Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- recent upper respiratory tract infection
- dyspnea
- cough
- expiratory wheezes
- nasal polyposis
Factores de riesgo
- family history
- gene polymorphisms and epigenetics
- allergen/irritant exposure
- occupational exposure
- air pollution
- atopic disease history
- obesity
- cigarette smoking
- vaping
- early life respiratory viral infection and viral wheeze
- nasal polyposis
- aspirin and nonsteroidal anti-inflammatory drug (NSAID) use
- low socioeconomic status
- gastroesophageal reflux
- obstructive sleep apnea
- sex
- preterm birth
- polycystic ovary syndrome
- vitamin D deficiency
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- FEV₁/FVC ratio
- peak expiratory flow (PEF)
Pruebas diagnósticas que deben considerarse
- chest x-ray
- CBC with differential
- fractional exhaled nitric oxide (FeNO)
- bronchial challenge test
- serum radioallergosorbent test (RAST) immunoassay for allergen-specific IgE
- skin-prick allergy testing
- high-resolution CT (HRCT) chest
- CT sinus
Pruebas emergentes
- sputum eosinophil count
Algoritmo de tratamiento
initial treatment step 1: asthma symptoms 1-2 days per week or less and no risk factors for exacerbations
initial treatment step 2: asthma symptoms less than 3-5 days per week and normal (or mildly reduced) lung function
initial treatment step 3: asthma symptoms most days (e.g., 4-5 days per week or more), or waking due to asthma once a week or more, low lung function, and risk factors for exacerbations
initial treatment step 4: daily asthma symptoms, waking at night once a week or more, and low lung function
ongoing treatment step 1: patients using short-acting beta agonist (SABA) alone or with newly diagnosed asthma, with normal (or mildly reduced) lung function
ongoing treatment step 2: asthma not controlled on step 1 treatment
ongoing treatment step 3: asthma not controlled on steps 1-2 treatment (track 1) or step 2 treatment (track 2), with risk factors for exacerbations
ongoing treatment step 4: asthma not controlled on step 3 treatment
ongoing treatment step 5: asthma not controlled on step 4 treatment and patient reviewed by specialist
Colaboradores
Autores
Lauren E. Eggert, MD
Clinical Assistant Professor
Division of Pulmonary, Allergy, and Critical Care Medicine
Department of Medicine
Stanford University School of Medicine
Stanford
CA
Divulgaciones
LEE has participated on advisory boards for Regeneron and AstraZeneca.
Sourav Majumdar, MD
Clinical Assistant Professor (Affiliated)
Division of Pulmonary and Critical Care Medicine
Department of Medicine
Stanford University School of Medicine
Stanford
CA
Divulgaciones
SM declares that he has no competing interests.
Agradecimientos
Dr Lauren E. Eggert and Dr Sourav Majumdar would like to gratefully acknowledge Dr Irwani Ibrahim, Dr Kay Choong See, Dr Francis Thien, and Dr Catherine Weiler, previous contributors to this topic.
Divulgaciones
II, KCS, FT, and CW declare that they have no competing interests.
Revisores por pares
Javed Sheikh, MD
Clinical Director
Division of Allergy and Inflammation
Beth Israel Deaconess Medical Center/Harvard Medical School
Boston
MA
Divulgaciones
JS is a consultant for Aventis, GSK, and Novartis/Genentech; is on the Speakers Bureau for Merck, Aventis, GSK, AstraZeneca, Pfizer, Novartis/Genentech, Inspire, and UCB; has had research sponsored by GSK; is an expert witness at Haemonetics; and has received publication honorarium at Emedicine.
Sheree M.S. Smith, PhD
Research Manager
Imperial College Healthcare Trust
NHLI Airways Division
Imperial College London (Honorary) Respiratory Research
Chest & Allergy
St Mary's Hospital
London
UK
Divulgaciones
SMSS declares that she has no competing interests.
Neil Thomson, MBChB, MD, FRCP
Professor of Respiratory Medicine
Respiratory Medicine Section
Division of Immunology, Infection & Inflammation
University of Glasgow
Glasgow
UK
Divulgaciones
NT declares that he has no competing interests.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
National Institutes of Health; National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program. Expert panel report 3: guidelines for the diagnosis and management of asthma. Aug 2007 [internet publication].Texto completo
Global Initiative for Asthma. 2024 global strategy for asthma management and prevention. May 2024 [internet publication].Texto completo
Parsons JP, Hallstrand TS, Mastronarde JG, et al. An official American Thoracic Society clinical practice guideline: exercise-induced bronchoconstriction. Am J Respir Crit Care Med. 2013 May 1;187(9):1016-27.Texto completo Resumen
Expert Panel Working Group of the National Heart, Lung, and Blood Institute (NHLBI) administered and coordinated National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC); Cloutier MM, Baptist AP, Blake KV, et al. 2020 focused updates to the asthma management guidelines: a report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol. 2020 Dec;146(6):1217-70.Texto completo Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- COPD
- Chronic rhinosinusitis
- Breathing pattern disorder
Más DiferencialesGuías de práctica clínica
- Global strategy for asthma management and prevention
- 2020 focused updates to the asthma management guidelines
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Asthma in adults: what is it?
Asthma in adults: what are the treament options?
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