Guia para o manejo da asma grave
Guideline for the management of severe asthma
Eduardo Costa; Janaina Michelle Lima Melo; Marcelo Vivolo Aun; Pedro Francisco Giavina Bianchi Jr.; Jose Laerte Boechat; Gustavo Falbo Wandalsen; José Angelo Rizzo; Alvaro Augusto Cruz; Adelmir Souza-Machado; Flavio Sano; Faradiba Sarquis Serpa
Resumo
O conceito e a abordagem da asma grave sofreram modificações ao longo das últimas décadas. Atualmente são considerados asmáticos graves os pacientes que necessitam das etapas 4 ou 5 de tratamento da Global Initiative for Asthma (GINA) para evitar o descontrole da doença ou que permanecem não controlados apesar dessa terapêutica. O diagnóstico de asma grave deve ser estabelecido após avaliação de condições que contribuem para o não controle da doença, como a adesão e o acesso ao tratamento, a técnica inalatória, os diagnósticos diferenciais e as comorbidades prevalentes nessa população. Além da terapia com corticosteroides inalados em alta dose associados a beta-2 agonistas de longa ação, antagonistas do receptor muscarínico de longa ação e agentes biológicos dirigidos contra moléculas bioativas envolvidas na fisiopatologia da doença têm demonstrado eficácia no controle da asma. A introdução das terapias alvo com agentes biológicos na etapa 5 da GINA permite um tratamento de precisão, baseado no fenótipo e/ou endótipo da asma, e representa uma nova e grande janela de oportunidade no controle da asma grave. Nesse contexto, este guia foi desenvolvido com o objetivo de contribuir para uma melhor abordagem da asma grave por parte do especialista.
Palavras-chave
Abstract
Over the past decades, the concept of and approach to severe asthma have changed. Currently, severe asthma patients are considered to be those who need Global Initiative for Asthma (GINA) treatment steps 4 or 5 to control the disease or those whose disease remains difficult to control despite this therapy. The diagnosis of severe asthma should be established after the evaluation of conditions that contribute to poor control, namely: adherence and access to treatment, inhalation technique, differential diagnosis, and comorbidities that affect this population. In addition to high-dose inhaled corticosteroid therapy associated with long-acting beta-2 agonists, long-acting muscarinic receptor antagonists and biological agents targeted against bioactive molecules involved in the pathophysiology of the disease have been shown to be effective in asthma control. The introduction of targeted therapies with biological agents in GINA step 5 allows precision treatment, based on the asthma phenotype and/or endotype, and represents a new window of opportunity for severe asthma control. In this context, this guide was developed with the objective of contributing to a better approach to severe asthma by the specialist.
Keywords
Referências
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Submetido em:
09/10/2016
Aceito em:
03/11/2016
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