Carta al Director
Reflexiones sobre la rinitis como un marcador clínico de fenotipo EPOC-asma
Rhinitis: A clinical marker of COPD-asthma overlap phenotype?
Juan Marco Figueira Gonçalves
Servicio de Neumología, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España
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GesEPOC propone para su diagnóstico los siguientes criterios mayores: prueba broncodilatadora mayor del 15% y 400<span class="elsevierStyleHsp" style=""></span>ml, eosinofilia en esputo y un diagnóstico de asma antes de los 40 años; y criterios menores: IgE total elevada, atopia y prueba broncodilatadora mayor del 12% y 200<span class="elsevierStyleHsp" style=""></span>ml en 2 o más ocasiones.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Sorprendentemente la rinitis, una enfermedad presente en hasta el 75% de los pacientes con asma alérgica, y hasta en un 80% de pacientes asmáticos no alérgicos fue excluida de los criterios diagnósticos, dando prioridad a la presencia de atopia y a altos niveles de IgE total con intención de identificar un sustrato inflamatorio eosinofílico. No obstante, enfermedades como son el asma o la rinitis pueden cursar con infiltración eosinofílica sin poder demostrarse ni sensibilización alguna ni elevación en los niveles de IgE.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Si bien el concepto de vía única en el asma está bastante arraigado, la evidencia científica acerca de la coexistencia de rinitis y EPOC es escasa hasta la fecha. Diversos estudios describen que hasta el 88% de los pacientes con EPOC refieren clínica de vía aérea superior siendo la rinorrea el síntoma principal<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a>. Jamieson et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> identificaron lo que definieron como fenotipo alérgico en pacientes con EPOC al presentar una sensibilización positiva a neumoalérgenos y/o síntomas alérgicos de vía respiratoria superior, demostrando que son sujetos más sintomáticos y que tienen mayor riesgo de presentar agudizaciones.En concordancia con el concepto de vía única, el tipo de sustrato inflamatorio existente en la vía aérea superior debería orientarnos hacia el tipo de inflamación presente a nivel bronquial. Hurst et al. detectaron elevadas concentraciones de IL-8 en el lavado nasal de pacientes con EPOC, las cuales orientan a la presencia de una respuesta neutrofílica<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a>. Dichos hallazgos irían en consonancia con los datos aportados por Vachier et al., los cuales, al analizar biopsias de la mucosa nasal de sujetos con EPOC y tabaquismo activo apreciaron un aumento de neutrófilos y CD8<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>. En contrapartida, Hens et al. describieron en su estudio elevadas concentraciones de eotaxina en lavados nasales de sujetos con EPOC sin un incremento de las concentraciones de IL8 respecto a sujetos con asma, lo que podría orientar a la existencia de una respuesta eosinofílica<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a>. Así mismo, Neves MC et al. afirman como la clínica de rinitis en sujetos con EPOC se relaciona con la presencia de eosinofilia nasal con un OR de 4,1 (1,59-11,39) siendo más frecuente en dichos sujetos detectar una respuesta broncodilatadora positiva<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">6</span></a>.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Esta disparidad en los resultados podría estar en consonancia con el concepto fenotipos en la EPOC. A falta de ensayos clínicos que lo corroboren, dada la alta prevalencia de rinitis en sujetos con asma es razonable plantearse la posibilidad de utilizar la presencia de esta como un marcador clínico que nos oriente al diagnóstico de fenotipo EPOC-asma.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The frequency of chronic rhinosinusitis/nasal polyp in COPD and its effect on the severity of COPD" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Kelemence" 1 => "O. Abadoglu" 2 => "C. Gumus" 3 => "S. Berk" 4 => "K. Epozturk" 5 => "I. 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Wedzicha" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.127.4.1219" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2005" "volumen" => "127" "paginaInicial" => "1219" "paginaFinal" => "1226" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15821198" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of allergic phenotype on respiratory symptoms and exacerbations in patients with COPD" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.B. Jamieson" 1 => "E.C. Matsui" 2 => "A. Belli" 3 => "M.C. McCormack" 4 => "E. Peng" 5 => "S. Pierre-Louis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/rccm.201211-2103OC" "Revista" => array:6 [ "tituloSerie" => "Am J Respir Crit Care Med" "fecha" => "2013" "volumen" => "188" "paginaInicial" => "187" "paginaFinal" => "192" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23668455" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inflammatory features of nasal mucosa in smokers with and without COPD" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "I. Vachier" 1 => "A.M. Vignola" 2 => "G. Chiappara" 3 => "A. Bruno" 4 => "H. Meziane" 5 => "P. Godard" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Thorax" "fecha" => "2004" "volumen" => "59" "paginaInicial" => "303" "paginaFinal" => "307" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15047949" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "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" => "bib0055" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of atopy in patients with COPD" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.C. Neves" 1 => "Y.C. Neves" 2 => "C.M. Mendes" 3 => "M.N. Bastos" 4 => "A.A. Camelier" 5 => "C.F. Queiroz" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/S1806-37132013000300006" "Revista" => array:6 [ "tituloSerie" => "J Bras Pneumol" "fecha" => "2013" "volumen" => "39" "paginaInicial" => "296" "paginaFinal" => "305" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23857681" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/03002896/0000005200000006/v1_201605260144/S0300289615003750/v1_201605260144/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/03002896/0000005200000006/v1_201605260144/S0300289615003750/v1_201605260144/es/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289615003750?idApp=UINPBA00003Z" ]
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