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Homeostasia do ferro em doentes com asma
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Até ao momento, vários estudos sugerem uma relação entre os níveis de ferro, a sua regulação, a patogénese e a gravidade da asma. No entanto, não foi possível estabelecer ainda, com significância, uma relação de causalidade entre a homeostasia do ferro e o seu papel na fisiopatologia da asma, podendo a alteração dos níveis de ferro ser uma consequência da inflamação crónica inerente à própria doença. O objetivo deste estudo foi avaliar a existência de uma correlação entre a asma grave e a anemia ferropénica. Foi efetuado um estudo clínico observacional retrospetivo, com base em dados de doentes com diagnóstico de asma grave seguidos no Serviço de Imunoalergologia do Centro Hospitalar Universitário Lisboa Norte até 2019, avaliando-se parâmetros laboratoriais, como hemograma e estudo do metabolismo do ferro. Foram igualmente recolhidos dados referentes a variáveis demográficas, tratamento com corticoterapia sistémica e resultados de questionários de avaliação do controlo da asma (ACT e CARAT). Dos 79 doentes com asma grave seguidos no Serviço de Imunoalergologia do Centro Hospitalar Universitário Lisboa Norte e com estudo do metabolismo do ferro, 2 doentes tinham ferropénia absoluta sem anemia (2,53%), 16 doentes tinham anemia (20,3%), dos quais apenas 7 tinham anemia ferropénica (8,9%). Segundo um estudo publicado em 2016, a prevalência de anemia em Portugal foi de 19,9%, sendo a prevalência de anemia ferropénica variável entre 5,8% e 18,4%, dependendo do valor de referência de ferritina utilizado. Concluindo, não foi possível estabelecer uma relação significativa de causalidade entre a asma grave e a anemia, sendo ela ferropénica ou de outra etiologia. Analisando os resultados deste estudo, pode ser colocada a hipótese do mau controlo da asma grave favorecer o desenvolvimento de anemia ou anemia ferropénica. Não foi possível, no entanto, inferir se a toma de corticosteroides sistémicos poderá favorecer o desenvolvimento de anemia ferropénica.
Several studies have suggested a relationship between low iron levels and asthma. However, it has not yet been possible to establish, with significance, a causal relationship between iron homeostasis and its role in the pathophysiology of asthma, and the change in iron levels may be a consequence of the chronic inflammation inherent to the disease itself. The aim of this study was to assess the existence of a correlation between severe asthma and iron deficiency anemia. A retrospective observational clinical study was carried out, based on data from patients diagnosed with severe asthma followed at the Immunoallergology Service of Centro Hospitalar Universitário Lisboa Norte until 2019, evaluating certain laboratory parameters, such as blood count and study of iron metabolism. Data were also collected on demographic variables, treatment with systemic corticosteroid therapy and results from questionnaires for assessing asthma control (ACT and CARAT). Within the 79 patients with severe asthma followed at the Immunoalergology Service of the Centro Hospitalar Universitário Lisboa Norte with an iron metabolism study, 2 patients had iron deficiency without anaemia (2,53%), 16 patients had anaemia (20.3%), of which only 7 had iron deficiency anaemia (8.9%). According to a study published in 2016, the prevalence of anemia in Portugal was 19.9%, with the prevalence of iron deficiency anemia varying between 5.8% and 18.4%, depending on the reference value of ferritin used. By analyzing the results of this study, there is a possibility that poor control of severe asthma may favor the development of anemia or iron deficiency anaemia. However, it was not possible to infer if taking systemic corticosteroids could favor the development of iron deficiency anaemia. In conclusion, it was not possible to establish a significant causal relationship between severe asthma and anemia, whether caused by iron deficiency or of another etiology.
Several studies have suggested a relationship between low iron levels and asthma. However, it has not yet been possible to establish, with significance, a causal relationship between iron homeostasis and its role in the pathophysiology of asthma, and the change in iron levels may be a consequence of the chronic inflammation inherent to the disease itself. The aim of this study was to assess the existence of a correlation between severe asthma and iron deficiency anemia. A retrospective observational clinical study was carried out, based on data from patients diagnosed with severe asthma followed at the Immunoallergology Service of Centro Hospitalar Universitário Lisboa Norte until 2019, evaluating certain laboratory parameters, such as blood count and study of iron metabolism. Data were also collected on demographic variables, treatment with systemic corticosteroid therapy and results from questionnaires for assessing asthma control (ACT and CARAT). Within the 79 patients with severe asthma followed at the Immunoalergology Service of the Centro Hospitalar Universitário Lisboa Norte with an iron metabolism study, 2 patients had iron deficiency without anaemia (2,53%), 16 patients had anaemia (20.3%), of which only 7 had iron deficiency anaemia (8.9%). According to a study published in 2016, the prevalence of anemia in Portugal was 19.9%, with the prevalence of iron deficiency anemia varying between 5.8% and 18.4%, depending on the reference value of ferritin used. By analyzing the results of this study, there is a possibility that poor control of severe asthma may favor the development of anemia or iron deficiency anaemia. However, it was not possible to infer if taking systemic corticosteroids could favor the development of iron deficiency anaemia. In conclusion, it was not possible to establish a significant causal relationship between severe asthma and anemia, whether caused by iron deficiency or of another etiology.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
Anemia ferropénica Asma grave Controlo/gravidade da asma Corticosteroides sistémicos Homeostasia do ferro Imunoalergologia