Normativa sobre el estudio de la hiperrespuesta bronquial inespecífica en el asma

doi:10.1016/j.arbres.2013.05.001

Archivos de Bronconeumología

Volume 49, Issue 10, October 2013, Pages 432-446

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Introducción

La primera normativa sobre los test de provocación bronquial inespecífica auspiciada por SEPAR fue publicada en 1987¹. Años después, en 2004, tuvo lugar una actualización de la misma bajo el formato de Manual de Procedimientos². Transcurrido ya un tiempo prudencial, el Comité Científico y de Investigación de nuestra Sociedad solicitó recientemente al Área de Asma la elaboración de una nueva puesta al día sobre el tema, procurando recoger lo que la práctica diaria y la experiencia acumulada han

Fundamentos básicos

La metacolina y la histamina han sido las 2 sustancias tradicionalmente manejadas como estímulos inespecíficos directos, y en condiciones de medida similares consiguen efectos comparables27, 28. Sin embargo, la metacolina es hoy la más utilizada, ya que ofrece 2 grandes ventajas27, 28, 29: a) puede emplearse a concentraciones hasta 200 mg/ml sin efectos secundarios, mientras que concentraciones de histamina superiores a 32 mg/ml son capaces de ocasionar eritema facial, cefalea, náuseas, disfonía o

Fundamentos básicos

La adenosina es un nucleósido endógeno implicado en numerosos procesos fisiológicos (control del tono vascular e intestinal, neurotransmisión, neurosecreción, etc.) y reacciones inflamatorias⁵⁴. La síntesis tiene lugar dentro de las células a partir de la hidrólisis de la adenosina 5’-monofosfato (AMP) por la 5’-nucleotidasa, o por el catabolismo de la 5-adenosinhomocisteína. Cuando la concentración intracelular de AMP aumenta (hipoxia, activación celular), pasa al exterior para ser recaptada

Conflicto de intereses

Los autores declaran no tener ningún conflicto de intereses.

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Ficha técnica Provocholine™ 100mg, polvo para inhalación. Agencia Española de Medicamentos y Productos Sanitarios....

Cited by (23)

A new tidal breathing measurement device detects bronchial obstruction during methacholine challenge test
2024, Advances in Medical Sciences
Bronchial hyperresponsiveness (BHR), a hallmark of bronchial asthma, is typically diagnosed through a methacholine inhalation test followed by spirometry, known as the methacholine challenge test (MCT). While spirometry relies on proper patients' cooperation and precise execution of forced breathing maneuvers, we conducted a comparative analysis with the portable nanomaterial-based sensing device, SenseGuard™, to non-intrusively assess tidal breathing parameters.
In this prospective study, 37 adult participants with suspected asthma underwent sequential spirometry and SenseGuard™ measurements after inhaling increasing methacholine doses.
Among the 37 participants, 18 were MCT responders, 17 were non-responders and 2 were excluded due to uninterpretable data. The MCT responders exhibited a significant lung function difference when comparing the change from baseline to maximum response. This was evident through a notable decrease in forced expiratory volume in 1 s (FEV₁) levels in spirometry, as well as in prominent changes in tidal breathing parameters as assessed by SenseGuard™, including the expiratory pause time (T_rest) to total breath time (T_tot) ratio, and the expiratory time (T_ex) to T_tot ratio. Notably, the ratios T_rest/T_tot (∗p = 0.02), T_ex/T_tot (∗p = 0.002), and inspiratory time (T_in) to T_ex (∗p = 0.04) identified MCT responders distinctly, corresponding to spirometry (∗p < 0.0001).
This study demonstrates that tidal breathing assessment using SenseGuard™ device reliably detects clinically relevant changes of respiratory parameter during the MCT. It effectively distinguishes between responders and non-responders, with strong agreement to conventional spirometry-measured FEV₁. This technology holds promise for monitoring clinical respiratory changes in bronchial asthma patients pending further studies.
GEMA 5.3. Spanish Guideline on the Management of Asthma
2023, Open Respiratory Archives
The Spanish Guideline on the Management of Asthma, better known by its acronym in Spanish GEMA, has been available for more than 20 years. Twenty-one scientific societies or related groups both from Spain and internationally have participated in the preparation and development of the updated edition of GEMA, which in fact has been currently positioned as the reference guide on asthma in the Spanish language worldwide.
Its objective is to prevent and improve the clinical situation of people with asthma by increasing the knowledge of healthcare professionals involved in their care. Its purpose is to convert scientific evidence into simple and easy-to-follow practical recommendations. Therefore, it is not a monograph that brings together all the scientific knowledge about the disease, but rather a brief document with the essentials, designed to be applied quickly in routine clinical practice. The guidelines are necessarily multidisciplinary, developed to be useful and an indispensable tool for physicians of different specialties, as well as nurses and pharmacists.
Probably the most outstanding aspects of the guide are the recommendations to: establish the diagnosis of asthma using a sequential algorithm based on objective diagnostic tests; the follow-up of patients, preferably based on the strategy of achieving and maintaining control of the disease; treatment according to the level of severity of asthma, using six steps from least to greatest need of pharmaceutical drugs, and the treatment algorithm for the indication of biologics in patients with severe uncontrolled asthma based on phenotypes. And now, in addition to that, there is a novelty for easy use and follow-up through a computer application based on the chatbot-type conversational artificial intelligence (ia-GEMA).
La Guía Española para el Manejo del Asma, mejor conocida por su acrónimo en español, GEMA, está a nuestra disposición desde hace más de veinte años. Veintiuna sociedades científicas o grupos relacionados, tanto de España como de otros países, han participado en la preparación y desarrollo de la edición actualizada de GEMA que, de hecho, se ha posicionado en la actualidad a nivel mundial como la guía de referencia sobre asma en lengua española.
Su objetivo es prevenir y mejorar la situación clínica de las personas con asma, aumentando el conocimiento de los profesionales sanitarios involucrados en su cuidado. Su propósito es convertir la evidencia científica en recomendaciones prácticas sencillas y fáciles de seguir. Por lo tanto, no se trata de una monografía que reúna todo el conocimiento científico sobre la enfermedad, sino más bien de un documento conciso con lo esencial, diseñado para ser aplicado rápidamente en la práctica clínica de rutina. Las recomendaciones son necesariamente multidisciplinares, están desarrolladas para ser útiles y una herramienta indispensable para médicos de diferentes especialidades, así como para profesionales de enfermería y farmacia.
Seguramente, los aspectos más destacados de la guía son las recomendaciones para: establecer el diagnóstico del asma utilizando un algoritmo secuencial basado en pruebas diagnósticas objetivas; el seguimiento de los pacientes, preferentemente basado en la estrategia de lograr y mantener el control de la enfermedad; el tratamiento según el nivel de gravedad del asma utilizando seis escalones, desde la menor hasta la mayor necesidad de medicamentos, y el algoritmo de tratamiento basado en fenotipos para la indicación de biológicos en pacientes con asma grave no controlada. A esto se suma ahora una novedad para su fácil uso y seguimiento a través de una aplicación informática basada en la inteligencia artificial conversacional de tipo chatbot (ia-GEMA).
Frequency of alleles and genotypes associated with alpha-1 antitrypsin deficiency in clinical and general populations: Revelations about underdiagnosis
2023, Pulmonology
Citation Excerpt :
In these cases, and when appropriate, counselling about preventive health behaviours was offered. The respiratory pathologies diagnosed in the pneumology outpatients, following the criteria of specific guidelines, were bronchial asthma, chronic obstructive pulmonary disease (COPD), sleep apnea-hypopnea syndrome (SAHS), hypoventilation-obesity syndrome (HOS) and non-specific bronchial hyperreactivity (BHR).10-13 The approach followed for the genetic characterization of SERPINA1 is summarized in Fig. 1.
Alpha-1 antitrypsin deficiency (AATD) is an underdiagnosed hereditary condition that promotes the development of lung and liver diseases, and the most common potentially life-threatening genetic condition in Caucasian adults. In this study, the clinical and genetic profile of pulmonary patients from a single center in La Palma Island (Canary Islands, Spain) was assessed to predict how to increase AATD diagnosis.
AATD was tested in 1,493 pulmonary outpatients without regard to respiratory symptoms and 465 newborns. Variants of the SERPINA1 gene were characterised by real-time PCR, DNA sequencing, molecular haplotyping and phenotyping (AAT isoelectric focusing). Different respiratory pathologies were diagnosed in patients and their levels of serum AAT were measured by nephelometry.
The prevalence of pneumological patients with AATD alleles was 30.5%, including PI*S, PI*Z and 6 rare genetic variants. Certain deficiency genotypes were unevenly distributed among patients diagnosed with respiratory diseases: PI*ZZ (71.4%) and PI*SS (34.8%) genotypes were more represented in patients with chronic obstructive pulmonary disease (COPD), whereas PI*MZ (27.7%) and PI*SZ (34.5%) genotypes were more abundant in patients with bronchial asthma. The estimated frequency of PI*S and PI*Z alleles in the general population was 8.2% and 2.1%, respectively. A very significant enrichment (p< 0.01) of PI*S allele, independent of the PI*Z allele, was detected in the clinical population.
AATD diagnosis would improve if both the COPD and the asthmatic patients were included to screening programs. The prevalence of PI*ZZ genotype in La Palma (1/2,162) was relatively high within Spain (average 1/3,344).
Respiratory pathology
2018, Medicine (Spain)
El conocimiento de los síntomas y signos del aparato respiratorio es fundamental para una adecuada historia clínica neumológica. La anamnesis debe recoger los síntomas respiratorios como son la tos, expectoración, hemoptisis, disnea, dolor torácico y también síntomas propios de otros aparatos y sistemas que nos pueden orientar hacia la etiología. El examen físico debe hacerse según el orden ya establecido de inspección, palpación, percusión y auscultación, y no debe únicamente centrarse en el tórax. La obtención de toda esta información constituye la base para la correcta solicitud de pruebas de función pulmonar o técnicas complementarias que permitirán a su vez llegar al diagnóstico de la patología respiratoria.
A deep knowledge of symptoms and signs of respiratory system is mandatory to perform an appropriate pulmonary history. In order to identify the etiology, anamnesis have to list all respiratory symptoms (cough, expectoration, hemoptysis, dyspnea, chest pain) as well as symptoms in other organ systems. Physical examination have to be conducted orderly (inspection, palpation, percussion and auscultation) and extended beyond the chest. With this data, proper pulmonary function test and supplementary ones selection will be done. These steps allow us to reach the correct diagnosis.
An update on asthma
2017, Medicine (Spain)
El asma, por su elevada prevalencia ligada estrechamente al aumento de las enfermedades alérgicas y su cronicidad, constituye un problema de salud a nivel mundial. No se trata de una enfermedad propiamente dicha, sino de un síndrome de la vía aérea que, compartiendo manifestaciones clínicas (tos, disnea y sibilancias), presenta diferentes patrones inflamatorios que se traducen como fenotipos específicos.
El abordaje diagnóstico secuencial permite alcanzar un diagnóstico de certeza en casi todos los casos, aunque excepcionalmente exista un síndrome mixto Asthma/COPD overlap syndrome (ACOS) que comparte características con otras patologías obstructivas crónicas.
El objetivo del tratamiento en la actualidad es alcanzar el control del asma durante el mayor tiempo posible con una triple estrategia de información, medidas farmacológicas y seguimiento. El tratamiento farmacológico estandarizado y escalonado en base a los niveles de gravedad, realizando una técnica de inhalación correcta, es seguro y sirve para alcanzar el control, salvo en una pequeña proporción de pacientes con asma grave no controlado (AGNC) en los que se hace necesario descartar comorbilidades (rinosinusitis, reflujo gastroesofágico) e identificar el fenotipo inflamatorio con biomarcadores específicos hacia los que dirigir un tratamiento inmunomodulador concreto que posibilite modificar el curso y el pronóstico de la enfermedad. El tratamiento biológico, aún limitado, sin duda ofrece una atractiva posibilidad de utilización más amplia en un futuro muy cercano.
Asthma is a global health problem due to its high prevalence, closely linked to the increase of allergies, and to its chronicity. It is not a disease per se, but rather an airway syndrome that, sharing clinical manifestations (cough, dyspnea and wheezing), presents different inflammatory patterns that translate into specific phenotypes.
A sequential diagnostic approach allows to establish a diagnostic certainty in almost all cases, even if exceptionally there is a mixed ACOS syndrome that shared features from other chronic obstructive conditions.
The goal of the treatment nowadays is to control the asthma for as long as possible with a tripe strategy of information, pharmacological measures and follow-ups. Standardised pharmacological treatment that is stepped according to the severity degrees, carrying out a correct inhaler technique, is safe and works to reach control, except for a small proportion of patients with SUA where it is necessary to rule out comorbidities (rhinosinusitis, gastroesophageal reflux) and identify the inflammatory phenotype with specific biomarkers that need to be targeted with a specific immunomodulatory treatment that can modify the course and prognosis of the disease. Biological treatment, still limited, undoubtedly offers an attractive possibility for a broader use in the close future.
Excessive variability in the performance and interpretation of the metacholine bronchial challenge test
2016, Archivos de Bronconeumologia

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Normativa SEPARNormativa sobre el estudio de la hiperrespuesta bronquial inespecífica en el asmaGuidelines for the Study of Nonspecific Bronchial Hyperresponsiveness in Asthma

Section snippets

Introducción

Fundamentos básicos

Fundamentos básicos

Conflicto de intereses

First page preview

Chest

Chest

Chest

Lancet

Chest

Chest

Ann Allergy Asthma Immunol

Chest

Respir Physiol Neurobiol

Chest

Chest

Chest

J Allergy Clin Immunol

Chest

J Allergy Clin Immunol

Respir Med

Respir Med

Respir Med

Respir Med

J Allergy Clin Immunol

Arch Bronconeumol

Eur J Pharmacol

Pharmacol Ther

Pulm Pharmacol

Trends Pharmacol Sci

Ann Allergy Asthma Immunol

Lancet

Respir Med

Respir Med

Chest

Recomendaciones SEPAR n.° 4. Normativa para los test de provocación bronquial inespecífica

Bronchial hyperreactivity

Am Rev Respir Dis

Descriptive epidemiology of bronchial reactivity in an adult population: Results from a community study

Thorax

Prevalence of bronchial hyperresponsiveness and asthma in a rural adult population

Thorax

PEF variability, bronchial responsiveness and their relation to allergy markers in a random population (20-70 yr)

Am J Respir Crit Care Med

Increased bronchial responsiveness to exercise as a risk factor for symptomatic asthma: Findings from a longitudinal population study of children and adolescents

Eur Respir J

Bronchial hyperresponsiveness and the development of asthma and COPD in asymptomatic individuals: SAPALDIA Cohort Study

Thorax

Are asymptomatic airway hyperresponsiveness and allergy risk factors for asthma? A longitudinal study

Eur Respir J

Bronchial hyperresponsiveness: Too complex to be useful?

Curr Opin Pharmacol

Indirect airway challenges

Eur Respir J

Hiperreactividad bronquial. Concepto y consideraciones generales

Bronchial hyperresponsiveness: The need for a distinction between hypersensitivity and excessive airway narrowing

Eur Respir J

Noninflammatory mechanisms of airway hyper-responsiveness in bronchial asthma: An overview

Ther Adv Respir Dis

Mechanisms of airway hyperresponsiveness

J Allergy Clin Immunol

Hiperrespuesta bronquial en el asma. Patogenia y medición

Arch Bronconeumol

Provoked models of asthma: What have we learnt?

Clin Exp Allergy

Airway responsiveness. Standarized challenge testing with pharmacological, physical and sensitizing stimuli in adults. Report Working Party Standarization of Lung Function Tests, European Community for Steel and Coal. Official Statement of the European Respiratory Society

Eur Respir J Suppl

Guidelines for methacholine and exercise challenge testing-1999

Am J Respir Crit Care Med

Normativa SEPAR
Normativa sobre el estudio de la hiperrespuesta bronquial inespecífica en el asmaGuidelines for the Study of Nonspecific Bronchial Hyperresponsiveness in Asthma