Article information
Resumen
El asma se caracteriza por inflamación y remodelación de la vía aérea, que da lugar a la obstrucción de ésta y síntomas de sibilancias, opresión torácica, tos y disnea. La mayoría de estas observaciones surgen del estudio de muestras obtenidas de las vías aéreas centrales por distintos métodos, pero hoy en día se acepta que este proceso inflamatorio ocurre no sólo en la vía aérea central, sino también en la vía aérea pequeña (VAP) e incluso en el parénquima pulmonar de todos los pacientes asmáticos, incluso en aquellos con asma leve. Los linfocitos CD4+, eosinófilos activados, y la expresión de ARNm para interleucina 5 están presentes en mayor cantidad en la VAP. También existe remodelación, con incremento del grosor de la submucosa, capa muscular y adventicia. Este proceso inflamatorio causa un desacoplamiento entre el parénquima pulmonar y la vía aérea, dando lugar a una obstrucción de la pequeña vía aérea que hoy en día se considera como predominante en pacientes asmáticos. Los estudios de asma experimental en animales apoyan asimismo una relevante participación de la vía aérea distal. El reconocimiento del asma como una enfermedad que afecta a toda la vía aérea puede tener importancia clínica y obliga a considerar al pulmón distal como diana de cualquier estrategia terapéutica para un tratamiento efectivo de la enfermedad, aunque faltan estudios longitudinales que ayuden a valorar el impacto de la inflamación de la VAP y de su tratamiento en el asma.
Palabras clave:
Asma
Inflamación
Remodelación
Vía aérea pequeña
Abstract
Asthma is characterized by inflammation and remodeling of the airways, giving rise to airway obstruction and symptoms of wheezing, chest tightness, cough and dyspnea. Most of these observations arise from the study of samples obtained from the central airways by distinct methods. However, it is currently accepted that this inflammatory process occurs not only in the central airway but also in the small airway and even in the pulmonary parenchyma of all asthmatic patients, even those with mild asthma. CD4+ lymphocytes, activated eosinophils and IL-5 mRNA expression are present in a greater quantity in the small airways. Also present is remodeling, with an increase in submucosal thickness, the muscular layer and adventitia. This inflammatory process causes a disconnection between the pulmonary parenchyma and the airway, giving rise to obstruction of the small airway, which is currently considered to be predominant in asthmatic patients. Likewise, studies of experimental asthma in animals support the substantial role of the distal airway. Recognition that asthma affects the entire airway could be clinically important and lead to the distal lung being considered as a target in any effective therapeutic strategy. However, longitudinal studies are required to evaluate the impact of distal airway inflammation and its treatment in asthma.
Keywords:
Asthma
Inflammation
Remodeling
Small airways
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