggers. This hyper-reactivity is documented in the laboratory by the methacholine challenge procedure. From an anatomic viewpoint, asthma is characterized as peribronchial inflammation, with infiltration by eosinophils, monocytes, lymphocytes, and basophils.

Asthma affects at least 15 million Americans and is the most common, chronic disease in children. Asthma is a major cause of physician and emergency department visits and hospitalizations, and morbidity statistics seem on the rise. In the United States, at least 5000 deaths are attributed annually to asthma. There is evidence that the impact of the disease is significantly more severe among young African-Americans.

Because of the national concern for these bleak statistics, an initial, expert panel was organized in 1990.^{15 Expert Panel Report 2: Guidelines for the diagnosis and management of asthma Washington, DC: National Institutes of Health publication (1997). 97–4051.

Haga clic aquí para ir a la sección de Referencias} The first Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma (EPR-1) was published in 1991. This document stimulated two international reports and additional documents on asthma management.^{33 Spector S.L., Nicklas R.A. Practice parameters for the diagnosis and treatment of asthma J Allergy Clin Immunol 1995 ; 96 : 707-870

Haga clic aquí para ir a la sección de Referencias} The Expert Panel Report 2 (EPR-2)^{15 Expert Panel Report 2: Guidelines for the diagnosis and management of asthma Washington, DC: National Institutes of Health publication (1997). 97–4051.

Haga clic aquí para ir a la sección de Referencias} was published in 1997. This article reviews the major points of this important new document. These clinical practice guidelines should be useful for both primary care and specialty physicians who manage patients with asthma. The EPR-2 is based on a thorough review of the literature as well as the consensus of a quite diverse committee. It is anticipated that the EPR-2 may increase the number of physician visits and use of drugs and devises; however, the overall health of asthma sufferers should be improved, and costs related to lost work and school days, hospitalizations and emergent visits, and premature mortality should be reduced.

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Esquema

Address reprint requests to J. Andrew Grant, MD, Allergy and Immunology Division, 301 University Boulevard, Clinical Sciences Building #409, Galveston, TX 77555–0762, e-mail: Andrew.Grant@UTMB.edu
Adapted from Expert Panel Report 2: Guidelines for the diagnosis and management of asthma. Washington DC; 1997. National Institutes of Health Publication 97–4051