Fatores associados ao sexo para sibilância recorrente e asma
Sex-related factors for recurrent wheezing and asthma
Wellington Fernando da Silva Ferreira; Débora Carla Chong-Silva; Juliana Mayumi Kamimura Murata; Cristine Secco Rosário; Giovanna Daneluz Brito; Joao Pedro Giacomet; Nelson Augusto Rosario-Filho; Herberto Jose Chong-Neto
Resumo
Nas últimas décadas, consolidou-se o conhecimento da heterogeneidade de fatores associados à asma. Sexo, condições ambientais, genética, raça, obesidade, questões hormonais e imunológicas influenciam sintomas e resposta ao tratamento da asma. Associação entre asma e obesidade é observada em adultos e crianças e parece ser muito mais consistente no sexo feminino. As mulheres adultas também apresentam maior prevalência de asma em comparação aos homens, e têm três vezes mais chances de hospitalização, o que é mantido até a menopausa. Mulheres são mais afetadas quando expostas ao tabagismo passivo e ativo, e, nos meninos, a exposição intrauterina ao tabaco tem maior influência negativa no crescimento de vias aéreas. Homens e mulheres apresentam diferenças em relação ao envolvimento de pequenas vias aéreas. Os homens apresentaram mais aprisionamento aéreo induzido pela metacolina, enquanto as mulheres têm frações mais elevadas de óxido nítrico exalado. Mulheres apresentam maior diversidade de polimorfismos genéticos associados à asma. Quanto à resposta ao tratamento, homens respondem melhor funcionalmente, com aumento do VEF1, quando utilizam corticoides inalatórios. Meninos entre 2-9 anos respondem melhor aos antagonistas de leucotrienos, resposta que se inverte e passa a ser mais significativa em meninas entre 10-14 anos. O enfoque do manejo atual da sibilância recorrente e da asma deve levar em consideração aspectos individuais específicos, que variam entre homens e mulheres, e que impactam no tratamento e prognóstico da doença.
Palavras-chave
Abstract
In recent decades, knowledge of the heterogeneity of asthma-related factors has been consolidated. Sex, environmental conditions, genetics, race, obesity, and hormonal and immunological factors influence symptoms and response to the treatment of asthma. The association between asthma and obesity is seen in adults and children and appears to be much more consistent in women. Adult women also have a higher prevalence of asthma compared to men and are three times more likely to be hospitalized, which persists until menopause. Women are more affected when exposed to passive and active smoking and, in boys, intrauterine tobacco exposure has a greater negative influence on airway growth. Men and women differ in terms of involvement of small airways. Men present with greater methacholine-induced air trapping, while women have higher fractions of exhaled nitric oxide. Women show a greater diversity of genetic polymorphisms associated with asthma. As for treatment response, men respond better functionally, with increased forced expiratory volume in 1 second (FEV1) when using inhaled corticosteroids. Boys aged 2-9 years respond better to leukotriene antagonists, a response that is then reversed and becomes more significant in girls aged 10-14 years. The current approach to recurrent wheezing and asthma must take specific aspects into account, which vary between men and women and impact the treatment and prognosis of the disease.
Keywords
Referências
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Submetido em:
06/06/2020
Aceito em:
24/06/2020
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