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Antes Revista del Instituto Nacional de Enfermedades Respiratorias

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2009, Número S2

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Neumol Cir Torax 2009; 68 (S2)


Tratamiento del asma

Larenas LD

Idioma: Español
Referencias bibliográficas: 79
Paginas: 149-162
Archivo PDF: 184.13 Kb.


RESUMEN

El tratamiento del asma inicia con la prevención primaria en la población de alto riesgo. Su manejo propiamente dicho consiste en la prevención secundaria (evitar exposición a factores agravantes como alergenos y humo de cigarro, dieta rica en fruta y verdura, aceites y vacunación oportuna contra influenza y neumococo), la educación del paciente, la farmacoterapia y en los que sean alérgicos se puede considerar inmunoterapia. La farmacoterapia se divide en tratamiento de rescate para los episodios de síntomas y el tratamiento de mantenimiento para conservar el control. En pacientes con asma leve y síntomas intermitentes no más de dos veces por semana, sin despertares nocturnos y sin crisis asmática el último año, sólo se dará tratamiento de rescate. En todos los pacientes se instalará algún tratamiento de mantenimiento con antiinflamatorio inhalado y eventualmente otros medicamentos que aumentan el control. Para elegir el tratamiento adecuado se toma en cuenta la gravedad del cuadro crónico y los síntomas en el momento de la consulta, siguiendo cinco niveles del algoritmo que llevará al médico a mantener el control del asma. Nivel 1. Rescate: Broncodilatador. 1ª opción agonista β2 inhalado; aplica para exacerbaciones en cualquiera de los niveles abajo mencionados. Nivel 2. Mantenimiento: corticosteroide inhalado (CEInhal) a dosis baja o intermedia. Alternativos: antileucotrieno, teofilinas de liberación prolongada, β2 agonistas vía oral. Nivel 3. Mantenimiento: combinación del CEInhal dosis intermedia con agonista β2 de acción prolongada. Alternativa: CEInhal con antileucotrieno, teofilinas de liberación prolongada, β2 agonistas vía oral. Nivel 4. Aumentar a dosis altas - muy altas esteroide inhalado, más tratamiento combinado. Nivel 5. Inmunosupresión y Anti-IgE.


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