Asma
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Transcript of Asma
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Dra. Yokary Mellado Ortiz R1MI
Profesor Titular: Dr. Enrique Díaz GreeneProfesor Adjunto: Dr. Federico Rodríguez WeberRevisor: Dr. Braulio Solano Estrada R2MI
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Mujer de 30 años de edad, administradora, con antecedente de asma de larga evolución. Durante la infancia acudió a urgencias en repetidas ocasiones pero nunca requirió hospitalización. Después de la pubertad no presentó exacerbaciones hasta hace cinco años con disnea de grandes esfuerzos. En ese entonces, era despertada una vez al mes debido al asma, pero nunca requirió acudir a urgencias. su médico le prescribió beclometasona, dos disparos (80 mcg por disparo) dos veces al día y salbutamol como rescate.
Kraft, Monica Treatment of Mild Persistent Asthma N Engl J Med 356;20 Mayo 2007
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Estable los últimos 4 años con éste tratamiento Espirometría:
VEF1 82% del valor predicho CVF 82% del valor predicho Relación VEF1/CVF 0.82
Sólo utiliza el salbutamol 2 o 3 veces a la semana como premedicación para el ejercicio
No tiene síntomas nocturnos No ha requerido acudir a visitas de urgencias
Kraft, Monica Treatment of Mild Persistent Asthma N Engl J Med 356;20 Mayo 2007
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La paciente acude a su consulta preguntándose si es posible recibir menos tratamiento para el asma
Está dispuesta a tolerar algunos síntomas si con ello puede prevenir efectos secundarios
Kraft, Monica Treatment of Mild Persistent Asthma N Engl J Med 356;20 Mayo 2007
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1. Cambiar el tratamiento a beclometasona y salbutamol sólo cuando la paciente presente síntomas
2. Cambiar el tratamiento a un antagonista de receptores de leucotrienos más rescates con salbutamol
3. Cambiar el tratamiento a un corticosteroide y un β2 agonista de larga duración en un inhalador único por las mañanas, más rescates con salbutamol
Kraft, Monica Treatment of Mild Persistent Asthma N Engl J Med 356;20 Mayo 2007
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Balkinson Asthma Overview Prim Care Clin Office Pract 35 (2008) 41–60
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Mathur et al Asthma: Diagnosis and Management Med Clin N Am 90 (2006) 39–60
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Masoli et al (editores) Global Burden of Asthma GINA 2004, www.ginasthma.com
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Masoli et al (editores) Global Burden of Asthma GINA 2004, www.ginasthma.com
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Masoli et al (editores) Global Burden of Asthma GINA 2004, www.ginasthma.com
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Masoli et al (editores) Global Burden of Asthma GINA 2004, www.ginasthma.com
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Masoli et al (editores) Global Burden of Asthma GINA 2004, www.ginasthma.com
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Masoli et al (editores) Global Burden of Asthma GINA 2004, www.ginasthma.com
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Masoli et al (editores) Global Burden of Asthma GINA 2004, www.ginasthma.com
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Masoli et al (editores) Global Burden of Asthma GINA 2004, www.ginasthma.com
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Masoli et al (editores) Global Burden of Asthma GINA 2004, www.ginasthma.com
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Masoli et al (editores) Global Burden of Asthma GINA 2004, www.ginasthma.com
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McKay et al Asthma N Engl J Med, Vol. 344, No. 5 · February 1, 2001
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McKay et al Asthma N Engl J Med, Vol. 344, No. 5 · February 1, 2001
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McKay et al Asthma N Engl J Med, Vol. 344, No. 5 · February 1, 2001
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Tilles Differential Diagnosis of Adult Asthma Med Clin N Am 90 (2006) 61–76
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Tilles Differential Diagnosis of Adult Asthma Med Clin N Am 90 (2006) 61–76
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GINA Complete Report 2009 http://www.ginasthma.org
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GINA Complete Report 2009 http://www.ginasthma.org
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GINA Complete Report 2009 http://www.ginasthma.org
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GINA Complete Report 2009 http://www.ginasthma.org
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GINA Complete Report 2009 http://www.ginasthma.org
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GINA Complete Report 2009 http://www.ginasthma.org
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Fanta Asthma: Drug therapy N Engl J Med 2009;360:1002-14
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Fanta Asthma: Drug therapy N Engl J Med 2009;360:1002-14
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Fanta Asthma: Drug therapy N Engl J Med 2009;360:1002-14
Fanta Asthma: Drug therapy N Engl J Med 2009;360:1002-14
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Fanta Asthma: Drug therapy N Engl J Med 2009;360:1002-14
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Fanta Asthma: Drug therapy N Engl J Med 2009;360:1002-14
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Fanta Asthma: Drug therapy N Engl J Med 2009;360:1002-14
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Kraft, Monica Treatment of Mild Persistent Asthma N Engl J Med 356;20 Mayo 2007
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210 pacientes Glucocorticoide inhalado: doble dosis vs bromuro de
ipatropio vs salmeterol Mejoró 25.8 l/min en PEF matutino, vespertino 35.3 l/min,
menos síntomas diarios -0.11 p>0.001 Tiotropio similar a salmeterol
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Kraft, Monica Treatment of Mild Persistent Asthma N Engl J Med 356;20 Mayo 2007
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Kraft, Monica Treatment of Mild Persistent Asthma N Engl J Med 356;20 Mayo 2007
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Kraft, Monica Treatment of Mild Persistent Asthma N Engl J Med 356;20 Mayo 2007
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Kraft, Monica Treatment of Mild Persistent Asthma N Engl J Med 356;20 Mayo 2007
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¡GRACIAS!