medigraphic.com
ISSN 1405-1699 (Impreso)
Órgano Oficial del Colegio Mexicano de Alergia, Asma e Inmunología Pediátrica y de la Asociación Latinoamericana de Pediatría

2004, Número 3

<< Anterior

Alerg Asma Inmunol Pediatr 2004; 13 (3)


Tratamiento de la crisis asmática en niños

Rubén Eduardo Vázquez García, José G Huerta López, Álvaro Pedroza, Mario Acosta Bastidas

Idioma: Español
Referencias bibliográficas: 96
Paginas: 109-119
Archivo PDF: 226.32 Kb.


RESUMEN

La crisis asmática es la emergencia médica más común en niños. Se asocia con una tasa de morbilidad y mortalidad significativa por lo que impone una tremenda carga social mundial. El manejo de la crisis asmática aguda involucra un acercamiento o terapia inicial que incluye Β2-agonistas y terapia esteroidea, los cuales son la esencia del tratamiento en el departamento de urgencias. La mayoría de los pacientes responderá a este régimen y podrán egresarse de la sala de urgencias. El fracaso para responder al tratamiento inicial hace necesario la admisión hospitalaria y a veces la admisión a la unidad del cuidado intensivo (UCI). El manejo en UCI involucra una terapia farmacológica más agresiva, incluso con terapéuticas no convencionales, en un esfuerzo por evitar la intubación e inicio de ventilación mecánica. Cuando sea necesario y como último recurso, puede darse apoyo ventilatorio mecánico con bastante seguridad y poca morbilidad si se usan estrategias ventilatorias apropiadas. En las últimas dos décadas, la disponibilidad de nuevos fármacos además de mejores equipos de monitorización y ventilación han producido una disminución en la morbilidad y mortalidad en la UCI. Por lo que el objetivo de este artículo de revisión es dar un acercamiento al manejo actual de la crisis asmática aguda.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. British Thoracic Society and others. Guidelines on the management of asthma. Thorax 1993; 48: S1-S24.

  2. British Thoracic Society, Research Unit of the Royal College of Physicians of London, King’s Fund Centre. National Asthma Campaign. Guidelines for management of asthma in adultsII-acute severe asthma. BMJ 1990; 301: 767-800.

  3. Guidelines for the management of asthma: a summary. BMJ 1993; 306: 776-82.

  4. International Consensus Report on the Diagnosis and Management of Asthma. Clin Exp Allergy 1992; 22: 1-72.

  5. National Heart, Lung, and Blood Institute. National Asthma Education and Prevention Program Expert Panel Report 2: Guidelines for the diagnosis and management of asthma. Publ No. 55-4051, Bethesda: National Institutes of Health; 1997.

  6. Nowak RM. National and international guidelines for the emergency management of adult asthma. In: Brenner BE, editors. Emergency asthma. New York: Marcel Dekker; 1999: 284-305.

  7. Greenberger PA, Miller TP, Lifschultz B. Circumstances surrounding deaths from asthma in Cook County (Chicago) Illinois. Allergy Asthma Proc 1993; 14: 321-6.

  8. Kallenbach JM, Frankel AH, Lapinsky SE et al. Determinants of near fatality in acute severe asthma. Am J Med 1993; 95: 265-72.

  9. O’Hallaren MT, Yunginger JW, Offord KP et al. Exposure to an aeroallergen as a possible precipitating factor in respiratory arrest in young patients with asthma. N Engl J Med 1991; 324: 359-63.

  10. Rodrigo G, Rodrigo C. Assessment of the patient with acute asthma in the emergency department: a factor analytic study. Chest 1993; 104: 1325-8.

  11. Suissa S, Blais L, Ernst P. Patterns of increasing beta-agonist use and the risk of fatal or near-fatal asthma. Eur Respir J 1994; 7: 1602-9.

  12. Tuxen DV, Anderson MB, Scheinkestel CD. Mechanical ventilation for severe asthma. In: Hall JB, Corbridge TC, Rodrigo C, editors. Acute asthma: assessment and management. New York: McGraw-Hill; 2000: 209-28.

  13. Wasserfallen J, Schaller M, Feihl F et al. Sudden asphyxic asthma: a distinct entity? Am Rev Respir Dis 1990; 142: 108-11.

  14. Robin E, Lewiston N. Unexpected, unexplained sudden death in young asthmatic subjects. Chest 1989; 96: 790-3.

  15. Hetzel M, Clark T, Branthwaite M. Asthma: analysis of sudden deaths and ventilatory arrests in hospital. BMJ 1977; 1: 808-11.

  16. Strunk RC. Identification of the fatality-prone subject with asthma. J Allergy Clin Immunol 1989; 83: 477-85.

  17. Molofino N, Nannini L, Martelli A et al. Respiratory arrest in near-fatal asthma. N Engl J Med 1991; 324: 285-8.

  18. Williams T, Tuxen D, Scheinkestel C et al. Risk factors for morbidity in mechanically ventilated patients with acute severe asthma. Am Rev Respir Dis 1992; 146: 607-15.

  19. Shim CS, Williams MH. Evaluation of the severity of asthma: patients versus physicians. Am J Med 1980; 68: 11-3.

  20. Nowak RM, Tomlanovich MC, Sarker DD et al. Arterial blood gases and pulmonary function testing in acute bronchial asthma: predicting patient outcomes. JAMA 1983; 249: 2043-6.

  21. Bodenhammer J, Bergstrom R, Brown D et al. Frequently nebulized beta-agonists for asthma: effects on serum electrolytes. Ann Emerg Med 1992; 21: 1337-42.

  22. Heimer D, Shim C, Williams MH. The effect of sequential inhalations of metaproterenol aerosol in asthma. J Allergy Clin Immunol 1980; 66: 75-7.

  23. Lin RY, Sauter D, Newman T et al. Continuous versus intermittent albuterol nebulization in the treatment of acute asthma. Ann Emerg Med 1993; 22: 1847-53.

  24. Lipworth BJ, Clark RA, Dhillon DP et al. Beta-adrenoceptor responses to high doses of inhaled salbutamol in patients with bronchial asthma. Br J Clin Pharmacol 1988; 26: 527-33.

  25. Rudnitsky GS, Eberlein RS, Schoffstall JM et al. Comparison of intermittent and continuously nebulized albuterol for treatment of asthma in an urban emergency department. Ann Emerg Med 1993; 22: 1842-6.

  26. Robertson CF, Smith F, Beck R et al. Response to frequent low doses of nebulized salbutamol in acute asthma. J Pediatr 1985; 106: 672-4. — Jenne JW. The debate on S-enantiomers of B-agonists: tempest in a teapot or a gathering storm? J Allergy Clin Immunol 1998; 102: 893-5.

  27. Mitra S, Ugur M, Ugur O et al. (S)-albuterol increases intracellular free calcium by muscarinic receptor activation and phospholipase C-dependent mechanism in airway smooth muscle. Mol Pharmacol 1998; 53: 347-54.

  28. Dhand R, Goode M, Ried R et al. Preferential pulmonary retention of (S)-albuterol after inhalation of racemic albuterol. Am J Respir Crit Care Med 1999; 160: 1136-41.

  29. Page CP, Morley J. Contrasting properties of albuterol stereoisomers. J Allergy Clin Immunol 1999; 104(2 pt 2): S31-41.

  30. Gawchik SM, Saccar CL, Noonan M et al. The safety and efficacy of nebulized levalbuterol compared with racemic albuterol and placebo in the treatment of asthma in pediatric patients. J Allergy Clin Immunol 1999; 103: 615-21.

  31. Handley DA, Tinkelman D, Noonan M et al. Dose-response evaluation of levalbuterol versus racemic albuterol in patients with asthma. J Asthma 2000; 37: 319-27.

  32. Nelson HS, Bensch G, Pleskow WW et al. Improved bronchodilation with levalbuterol compared with racemic albuterol in patients with asthma. J Allergy Clin Immunol 1998; 102(6 part 1): 943-52.

  33. Nowak RM, Emerman CL. Levalbuterol is effective in acute asthma. Am J Respir Crit Care Med 2001; 163: A590.

  34. Milgrom H, Skoner DP, Bensch G. Low-dose levalbuterol in children with asthma: safety and efficacy in comparison with placebo and racemic albuterol. J Allergy Clin Immunol 2001; 108: 938-45.

  35. Lötvall J, Palmqvist M, Arvidsson P et al. The therapeutic ratio of R-albuterol is comparable with that of RS-albuterol in asthmatic patients. J Allergy Clin Immunol 2001; 108: 726-31.

  36. Colacone A, Afilalo M, Wolkove N et al. A comparison of albuterol administered by metered dose inhaler (and holding chamber) or wet nebulizer in acute asthma. Chest 1993; 104: 835-41.

  37. Idris AH, McDermott MF, Raucci JC et al. Emergency department treatment of severe asthma: metered-dose inhaler plus holding chamber is equivalent in effectiveness to nebulizer. Chest 1993; 103: 665-72.

  38. Kerem E, Levison H, Schuh S et al. Efficacy of albuterol administered by nebulizer versus spacer device in children with acute asthma. J Pediatrics 1993; 123: 313-7.

  39. Aaron SD. The use of ipratropium bromide for the management of acute asthma exacerbation in adults and children: a systemic review. J Asthma 2001; 38: 521-30.

  40. Plotnick LH, Ducharme FM. Should inhaled anticholinergics be added to beta2-agonists for treating acute childhood and adolescent asthma? A systemic review. BMJ 1998; 317: 971-7.

  41. Qureshi F, Pestian J, Davis P et al. Effect of nebulized ipratropium on hospitalization rates of children with asthma. N Engl J Med 1998; 339: 1030-5.

  42. Zorcc JJ, Pusic MV, Ogborn CJ et al. Ipratropium bromide added to asthma treatment in the pediatric emergency department. Pediatrics 1999; 103: 748-52.

  43. Lanes SF, Garrett JE, Wentworth III CE et al. The effect of adding ipratropium bromide to salbutamol in the treatment of acute asthma: a pooled analysis of three trials. Chest 1998; 1114: 365-72.

  44. Rodrigo G, Rodrigo C, Burschtin O. A meta-analysis of the effects of ipratropium bromide in adults with acute asthma. Am J Med 1999; 107: 363-70.

  45. Rodrigo GJ, Rodrigo C. First-line therapy for adult patients with acute asthma receiving a multiple-dose of ipratropium bromide plus albuterol in the emergency department. Am J Respir Crit Care Med 2000; 161: 1862-8.

  46. Stoodley RG, Aaron SD, Dales RE. The role of ipratropium bromide in the emergency management of acute asthma exacerbations: a meta-analysis of randomized clinical trials. Ann Emerg Med 1999; 34: 8-18.

  47. Fanta CH, Rossing TH, McFadden Jr ER. Glucocorticoids in acute asthma: a critical controlled trial. Am J Med 1983; 74: 845-51.

  48. Chapman KR, Verbeek PR, White JG et al. Effect of a short course of prednisone in the prevention of early relapse after emergency room treatment of acute asthma. N Engl J Med 1991; 324: 788-94.

  49. Benatar SR. Fatal asthma. N Engl J Med 1986; 314: 423-9.

  50. Littenberg B, Gluck EH. A controlled trial of methylprednisolone in the emergency treatment of acute asthma. N Engl J Med 1986; 314: 150-2.

  51. Connett GJ, Warde C, Wooler E et al. Prednisolone and salbutamol in the hospital treatment of acute asthma. Arch Dis Child 1994; 70: 170-3.

  52. Rowe BH, Keller JL, Oxman AD. Effectiveness of steroid therapy in acute exacerbations of asthma: a meta-analysis. Am J Emerg Med 1992; 10: 301-10.

  53. Rowe BH, Spooner C, Ducharme FM et al. Early emergency department treatment of acute asthma with systemic corticosteroids. Cochrane Database of Systemic Reviews [computer file] 2000; 2: CD002178.

  54. Silverman R. Treatment of acute asthma: a new look at the old and at the new. Clin Chest Med 2000; 21: 361-79.

  55. Rowe BH, Botak GW, Fabris L et al. Inhaled budesonide in addition to oral corticosteroids to prevent asthma relapse following discharge from the emergency department: a randomized controlled trial. JAMA 1999; 281: 2119-26.

  56. Haalboon JRE, Denstra M, Stuyvenberg A. Hypokalemia induced by inhalation of fenoterol. Lancet 1985; 1: 1125-7.

  57. Rodrigo C, Rodrigo G. Therapeutic response patterns to high and cumulative doses of salbutamol in acute severe asthma. Chest 1998; 113: 593-8.

  58. Strauss L, Hejal R, Galan G et al. Observations on the effects of aerosolized albuterol in acute asthma. Am J Respir Crit Care Med 1997; 155: 454-8.

  59. Green SM, Rothrock SG. Intravenous magnesium for acute asthma: failure to decrease emergency treatment duration or need for hospitalization. Ann Emerg Med 1992; 21: 260-5.

  60. Kuitert LM, Kletchko SL. Intravenous magnesium sulfate in acute, life threatening asthma. (erratum in Ann Emerg Med 1992;21:1272) Ann Emerg Med 1991; 20: 1243-5.

  61. Skorodin MS, Tenholder MF, Yetter B et al. Magnesium sulfate in exacerbations of chronic obstructive pulmonary disease. Arch Intern Med 1995; 155: 496-500.

  62. Tiffany BR, Berk WA, Todd IK et al. Magnesium bolus or infusion fails to improve expiratory flow in acute asthma exacerbations. Chest 1993; 104: 831-4.

  63. Bloch H, Silverman R, Mancherje N et al. Intravenous magnesium sulfate as an adjunct in the treatment of acute asthma. Chest 1995; 107: 1576-81.

  64. Mangat HS, D’Souza GA, Jacob MS. Nebulized magnesium sulfate versus nebulized salbutamol in acute bronchial asthma: a clinical trial. Eur Respir J 1998; 12: 341-4.

  65. Nannini Jr LJ, Pendino JC, Corna RA et al. Magnesium sulfate as a vehicle for nebulized salbutamol in acute asthma. Am J Med 2000; 108: 193-7.

  66. Pavord ID, Ward R, Woltmann G et al. Induced sputum eicosanoid concentrations in asthma. Am J Respir Crit Care Med 1999; 160: 1905-9.

  67. Dockhorn RJ, Baumgartner RA, Leff JA et al. Comparison of the effects of intravenous and oral montelukast on airway function: a double blind, placebo controlled, three period, crossover study in asthmatic patients. Thorax 2000; 55: 260-5.

  68. Silverman RA, Chen Y, Bonucelli CM et al. The Zafirlukast Acute Asthma Study Group: Zafirlukast improves emergency department outcomes after an acute asthma episode. Ann Emerg Med 2000; 35: S10.

  69. Carmago CA, Green SA, Smithline HA et al. Rapid bronchodilator response to intravenous montelukast in acute asthma. [abstract] Acad Emerg Med 2001; 8: 414.

  70. Rodrigo GJ, Rodrigo C. Inhaled flunisolide for acute severe asthma. Am J Respir Crit Care Med 1998; 157: 698-703.

  71. Devidayal, Singhi S, Kumar L et al. Efficacy of nebulized budesonide compared to oral prednisone in acute bronchial asthma. Acta Paediatr 1999; 88: 835-40.

  72. Kumar SD, Brieva JL, Danta I et al. Transient effect of inhaled fluticasone on airway mucosal blood flow in subjects with and without asthma. Am J Respir Crit Care Med 2000; 161: 918-21.

  73. Hargreaves FE, Dolovich J, Newhouse MT. The assessment and treatment of asthma: a conference report. J Allergy Clin Immunol 1990; 85: 1098-111.

  74. Maguire JF, O’Rourke PP, Colan SD et al. Cardiotoxicity during treatment of severe childhood asthma. Pediatrics 1991; 88: 1180-6.

  75. Nowak RM, Tokarski G. Asthma. In: Falk K, Stein D, editors. Rosen’s emergency medicine: concepts and clinical practice. St. Louis: Mosby; 2000: 938-56.

  76. Simons EF, Ziaochen G, Simons KJ. Epinephrine absorption in adults: intramuscular versus subcutaneous injection. J Allergy Clin Immunol 2001; 108: 871-3.

  77. Bishop GF, Hillman KM. Acute severe asthma. Intensive Care World 1993; 10: 166-71.

  78. Coleridge J, Cameron P, Epstein J et al. Intravenous aminophylline confers no benefit in acute asthma treated with intravenous steroids and inhaled bronchodilators. Aust N Z J Med 1993; 23: 348-54.

  79. Littenberg B. Aminophylline treatment in severe acute asthma: a meta-analysis. JAMA 1988; 259: 1678-84.

  80. Murphy DG, McDermott MF, Rydman RJ et al. Aminophylline in the treatment of acute asthma when beta 2-adrenergics and steroids are provided. Arch Intern Med 1993; 153: 1784-8.

  81. Rodrigo C, Rodrigo G. Treatment of acute asthma: lack of therapeutic benefit and increase of the toxicity from aminophylline given in addition to high doses of salbutamol delivered by metered-dose inhaler with a spacer. Chest 1994; 106: 1071-6.

  82. Huang D, O’Brien RG, Harman E et al. Does aminophylline benefit adults admitted to the hospital for an acute exacerbation of asthma? Ann Intern Med 1993; 119: 1155-60.

  83. Wrenn K, Slovis CM, Murphy F et al. Aminophylline therapy for acute bronchospastic disease in the emergency room. Ann Intern Med 1991; 115: 241-7.

  84. Yung M, South M. Randomized controlled trial of aminophylline for severe acute asthma. Arch Dis Child 1998; 79: 405-10.

  85. Emerman CL, Nowak RM, Tomlanovich MC. Theophylline concentrations in the emergency treatment of acute bronchial asthma. Am J Emerg Med 1983; 1: 12-6.

  86. Berkovich S, Millian SJ, Snyder RD. The association of viral and mycoplasma infections with recurrence of wheezing in the asthmatic child. Ann Allergy 1970; 28: 43-9.

  87. Friedman R, Ackerman M, Wald E et al. Asthma and bacterial sinusitis in children. J Allergy Clin Immunol 1984; 74: 185-9.

  88. Johnsonton SL. Influence of viral and bacterial respiratory infections on exacerbations and symptom severity in childhood asthma. Pediatr Pulmonol Suppl 1997; 16: 88-9.

  89. Johnston SL, Pattemore PK, Sanderson G et al. The relationship between upper respiratory infections and hospital admissions for asthma: a time-trend analysis. Am J Respir Crit Care Med 1996; 154: 654.

  90. Miyashita N, Kubota Y, Nakjima M et al. Chlamydia pneumoniae and exacerbations of asthma in adults. Ann Allergy Asthma Immunol 1998; 80: 405-9.

  91. Nicholson KG, Kent JK, Ireland DC. Respiratory viruses and exacerbations of asthma in adults. BMJ 1993; 307: 982.

  92. Oehling AK. Bacterial infection as an important triggering factor in bronchial asthma. J Investig Allergol Clin Immunol 1999; 9: 6-13.

  93. Seffev JS, Lis I, Siman-Tov S et al. Mycoplasma pneumoniae is a frequent cause of exacerbation of bronchial asthma in adults. Ann Allergy 1986; 57: 262-5.

  94. Spagnolo SV. Status asthmaticus and hospital management of asthma. Immunology and Allergy Clinics of North America 2001; 21: 503-33.

  95. Black PN, Blasi F, Jenkins C et al. Trial of roxithromycin in subjects with asthma and serological evidence of infection with Chlamydia pneumoniae. Am J Respir Crit Care Med 2001; 164: 536-41.

  96. Senior BA, Kennedy DW. Management of sinusitis in the asthmatic patient. Ann Allergy Asthma Immunol 1996; 77: 6-19.




2020     |     www.medigraphic.com