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Macrólidos : contributo no tratamento da asma grave
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A asma é uma doença inflamatória crónica das vias aéreas, cuja prevalência tem aumentado nos últimos anos. Cerca de 5-10% dos doentes têm asma grave que necessita de terapêutica com doses máximas de corticosteroides orais e broncodilatadores ou que se mantêm incontrolável, além disso, têm um risco acrescido para perda de função pulmonar, exacerbações e efeitos adversos da medicação.
Devido à heterogeneidade da asma a resposta aos tratamentos é diferente entre doentes. Assim, poderá ser benéfico a determinação de fenótipos de asma para direcionar o tratamento e não submeter os doentes a terapêuticas ineficazes. Contudo, a determinação de fenótipos não é feita na prática clinica.
Atualmente, a terapêutica convencional da asma é realizada com corticosteroides e broncodilatadores, que mesmo em doses máximas poderão não ser suficientes para controlar a asma grave. Novas terapêuticas têm surgido com alvos mais específicos, que poderão beneficiar doentes com inflamação tipo 2.
A dificuldade de tratamento da asma grave e o risco acrescidos que apresenta, sustenta a necessidade de encontrar novas soluções terapêuticas. Nesse seguimento, vários estudos têm a azitromicina como alvo devido às suas características antibióticas, anti-inflamatórias e imunomodeladoras a longo prazo. Os resultados de muitos estudos mostram melhoria do volume expiratório forçado no 1 segundo (FEV1), o fluxo expiratório máximo (PEF), a hiperreactividade das vias aéreas (AHR), a capacidade vital forçada (FVC) e FEV1/FVC, mas sem redução das exacerbações ou da sua gravidade. Contudo, estudos posteriores apresentam redução da taxa de exacerbações em doentes com asma moderada a grave. Porém, novos estudos são necessários para caracterizar melhor os efeitos da azitromicina em cada fenótipo e avaliar o desenvolvimento de resistência aos antibióticos a longo-prazo.
Asthma is a chronic inflammatory disease of the airways, whose prevalence has increased in recent years. Approximately 5-10% of patients have severe that is characterized by asthma requiring therapy with maximum doses of oral corticosteroids and bronchodilators or asthma that remain uncontrollable. In addition, severe asthma has an increased risk for loss of pulmonary function, exacerbations and adverse effects of the medication. It is essential to find new drugs in the therapeutic plans to suppress current flaws. Due to the heterogeneity of asthma the response to treatments is different among patients. Thus, it may be beneficial to determine asthma phenotypes to target treatment and not to subject patients to ineffective therapies. However, the determination of phenotypes is not done in clinical practice. Currently, conventional asthma therapy is performed with corticosteroids and bronchodilators. New therapies have emerged with specific targets that may benefit patients with type 2 inflammation. The difficulty of treating severe asthma and the increased risk it presents, supports the need to find new therapeutic solutions. In the following, several studies have azithromycin target features due to its antibiotic, anti-inflammatory and immunomodulatory in long term therapy. The results of many studies showed improvement of forced expiratory volume in the first second (FEV1), peak expiratory flow (PEF), airway hyperreactivity (AHR), forced vital capacity (FVC) and FEV1 / FVC, but without improvement on exacerbations or their severity. Yet, further studies show a reduction in the rate of exacerbations in patients with moderate to severe asthma. However, further studies to better characterize the effects of azithromycin on each phenotype and to evaluate the development of long-term antibiotic resistance.
Asthma is a chronic inflammatory disease of the airways, whose prevalence has increased in recent years. Approximately 5-10% of patients have severe that is characterized by asthma requiring therapy with maximum doses of oral corticosteroids and bronchodilators or asthma that remain uncontrollable. In addition, severe asthma has an increased risk for loss of pulmonary function, exacerbations and adverse effects of the medication. It is essential to find new drugs in the therapeutic plans to suppress current flaws. Due to the heterogeneity of asthma the response to treatments is different among patients. Thus, it may be beneficial to determine asthma phenotypes to target treatment and not to subject patients to ineffective therapies. However, the determination of phenotypes is not done in clinical practice. Currently, conventional asthma therapy is performed with corticosteroids and bronchodilators. New therapies have emerged with specific targets that may benefit patients with type 2 inflammation. The difficulty of treating severe asthma and the increased risk it presents, supports the need to find new therapeutic solutions. In the following, several studies have azithromycin target features due to its antibiotic, anti-inflammatory and immunomodulatory in long term therapy. The results of many studies showed improvement of forced expiratory volume in the first second (FEV1), peak expiratory flow (PEF), airway hyperreactivity (AHR), forced vital capacity (FVC) and FEV1 / FVC, but without improvement on exacerbations or their severity. Yet, further studies show a reduction in the rate of exacerbations in patients with moderate to severe asthma. However, further studies to better characterize the effects of azithromycin on each phenotype and to evaluate the development of long-term antibiotic resistance.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2018
Palavras-chave
Asma grave Azitromicina Pneumologia