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Órgano Oficial del Colegio Mexicano de Alergia, Asma e Inmunología Pediátrica y de la Asociación Latinoamericana de Pediatría

2012, Número 2

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Alerg Asma Inmunol Pediatr 2012; 21 (2)


Seguridad y eficacia del uso de la combinación de beta 2 agonistas y anticolinérgicos inhalados para el tratamiento de exacerbación grave de asma en niños

Ruiz HFR, Huerta LJ

Idioma: Español
Referencias bibliográficas: 75
Paginas: 48-62
Archivo PDF: 142.83 Kb.


RESUMEN

Antecedentes: Existe controversia sobre el tratamiento más adecuado de una exacerbación grave de asma. No están completamente definidas las ventajas de las estrategias terapéuticas y el impacto en la función pulmonar, así como los efectos secundarios o indeseables de estos tratamientos. Existen pocos metaanálisis y revisiones sistemáticas de la literatura que sugieren un tratamiento con beta 2 agonistas de acción corta combinado con un anticolinérgico, pero que puntualizan que aún hacen falta estudios de nivel alto de evidencia con mejores conclusiones para una mejor toma de decisiones para el tratamiento de una exacerbación grave de asma en población pediátrica entre el uso de un beta 2 agonista y un beta 2 agonista combinado con anticolinérgico.
Objetivo: Establecer mediante la mejor evidencia disponible la seguridad y eficacia del uso de la combinación de un beta 2 agonista de acción corta y un anticolinérgico inhalado para el tratamiento de exacerbación grave de asma en población pediátrica.
Material y métodos: Los estudios elegibles se identificaron mediante búsquedas en bases electrónicas de la literatura.
Tipos de estudios: Se incluyeron únicamente metaanálisis, revisiones sistemáticas, ensayos clínicos controlados aleatorizados que comparan la combinación de anticolinérgicos más beta 2 agonistas de acción corta inhalados vs agonistas beta 2 inhalados solos, en niños de 0 meses a 18 años de edad, con exacerbación grave de asma.
Calidad metodológica: Se realizó la evaluación de cada estudio con el documento CASP (Critical Appraisal Skills Programme).
Resultados: Se incluyeron 9 revisiones sistemáticas, 10 estudios clínicos aleatorizados doble ciego que cumplieron con los criterios de inclusión, de los cuales la extracción y la evaluación de la calidad de los datos se realizaron por un clínico y un metodólogo de manera independiente.
Conclusión: El uso de la combinación de los medicamentos evaluados confiere seguridad, pues disminuye la incidencia de efectos colaterales por su uso, contribuye a una mejoría clínica y de función pulmonar de los pacientes pediátricos con exacerbación grave de asma y disminuye la posibilidad de hospitalización por falta de respuesta a tratamiento. Sin embargo, las diferencias para estas variables aún no son estadísticamente significativas, pues los distintos ensayos clínicos tienen distinta metodología difícil de analizar en conjunto, por lo que aún faltan estudios que sean reproducibles en similares condiciones metodológicas.


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