Carta al Director
Una vía respiratoria unificada: las bronquiectasias también se asocian a rinosinusitis crónica y pólipos nasales
A United Airway: Bronchiectasis Is Also Associated With Chronic Rhinosinusitis and Nasal Polyps
Josep Maria Guilemany Tostea,b,c, C.. César Picado Vallésb,c,d, Joaquim Mullol i Mireta,b,c,
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a Unitat de Rinologia i Clínica de l’Olfacte, Servei d’Otorrino-laringologia, Hospital Clínic, Barcelona, España
b Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CibeRes)
c Immunoal·lèrgia Respiratòria Clínica i Experimental, IDIBAPS, Barcelona, España
d Servei de Pneumologia i Al·lèrgia Respiratòria, Institut Clínic del Tòrax, Hospital Clínic, Barcelona, España
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"nombre" => "César" "apellidos" => "Picado Vallés" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff4" ] ] ] 2 => array:4 [ "nombre" => "Joaquim" "apellidos" => "Mullol i Miret" "email" => array:1 [ 0 => "jmullol@clinic.ub.es" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor1" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Unitat de Rinologia i Clínica de l’Olfacte, Servei d’Otorrino-laringologia, Hospital Clínic, Barcelona, España" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CibeRes)" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] 2 => array:3 [ "entidad" => "Immunoal·lèrgia Respiratòria Clínica i Experimental, IDIBAPS, Barcelona, España" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] 3 => array:3 [ "entidad" => "Servei de Pneumologia i Al·lèrgia Respiratòria, Institut Clínic del Tòrax, Hospital Clínic, Barcelona, España" "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff4" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "⁎" "correspondencia" => "Autor para correspondencia." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "A United Airway: Bronchiectasis Is Also Associated With Chronic Rhinosinusitis and Nasal Polyps" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p class="elsevierStylePara elsevierViewall">En noviembre de 2008, <span class="elsevierStyleSmallCaps">Archivos</span><span class="elsevierStyleSmallCaps">de</span><span class="elsevierStyleSmallCaps">Bronconeumología</span> publicó la normativa de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR) sobre el diagnóstico y tratamiento de las bronquiectasias<a class="elsevierStyleCrossRef" href="#bib1"><span class="elsevierStyleSup">1</span></a>. Aunque de enorme importancia para el diagnóstico y tratamiento de las bronquiectasias, el documento no menciona en absoluto el impacto que dicha enfermedad tiene en la vía respiratoria superior en forma de rinosinusitis crónica con y sin pólipos nasales, hecho que ya se había puntualizado en un artículo de revisión publicado en esta Revista en 2006<a class="elsevierStyleCrossRef" href="#bib2"><span class="elsevierStyleSup">2</span></a>.</p><p class="elsevierStylePara elsevierViewall">El concepto de “una vía única” se ha demostrado mediante la asociación epidemiológica, fisiopatológica, de diagnóstico y tratamiento de la enfermedad broncopulmonar con la nasosinusal: asma con rinitis alérgica<a class="elsevierStyleCrossRef" href="#bib3"><span class="elsevierStyleSup">3</span></a>, asma con poliposis nasal<a class="elsevierStyleCrossRef" href="#bib4"><span class="elsevierStyleSup">4</span></a>, asma no alérgica y enfermedad pulmonar obstructiva crónica con rinosinusitis crónica<a class="elsevierStyleCrossRef" href="#bib5"><span class="elsevierStyleSup">5</span></a>. La experiencia clínica en los Servicios de Otorrinolaringología y Neumología del Hospital Clínic de Barcelona ha llevado a investigar desde hace varios años la asociación de enfermedad nasosinusal en pacientes con bronquiectasias.</p><p class="elsevierStylePara elsevierViewall">Como fruto de esta investigación, contamos hoy día con 2 artículos publicados<a class="elsevierStyleCrossRefs" href="#bib6"><span class="elsevierStyleSup">6,7</span></a> y uno actualmente en prensa sobre la asociación de bronquiectasias y rinosinusitis crónica con o sin poliposis nasal. Entre sus conclusiones, debemos destacar que 3 de cada 4 (77%) pacientes con bronquiectasias reúnen criterios clínicos y radiológicos de rinosinusitis crónica, mientras uno de cada 4 (25%) presenta pólipos nasales en la endoscopia nasal<a class="elsevierStyleCrossRef" href="#bib7"><span class="elsevierStyleSup">7</span></a>. Dichos resultados apoyan el concepto de “una única vía aérea” e indican que en las llamadas bronquiectasias postinfecciosas podría haber algún proceso todavía desconocido que afectara a toda la vía aérea. Además, los pacientes con bronquiectasias y rinosinusitis crónica tienen una peor calidad de vida, medida tanto con cuestionarios genéricos como específicos, que los afectados de bronquiectasias sin sinusopatía crónica<a class="elsevierStyleCrossRef" href="#bib6"><span class="elsevierStyleSup">6</span></a>.</p><p class="elsevierStylePara elsevierViewall">De estos resultados se puede concluir que los pacientes con bronquiectasias deberían evaluarse siempre, tanto clínicamento como mediante endoscopia nasal y/o tomografía computarizada nasosinusal, a fin de diagnosticar una posible rinosinusitis crónica, con o sin pólipos nasales. Así pues, a todos los pacientes con bronquiectasias, además de aquéllos con asma y enfermedad pulmonar obstructiva crónica, se les debería realizar un estudio otorrinolaringológico, idealmente en unidades multidisciplinarias, con el objetivo de mejorar su diagnóstico, tratamiento y seguimiento tanto de la enfermedad broncopulmonar como de la nasosinusal.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Vendrell M, De Gracia J, Oliveira C, Martínez MA, Girón R, Máiz L, et al. 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Bousquet" 1 => "N. Khaltaev" 2 => "A.A. Cruz" 3 => "J. Denburg" 4 => "W.J. Fokkens" 5 => "A. Togias" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1398-9995.2007.01620.x" "Revista" => array:7 [ "tituloSerie" => "Allergy" "fecha" => "2008" "volumen" => "63" "numero" => "Suppl 86" "paginaInicial" => "8" "paginaFinal" => "160" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18331513" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European position paper on rhinosinusitis and nasal polyps 2007" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "European Position Paper on Rhinosinusitis and Nasal Polyps group" "etal" => false "autores" => array:3 [ 0 => "W. Fokkens" 1 => "V. Lund" 2 => "J. Mullol" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rhinology" "fecha" => "2007" "numero" => "20" "paginaInicial" => "1" "paginaFinal" => "136" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sinonasal pathology in nonallergic asthma and COPD: “united airway disease” beyond the scope of allergy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Hens" 1 => "B.M. Vanaudenaerde" 2 => "D.M. Bullens" 3 => "M. Piessens" 4 => "M. Decramer" 5 => "L.J. Dupont" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1398-9995.2007.01545.x" "Revista" => array:6 [ "tituloSerie" => "Allergy" "fecha" => "2008" "volumen" => "63" "paginaInicial" => "261" "paginaFinal" => "267" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18053011" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The impact of bronchiectasis associated to sinonasal disease on quality of life" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. Guilemany" 1 => "I. Alobid" 2 => "J. Angrill" 3 => "F. Ballesteros" 4 => "M. Bernal-Sprekelsen" 5 => "C. Picado" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rmed.2006.02.016" "Revista" => array:6 [ "tituloSerie" => "Respir Med" "fecha" => "2006" "volumen" => "100" "paginaInicial" => "1997" "paginaFinal" => "2003" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16581240" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "United airway again: high prevalence of rhinosinusitis and nasal polyps in bronchiectasis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. Guilemany" 1 => "J. Angrill" 2 => "I. Alobid" 3 => "S. Centellas" 4 => "L. Pujols" 5 => "J. Bartra" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1398-9995.2008.01892.x" "Revista" => array:6 [ "tituloSerie" => "Allergy" "fecha" => "2009" "volumen" => "64" "paginaInicial" => "790" "paginaFinal" => "797" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19208088" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/03002896/0000004500000010/v1_201305150204/S0300289609001963/v1_201305150204/es/main.assets" "Apartado" => array:4 [ "identificador" => "9222" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the Director / Cartas al Director" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000004500000010/v1_201305150204/S0300289609001963/v1_201305150204/es/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289609001963?idApp=UINPBA00003Z" ]
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