Prueba broncodilatadora
Resumen
La prueba broncodilatadora (PBD) evalúa la reversibilidad de la obstrucción bronquial.
Es una de las pruebas más sencillas, baratas y útiles de las que se realizan en la práctica clínica habitual en Neumología, con utilidad diagnóstica, pronóstica y terapéutica (1).
La obstrucción de la vía aérea es determinada por el diámetro de la luz de la vía aérea y está influenciada por el edema y la inflamación de la pared bronquial, la hipersecreción de moco y la contracción del músculo liso bronquial.
La administración de medicación broncodilatadora induce una respuesta bronquial física integrada, que incluye el epitelio bronquial, las terminaciones nerviosas, mediadores y músculo liso bronquial; condicionando una disminución de la resistencia al flujo aéreo con el consiguiente incremento del volumen espirado.
La PBD se encarga de medir la mejoría que se produce en un determinado parámetro funcional más allá de la variabilidad biológica espontánea y de la respuesta biológica existente en sujetos sanos.
Lo habitual es medir la respuesta broncodilatadora mediante una espirometría, aunque también se pueden valorar los cambios producidos en las resistencias de la vía aérea (o mediante la conductancia), en la tolerancia al esfuerzo o incluso en el grado de disnea.
Otra forma de medir la reversibilidad también puede ser determinada como una mejoría en el FEV1 tras 2 semanas de tratamiento con corticoides orales (prednisona 40mg/d o equivalente) o tras 2-8 semanas de tratamiento con esteroides inhalados (1500-2000 mcg de fluticasona o equivalente) (2,3).
La reversibilidad de la obstrucción bronquial ha sido clásicamente considerada como la característica determinante del asma, estando siempre presente en su definición. Pero existen otras enfermedades que pueden cursar con cierta reversibilidad como son la enfermedad pulmonar obstructiva crónica (EPOC), las bronquiectasias y la fibrosis quística.
Esta revisión se refiere a la determinación de la PBD mediante la espirometría.
Referencias
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