Asma Bronquial

Asma es una enfermedad inflamatoria crnica que

afecta a las vas respiratorias perifricas, participando
fundamentalmente las clulas cebadas y los
eosinfilos, provocando un estado de hiperreactividad
bronquial que se manifiesta, luego de los estmulos
provocadores, como un estado de broncoespasmo, el
cual es reversible y autolimitado.
GINA
 PUNTOS CLAVE
Gen y su interaccin con el medio ambiente son
importantes para la expresin del asma.

La atopia, la predisposicin gentica para el desarrollo

la respuesta a aeroalrgenos , es el ms fuerte factor
identificable de predisposicin para el desarrollo de
asma.

Las infecciones virales respiratorias son una de las

causas ms importantes de la exacerbacin del asma y
tambin puede contribuir al desarrollo de asma.
Clasificacin de severidad - GINA
SINTOMAS LEVE SEVERO

Conciencia alterada NO AGITADO,CONFUSO

Oximetra >94 <90

Oraciones-palabras ORACIONES PALABRAS

FC < 100 >180

Cianosis central NO SI

Intensidad de sibilancias VARIABLE EN REPOSO

Clasificacin de severidad
Clasificacin de severidad
MANEJO DE LA EXACERBACIN
MANEJO DE LA HIPOXEMIA
Objetivo: mantener saturacin de oxgeno mayor a
94% (Evidencia A)
TERAPIA BRONCODILATADORA
Beta agonistas de accin rpida mediante
nebulizacin o inhalaciones dependiendo de
presencia o ausencia de hipoxemia
En la mayora de nios, las inhalaciones con
espaciador son tan efectivas como la nebulizacin
(Evidencia A)
MANEJO DE LA EXACERBACIN
BROMURO DE IPATROPIO
National Heart Lung and Blood Institute (NHLBI): not
be used as first-line therapy, but as adjunct to short-
acting beta-2 agonists (SABAs)
Addition of multiple doses of ipratropium bromide to
selective SABA therapy recommended in emergency
department (NHLBI Evidence A)
Ipratropium bromide NOT recommended for patients
hospitalized for severe acute asthma (NHLBI Evidence
A)
MANEJO DE LA EXACERBACIN
BROMURO DE IPATROPIO
Metered dose inhaler (MDI) (18 mcg/puff) 4-8 puffs
every 20 minutes as needed for up to 3 hours; children <
4 years old should use valved holding chamber (VHC)
and face mask
Reduce dose frequency as clinically indicated
Efficacy addition of multiple doses of inhaled
ipratropium to beta-2 agonists reduces rate of hospital
admissions in children and adults with moderate to
severe asthma exacerbations (level 1 [likely reliable]
evidence)
MANEJO DE LA EXACERBACIN
CORTICOIDES SISTMICOS
National Heart Lung and Blood Institute (NHLBI)
recommendations for management of acute asthma
systemic corticosteroids recommended for patients with
moderate or severe exacerbations and patients who do
not respond completely to initial short-acting beta
agonist (NHLBI Evidence A)
Oral prednisone as effective as IV methylprednisolone
(NHLBI Evidence A) and less invasive
Systemic corticosteroids recommended for patients
admitted to hospital (NHLBI Evidence A)
Patients given systemic corticosteroids should continue
oral corticosteroids for 3-10 days (NHLBI Evidence A)
MANEJO DE LA EXACERBACIN
Systemic steroids given within 1 hour of emergency
department (ED) visit for acute asthma may prevent
hospital admission (level 2 [mid-level] evidence)
Oral prednisolone appears as effective as intramuscular
dexamethasone in children presenting to ED with asthma
(level 2 [mid-level] evidence)
Oral steroids may be as effective as IV steroids for children
with acute asthma (level 2 [mid-level] evidence)
Comparisons of inhaled vs. oral steroids for children with
acute asthma have limited and inconsistent evidence
MANEJO DE LA EXACERBACIN
SULFATO DE MAGNESIO
National Heart Lung and Blood Institute (NHLBI)
recommends consideration of magnesium sulfate for
impending respiratory failure in asthma exacerbation
Magnesium sulfate may be considered to avoid intubation,
but do not delay intubation once deemed necessary (NHLBI
Evidence B)
Consider IV magnesium sulfate (NHLBI Evidence B) in
patients who have life-threatening exacerbations
Patients whose exacerbations remain in the severe category
after 1 hour of intensive conventional therapy
IV magnesium sulfate may reduce hospital admission rates
in children with acute asthma (level 2 [mid-level] evidence)