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El Asma
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El Asma

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El asma es una enfermedad pulmonar con las siguientes características:

  • Obstrucción de la vía aérea total o parcialmente reversible, bien espontáneamente o con tratamiento.

  • Inflamación bronquial y remodelado (fibrosis) de la arquitectura del bronquio, con infiltración de la mucosa por eosinófilos y otras células, y un mayor o menor grado de fibrosis subepitelial permanente, aún en ausencia de síntomas.

  • Hiperreactividad bronquial, o respuesta aumentada de la vía aérea frente a distintos estímulos, peor no específica de esta enfermedad.

De estas características, la inflamación de la mucosa bronquial debe existir siempre para poder hacer un diagnóstico de asma, las demás pueden pasar por periodos de mayor o menor actividad y presencia.

Síntomas

Al producirse esta inflamación de la mucosa bronquial aparecen los siguientes síntomas:

  • Tos
  • Silbidos en el pecho
  • Secreciones (flemas)
  • Disnea o fatiga

Pueden no aparecer ninguno de ellos y ser asintomático.

Estos síntomas suelen cursar en crisis, durando los síntomas unos días y cediendo, o bien cursar con síntomas de forma continua con agudizaciones ocasionales más intensas. De forma atípica, puede existir exclusivamente tos persistente, opresión torácica sin otros síntomas acompañantes, o bien estar oculto como bronquitis de repetición en niños, siendo solo un proceso de tos y flemas, sin fatiga al respirar. En todas las formas es característico el predominio nocturno de los síntomas.

Su origen

El origen del asma bronquial es la inflamación de predominio eosinófilo producida, en origen, por la alergia a productos conocidos o desconocidos. Es por ello que en una mayoría de los casos se acompaña de una rinitis con estornudos aguilla nasal, picor y obstrucción. Esta asociación es en la que se basa la teoría hoy en día aceptada de que el asma es una parte de una enfermedad alérgica y no un problema orgánico exclusivo pulmonar.

Sobre esta inflamación alérgica actúan otros mecanismos que desencadenan síntomas:

  • Las infecciones
  • Olores fuertes
  • Cambios bruscos de temperatura
  • Esfuerzo
  • Estrés, nerviosismo
  • Alteraciones de la digestión, reflujo gastroesofágico
  • Otros

La evolución esperada es hacia la curación en un gran porcentaje de los niños con asma ya que la prevalencia en la infancia es del 11% y en el adulto oscila entre el 4 y 6 %.

Por ello más de la mitad de los niños con asma dejan de padecer esta enfermedad después de la pubertad.

Factores de Riesgo

Los factores de riesgo para mantenerse con asma son:

  • Comienzo del asma antes de los 2 años
  • Madre con asma
  • Pruebas de alergia positivas, atopia
  • Alteración de función ventilatoria pulmonar persistente
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