No es asma todo lo que parece: eosinofilias pulmonares

Ana Gómez-Bastero, Virginia Almadana Pacheco, Agustín Salvador Valido Morales

Resumen


El asma grave es aquel que por definición se encuentra en escalones terapéuticos 5-6 de GEMA para su control, pudiendo a su vez tratarse de un asma de difícil control o difícil de tratar debido a comorbilidades, falta de adherencia o factores agravantes. Es en este punto donde debemos pensar en las enfermedades pulmonares eosinofílicas (EPE). Éstas pueden presentar diferentes manifestaciones clínicas y debemos pensar en ellas ante la presencia de una eosinofilia en sangre periférica > 500/mcL o > 250/mcL en pacientes en tratamiento con glucocorticoides orales, infiltrados radiológicos asociados así como cambios en la medicación o viajes a zonas endémicas de infección por helmintos. Si bien, muchas de ellas también se pueden plantear en pacientes sin antecedentes de atopia o asma bronquial.

Un aspecto común en muchas de las EPE, aunque no en todas, es su alta capacidad de respuesta al tratamiento con glucocorticoides. Así en determinados casos se precisará tratamiento antiparasitario, antifúngico, inmunosupresores o biológico (Ej: antiIgE). La incorporación reciente de nuevas dianas terapéuticas dirigidas a IL-5, IL-4 e IL-13 podrán proporcionar tanto opciones adicionales para el manejo como una mayor comprensión de la patogénesis de los trastornos pulmonares mediados por eosinófilos.


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