Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- presencia de factores de riesgo
- desencadenantes de episodios de sibilancias
- mayor esfuerzo respiratorio
- características de la enfermedad atópica
- antecedentes de respuesta al tratamiento dentro del plazo adecuado
Otros factores de diagnóstico
- edad >3 años
- tos nocturna seca
- disnea de esfuerzo
- sibilancia espiratoria
- deformidad de la pared torácica
Factores de riesgo
- sensibilización alérgica
- enfermedad atópica
- sibilancia desencadenada por factores ambientales no virales/no alérgicos
- infecciones virales respiratorias en las etapas tempranas de la vida
- eosinofilia en suero (4% o superior)
- antecedentes familiares de asma
- tabaquismo activo o pasivo
- función pulmonar anormal e hiperreactividad de las vías respiratorias
- contaminación del aire exterior
- sexo femenino
- obesidad
- uso de fármacos supresores de la acidez en el embarazo
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- espirometría
- respuesta al broncodilatador en la espirometría
- radiografía de tórax
Pruebas diagnósticas que deben considerarse
- flujo espiratorio máximo (FEM)
- pruebas de provocación de las vías respiratorias
- prueba de provocación con ejercicio
- hemograma completo (HC)
- broncoscopia
- prueba del sudor
- cultivo de esputo
- estudios ciliares de microscopía electrónica
- prueba de punción cutánea
- fracción exhalada de óxido nítrico (FeNO)
- lavado broncoalveolar
Algoritmo de tratamiento
Colaboradores
Autores
Paul D. Robinson, MBChB, MRCPCH, FRACP, PhD
Respiratory and Sleep Physician
The Children's Hospital at Westmead
Associate Professor
Discipline of Paediatrics and Child Health
Sydney Medical School
University of Sydney
Sydney
New South Wales
Australia
Divulgaciones
PDR provided training and quality control overreading for multiple breath washout measurements performed during a pharmaceutical sponsored study. Reimbursement for the services provided were paid to PDR's place of work.
Anne Chang, MBBS, FRACP, MPHTM, PhD, FAPSR, FThorSoc, FAHMS
Professor
Respiratory and Sleep Physician
Queensland Children's Hospital
Queensland University of Technology
Brisbane
Menzies School of Health Research
Charles Darwin University
Darwin
Australia
Divulgaciones
AC is a member of the data safety monitoring committee in a vaccine study manufactured by GSK, and is a member of an advisory board for a compound manufactured by Merck for cough. AC has received multiple peer reviewed competitive grants from the Australian National Health and Medical Research Council. She is an author of a number of references cited in this topic.
Revisores por pares
Chris Cates, MA, FRCGP
Senior Clinical Research Fellow
Community Health Sciences
St. George's University of London
London
UK
Divulgaciones
CC is an author of a number of references cited in this topic.
Peter Griffiths, MBChB
General Practitioner
Harborne Medical Practice
Birmingham
UK
Divulgaciones
PG declares that he has no competing interests.
Karin A. Pacheco, MD, MSPH
Assistant Professor
Division of Environmental & Occupational Health Sciences
National Jewish Health
Denver
CO
Divulgaciones
KAP declares that she has no competing interests.
Ware Kuschner, MD
Associate Professor of Medicine
Stanford University
Stanford
Staff Physician
US Department of Veterans Affairs
Palo Alto Health Care System
Palo Alto
CA
Divulgaciones
WK declares that he has no competing interests.
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