Asma en el adulto: características clínicas, comorbilidades y riesgo para apnea obstructiva de sueño
DOI:
https://doi.org/10.53732/rccsalud/2023.e5111Palabras clave:
asma, comorbilidad, apnea obstructiva del sueñoResumen
Introducción: Escasos reportes sobre asma existen en la literatura nacional. El objetivo del estudio es describir ciertas características clínicas, las comorbilidades y el riesgo para apnea obstructiva del sueño (AOS) en este colectivo. Material y métodos: Mediante un estudio observacional tipo caso-control, se incluyeron pacientes portadores de asma de ambos sexos y un grupo control pareado por sexo y edad. Se consignaron datos demográficos, características de la enfermedad, datos relativos al control del asma y espirometría, comorbilidades y riesgo de apnea de sueño medido por el cuestionario STOP-BANG durante una entrevista estructurada. Resultados: Se incluyeron 132 individuos en el grupo caso y 132 en el grupo control. Entre los asmáticos, se consignaron 38,63% de formas no controladas y 9% severas. También se constató mayor frecuencia de hipertensión arterial, obesidad, rinitis alérgica y trastornos de la memoria. Riesgo mayor para AOS, aunque no significativo, se consignó en el grupo de casos. En el subgrupo de asmáticos con obesidad o en adultos mayores, la diferencia fue estadísticamente significativa- Discusión: Aun disponiendo de medicamentos preventivos, la tasa de control de los asmáticos en esta muestra es llamativa y merece estudios sistemáticos. Es extremadamente importante tener en cuenta algunas comorbilidades para el manejo de este grupo de pacientes, incluyendo la estratificación de riesgo para AOS.
Citas
The Global Asthma Report. Int J Tuberc Lung Dis 2022; 26; S1-S102. http://globalasthmareport.org/resources/Global_Asthma_Report_2022.pdf
Asthma. World Health Organization. 2022. https://www.who.int/news-room/fact-sheets/detail/asthma
Keezer MR, Sander JW. Comorbidity as an epidemiological construct. Lancet Neurol. 2016;15(1):32. 10.1016/S1474-4422(15)00352-X
Gottlieb D, Punjabi N. Diagnosis and Management of Obstructive Sleep Apnea A Review. JAMA. 2020;323(14):1389-1400. 10.1001/jama.2020.3514
Teodorescu M, Polomis DA, Hall SV, Xie A, Sorkness CA, Jarjour N, et al. Association of Obstructive Sleep Apnea Risk with Asthma Control in Adults. Chest. 2010;138(3):543–550. 10.1378/chest.09-3066
Vandenbroucke JP, von Elm E, Altman DG Gøtzsche PC, Mulrow CD, Pocock SJ, et al. STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. I J Surg. 2014;12(12):1500-1524. 10.1016/j.ijsu.2014.07.014
Auckley D, Moallem M, Shaman Z, Mustafa M. Findings of a Berlin Questionnaire survey: Comparison between patients seen in an asthma clinic versus internal medicine clinic. Sleep Med Rev. 2008; 9(5):494-499. 10.1016/j.sleep.2007.06.010
Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, et al. Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Med Rev. 2017;34:70-81. 10.1016/j.smrv.2016.07.002
Chung K, Wenzel S, Brozek J, Bush A, Castro M, Sterk P, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J. 2014; 43(2):343–373. 10.1183/09031936.00202013
Chung F, Abdullah HR, Liao P. STOP-BANG Questionnaire: A Practical Approach to Screen for Obstructive Sleep Apnea. Chest. 2016;149(3):631-8. 10.1378/chest.15-0903
Chowdhury NU, Guntur VP, Newcomb DC, Wechsler ME. Sex and gender in asthma. EurRespir Rev. 2021;30(162):210067. 10.1183/16000617.0067-2021
Skloot GS, Busse PJ, Braman SS, Kovacs Ej, Dixon AN, Vaz Fragoso CA, et al. An Official American Thoracic Society Workshop Report: Evaluation and Management of Asthma in the Elderly. Ann Am Thorac Soc. 2016;13(11):2064-2077. 10.1513/AnnalsATS.201608-658ST
Thomas ET, Guppy M, Straus SE, Bell KJ, Glasziou P. Rate of normal lung function decline in ageing adults: a systematic review of prospective cohort studies. BMJ Open. 2019;9(6):e028150. 10.1136/bmjopen-2018-028150
Louis R, Satia I, Ojanguren I, Schleich F, Bonini M, Tonia T, et al. European Respiratory Society Guidelines for the Diagnosis of Asthma in Adults. Eur Respir J. 2022;60(3):(2101585). 10.1183/13993003.01585-2021
Alith MB, Gazzotti MR, Nascimento OA, Jardim JR. Impact of asthma control on different age groups in five Latin American countries. World Allergy Organ J. 2020;13(4):100113. 10.1016/j.waojou.2020.100113
Sastre J, Fabbri LM, Price D, Ulrich Wahn H, Bousquet J, Fish JE, et al. Insights, attitudes, and perceptions about asthma and its treatment: a multinational survey of patients from Europe and Canada. World Allergy Organ J. 2016;9(13). 10.1186/s40413-016-0105-4
Neffen H, Moraes F, Viana K, Di Biosco V, Levy G, Vieira C, et al. Asthma severity in four countries of Latin America. BMC Pulm Med. 2019;19(1):123. 10.1186/s12890-019-0871-1
Wang E, Wechsler ME, Tran TN, Heaney LG, Jones RC, Menzies-Gow AN, et al. Characterization of Severe Asthma Worldwide: Data From the International Severe Asthma Registry. Chest Journal. 2020;157(4):790-804. 10.1016/j.chest.2019.10.053
Radhakrishna N, Tay TR, Hore-Lacy F, Stirling R, Hoy R, Dabscheck E, et al. Validated questionnaires heighten detection of difficult asthma comorbidities. J Asthma. 2017;54(3):294-299. 10.1080/02770903.2016.1212369
Patel GB, Peters AT. Comorbidities associated with severe asthma. J Precis Respir Med. 2019;2(1):5-9. 10.2500/jprm.2019.190006
Tomisa G, Horváth A, Sánta B, Keglevich A, Tamási L. Epidemiology of comorbidities and their association with asthma control. Allergy Asthma ClinImmunol. 2021; 17(1):95. 10.1186/s13223-021-00598-3
Kankaanranta H, Kauppi P, Tuomisto LE, Ilmarinen P. Emerging Comorbidities in Adult Asthma: Risks, Clinical Associations, and Mechanisms. Mediators Inflamm. 2016;3690628. 10.1155/2016/3690628
Dogra S, Ardern CI, Baker J. The relationship between age of asthma onset and cardiovascular disease in canadians. J. Asthma. 2007; 44(10):849–854. 10.1080/02770900701752391
Christiansen SC, Schatz M, Yang SJ, Ngor E, Chen W, Zuraw BL. Hypertension and asthma: A comorbid relationship. J. Allergy Clin. Immunol. In Pract. 2016;4(1):76–81. 10.1016/j.jaip.2015.07.009
Johnson M, Nriagu J, Hammad A, Savoie K, Jamil H. Asthma, environmental risk factors, and hypertension among arab-americans in metro detroit. J. Immigr. Minor. Heal. 2010; 12:640-651. 10.1007/s10903-008-9205-8
Ferguson S, Teodorescu MC, Gangnon RE, Andrea G. Peterson, Consens FB, Chervin RD, Teodorescu M. Factors associated with systemic hypertension in asthma. Lung. 2014; 192, 675–683. 10.1007/s00408-014-9600-y
Zolotareva O, Saik OV, Königs C, Bragina EY, Goncharova IA, Freidin MB. Comorbidity of asthma and hypertension may be mediated by shared genetic dysregulation and drug side effects. Sci Rep. 2019;9(1):16302. 10.1038/s41598-019-52762-w
Christiansen SC, Zuraw BL. Treatment of Hypertension in Patients with Asthma. N Engl J Med. 2019; 381(11):1046-1057. https://pubmed.ncbi.nlm.nih.gov/31509675/
Gibeon D, Batuwita K, Osmond M, Heaney LG, Brightling CE, Niven R, et al. Obesity-associated severe asthma represents a distinct clinical phenotype: analysis of the British Thoracic Society Difficult Asthma Registry Patient cohort according to BMI. Chest. 2013;143(2):406-414. 10.1378/chest.12-0872
Jacob L, Keil T, Kostev K. Comorbid disorders associated with asthma in children in Germany - National analysis of pediatric primary care data. Pediatr Allergy Immunol. 2016;27(8):861-866. 10.1111/pai.12656
Boulet LP, Boulay MÈ. Asthma-related comorbidities. Expert Rev Respir Med. 2011;5(3):377-93. https://pubmed.ncbi.nlm.nih.gov/21702660/
Michalovich D, Rodriguez-Pérez N, Smolinska S, Pirozynski M, Mayhew D, Uddin S. Obesity and disease severity magnify disturbed microbiome-immune interactions in asthma patients. Nat Commun. 2019;10(1):5711. 10.1038/s41467-019-13751-9
Tashiro H, Takahashi K, Kurihara Y, Sadamatsu H, Kuwahara Y, Tajiri R, et al. Obesity affects pulmonary function in Japanese adult patients with asthma, but not those without asthma. Sci Rep. 2022;12(1):16457. 10.1038/s41598-022-20924-y
Okoniewski W, Lu KD, Forno E. Weight Loss for Children and Adults with Obesity and Asthma. A Systematic Review of Randomized Controlled Trials. Ann Am Thorac Soc. 2019; 16(5):613-625. https://pubmed.ncbi.nlm.nih.gov/30605347/
Togias A. Rhinitis and asthma: evidence for respiratory system integration. J Allergy Clin Immunol. 2003;111(6):1171-83. 10.1067/mai.2003.1592
Urrutia-Pereira M, Fernández C, Valentin-Rostan M, Cruz A, Torres O, Simon L, et al. Conocimiento de médicos de atención primaria sobre Rinitis Alérgica y su Impacto en el Asma (ARIA): estudio piloto comparativo Brasil, Paraguay, Uruguay.
Rev Alerg Mex. 2018; 65(4):321-330. 10.29262/ram.v65i4.525
de Groot EP, Duiverman EJ, Brand PL. Comorbidities of asthma during childhood: possibly important, yet poorly studied. Eur Respir J. 2010;36(3):671-8. 10.1183/09031936.00185709
Creavin ST, Cullum SJ, Haworth J, Wye L, Bayer A, Fish M, et al. Towards improving diagnosis of memory loss in general practice: TIMeLi diagnostic test accuracy study protocol. BMC Fam Pract. 2016;17:79. 10.1186/s12875-016-0475-2
Irani F, Barbone JM, Beausoleil J, Gerald L. Is asthma associated with cognitive impairments? A meta-analytic review. J Clin Exp Neuropsychol. 2017;39(10):965-978. https://pubmed.ncbi.nlm.nih.gov/28325118/
Lu H, Fu C, Li W, Jiang H, Xiaodan Wu X, Li S. Screening for obstructive sleep apnea syndrome in asthma patients: a prospective study based on Berlin and STOP-Bang questionnaires. J Thorac Dis. 2017;9(7):1945-1958. 10.21037/jtd.2017.06.03
Teodorescu M, Barnet JH, Hagen EW, Palta M, Young T, Peppard P. Association between asthma and risk of developing obstructive sleep apnea. JAMA. 2015;313(2):156-64. 10.1001/jama.2014.17822
Tiotiu A, Plavec D, Novakova S, Mihaicuta S, Novakova P, Labor M, et al. Current opinions for the management of asthma associated with ear, nose and throat comorbidities. EurRespir Rev. 2018;27(150):180056. 10.1183/16000617.0056-2018
Alkhalil M, Schulman ES, Getsy J. Obstructive sleep apnea syndrome and asthma: the role of continuous positive airway pressure treatment. Ann Allergy Asthma Immunol. 2008 Oct; 101(4):350-7. 10.1016/S1081-1206(10)60309-2
Lin CMA, Ng N, Orman A, Clement ND, Deehan DJ. Reliability of patient-reported comorbidities: a systematic review and meta-analysis. Postgrad Med J. 2021;99(1169):127-138. 10.1136/postgradmedj-2021-140857.
Kaplan A, Szefler SJ, Halpin DMG. Impact of comorbid conditions on asthmatic adults and children. NPJ Prim Care Respir Med. 2020;30(1):36. 10.1038/s41533-020-00194-9.
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