Hiperrespuesta bronquial inespecífica. Análisis de la relación entre sensibilidad, reactividad y respuesta máxima

Prieto, L.; Manuel Bertó, J.; López San Martín, M.; Peris, A.

doi:10.1016/S0300-2896(15)31257-6

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Para estudiar la relación entre sensibilidad (PC20FEV1), reactividad (pendiente de la curva concentración-respuesta) y respuesta máxima, hemos seleccionado 22 pacientes atópicos con PC20-metacolina ≤ 200 mg/ml y con curvas concentración-respuesta adecuadas para el análisis de la pendiente en su porción lineal. Se identificó respuesta máxima (platean) en tres de 11 pacientes asmáticos y en siete de 11 individuos con rinitis alérgica. Se encontró correlación entre el log PC20 y pendiente (r=–0,54, p<0,01) entre el log PC20 y nivel de platean (r=–0,79, p<0,01) y entre la pendiente y el nivel del platean (r=0,73, p<0,05). Además, los individuos con platean mostraron grados menores de sensibilidad bronquial que los individuos sin platean (media geométrica de la PC20 de 6,76 vs 0,76 mg/ml, p<0,001). La reactividad bronquial (pendiente) en los pacientes con platean (med + SEM: 17,6±2,6%/log mg/ml) fue menor (p<0,05) que la de los sujetos sin platean (30,1±4,3%/log mg/ml). Existe una relación entre sensibilidad, reactividad y respuesta máxima y aunque el platean se detecta con mayor frecuencia en los individuos menos sensibles, no es un hallazgo exclusivo de los sujetos no asmáticos.

To study the relation between sensitivity (PC20FEV1), reactivity (slope of the concentration-response curve) and maximum response, 22 atopic patients with PC20 methacholin ≤ 200 mg/ml and with concentration-response curves adequate for the analysis of the slope of its lineal portion were selected. Maximum response (platean) was identified in 7 of 11 individuals with allergic rhinitis. Correlatión was found between the PC20 log and slope (r=–0.54, p<0.01) between the PC20 log and plateau level (r=–0.79, p<0.01) and between the slope and the plateau level (r=0.73, p<0.05). In addition, the individuáis with plateau demonstrated lower degrees of bronchial sensitivity than those without plateau (geometric mean of the PC20 of 6.76 vs 0.76 mg/ml, p<0.001). Bronchial reactivity (slope) in patients with plateau (med + SEM: 17.6±2.6%/log mg/ml) was lower (p<0.05) than that of the subjects without plateau (30.1±4.3%/log mg/ml). There is a relation between sensitivity, reactivity and maximum response and, although the plateau is detected with greater frequency in less sensitive individuais, it is not an exclusive finding of non asthmatic subjects.

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