Disanapsis pulmonar e hiperrespuesta bronquial en el asma
Resumen
La hiperrespuesta bronquial (HB) es el estrechamiento excesivo y súbito de la luz aérea ante estímulos de naturaleza diversa que por lo común solo provocan una reducción escasa o nula en el calibre del tracto respiratorio. La mayoría de los autores coinciden a la hora de afirmar que su patogenia está ligada a la inflamación que experimenta la pared bronquial durante el curso de la enfermedad y señalan tres mecanismos claves: la participación de determinantes mecánicos, la disfunción del músculo liso de la vía aérea (MLVA) y la pérdida de componente(s) limitante(s) de la contractilidad del MLVA. Sin embargo, en los últimos años diversos investigadores han llamado la atención sobre la necesidad de considerar aquí también otro aspecto: la disanapsis pulmonar. Es decir, la incongruencia entre un (más rápido) crecimiento del volumen pulmonar y la longitud de las vías aéreas y un (más lento) aumento del calibre de estas últimas. Varios trabajos han demostrado fuera de toda duda que las desigualdades en la relación vía aérea/parénquima correlacionan con el grado de HB asmática y, bajo determinadas condiciones, constituye un factor que favorece el riesgo de padecer asma. La presente revisión recoge la información actualizada más destacable que liga disanapsis, HB y asma, con una especial atención a los estudios epidemiológicos realizados al respecto.
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