Doença das pequenas vias aéreas na asma: revisão
Small airways disease in asthma: a review
Ataualpa P. Reis; Álvaro A. Cruz
Resumo
Recentes evidências demonstram que anormalidades nas pequenas vias aéreas contribuem para a expressão clínica da asma. O conceito de que a asma é doença das grandes vias aéreas tem mudado bastante, e esta revisão enfoca os conhecimentos recentes do papel das pequenas vias aéreas. Existem várias técnicas pouco invasivas, incluindo medidas de fluxo aéreo, estimativas do aprisionamento de ar nos pulmões, dosagem do óxido nítrico alveolar (NO), impedância respiratória, técnicas de imagem e nariz eletrônico que podem estudar e avaliar as pequenas vias aéreas. Há considerável quantidade de evidência de que partículas extrafinas utilizadas em aerossóis para tratamento de asma terão maior chance de se depositar nas vias distais e podem melhorar a função destas pequenas vias aéreas, mais do que as comparativas formulações com partículas maiores de aerossol. Esta revisão incluiu artigos originais, revisões e consensos indexados nos bancos de dados PubMed, MEDLINE, LILACS, SCIELO e publicações on line nos últimos 20 anos, e pretende apresentar o conhecimento atual da importância das pequenas vias aéreas e a influência que tratamentos visando estas vias podem ter na asma.
Palavras-chave
Abstract
Recent evidence demonstrates that abnormalities in the small airways contribute to the clinical expression of asthma. The concept that asthma is a disease of the large airways has changed, and this review focuses on the recent interest in the small airways. Several non-invasive methods are available and can be used to evaluate the small airways, e.g., air flow measurement, evaluation of air trapping, alveolar nitric oxide (NO), respiratory impedance, imaging techniques, and electronic nose. There is a considerable amount of evidence suggesting that the extra fine particles used in aerosols for the treatment of asthma are more likely to deposit in distal airways and to improve their function when compared to non-extra fine formulations. The present review included original articles, reviews, and consensus statements retrieved from the PubMed, MEDLINE, LILACS, and SciELO databases, plus online documents published in the past 20 years. The objective was to describe the knowledge currently available on the importance of the small airways and the influence on asthma of treatments targeted at the small airways.
Keywords
References
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Submitted date:
06/19/2013
Accepted date:
06/07/2014
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