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      Asma Translated title: Asthma

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          Abstract

          El asma es una enfermedad inflamatoria crónica de las vías aéreas en la cual muchas células y productos celulares juegan un papel importante. La inflamación crónica produce un incremento en la reactividad de la vía aérea y episodios recurrentes de sibilancias, dificultad respiratoria, tiraje intercostal, tos y opresión torácica, especialmente en la noche y en la mañana. Estos episodios se asocian con obstrucción del flujo aéreo, reversible espontáneamente o con tratamiento. La inflamación también causa un aumento en la respuesta bronquial a una gran variedad de estímulos. Es la enfermedad crónica más común en la infancia, los estudios epidemiológicos en América Latina han revelado diferencias en prevalencia del asma con cifras de 5.7 a 16.5% en la población pediátrica. En los últimos años se han realizado estudios en la Ciudad de México aplicando la metodología del ISAAC, determinando que la prevalencia es de 8 a 12%. Varios factores de riesgo se asocian con el desarrollo de esta enfermedad, a continuación se exponen éstos, así como la fisiopatología de la enfermedad, manifestaciones clínicas, estrategias de diagnóstico y opciones terapéuticas.

          Translated abstract

          Asthma is a chronic inflammatory disorder of the airways in which many cells and cellular elements play a role. The chronic inflammation is associated with airway hyperresponsiveness that leads to recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, particularly at night or in the early morning. These episodes are usually associated with widespread, but variable, airflow obstruction within the lung that is often reversible either spontaneously or with treatment. It is the most common respiratory disease in childhood, epidemiologic studies in Latin America report prevalence varying from 5.7 to 16.5%. Recent studies using ISAAC methodology in Mexico City have reported prevalence from 8 to 12%. Numerous risk factors have been associated with this disease. This factors, physiopathology, clinical presentation, diagnosis and therapeutics options are reviewed.

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          Most cited references135

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          Exposure to house-dust mite allergen (Der p I) and the development of asthma in childhood. A prospective study.

          Children with asthma commonly have positive skin tests for inhaled allergens, and in the United Kingdom the majority of older children with asthma are sensitized to the house-dust mite. In a cohort of British children at risk for allergic disease because of family history, we investigated prospectively from 1978 to 1989 the relation between exposure to the house-dust mite allergen (Der p I) and the development of sensitization and asthma. Of the 67 children studied in 1989, 35 were atopic (positive skin tests), and 32 were nonatopic. Of the 17 with active asthma, 16 were atopic (P less than 0.005), all of whom were sensitized to the house-dust mite, as judged by positive skin tests and levels of specific IgE antibodies (P less than 0.001). For house-dust samples collected from the homes of 59 of the children in 1979 and from 65 homes in 1989, the geometric means for the highest Der p I exposure were, respectively, 16.1 and 16.8 micrograms per gram of sieved dust. There was a trend toward an increasing degree of sensitization at the age of 11 with greater exposure at the age of 1 (P = 0.062). All but one of the children with asthma at the age of 11 had been exposed at 1 year of age to more than 10 micrograms of Der p I per gram of dust; for this exposure, the relative risk of asthma was 4.8 (P = 0.05). The age at which the first episode of wheezing occurred was inversely related to the level of exposure at the age of 1 for all children (P = 0.015), but especially for the atopic children (r = -0.66, P = 0.001). In addition to genetic factors, exposure in early childhood to house-dust mite allergens is an important determinant of the subsequent development of asthma.
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            Early intervention with budesonide in mild persistent asthma: a randomised, double-blind trial.

            Although inhaled glucocorticosteroids are recommended for persistent asthma, their long-term effect on recent onset, mild, persistent asthma has yet to be established. We did a randomised, double-blind clinical trial in 7241 patients in 32 countries to assess the effects of budesonide in patients who had had mild persistent asthma for less than 2 years and who had not had previous regular treatment with glucocorticosteroids. Patients aged 5-66 years received either budesonide or placebo once daily for 3 years in addition to their usual asthma medications. The daily budesonide dose was 400 microg, or 200 microg for children younger than 11 years. The primary outcome was time to first severe asthma-related event, and analysis was by intention to treat. 198 of 3568 patients on placebo and 117 of 3597 on budesonide had at least one severe asthma exacerbation; hazard ratio 0.56 (95% CI 0.45-0.71, p<0.0001). Patients on budesonide had fewer courses of systemic corticosteroids and more symptom-free days than did those on placebo. Compared with placebo, budesonide increased postbronchodilator forced expiratory volume in 1 s (FEV1) from baseline by 1.48% (p<0.0001) after 1 year and by 0.88% (p=0.0005) after 3 years (expressed as percent of the predicted value). The corresponding increase in prebronchodilator FEV1 was 2.24% after 1 year and 1.71% after 3 years (p<0.0001 at both timepoints). The effect of treatment on all outcome variables was independent of the baseline lung function (prebronchodilator or postbronchodilator) or baseline medication. In children younger than 11 years, 3-year growth was reduced in the budesonide group by 1.34 cm. The reduction was greatest in the first year of treatment (0.58 cm) than years 2 and 3 (0.43 cm and 0.33 cm, respectively). Long-term, once-daily treatment with low-dose budesonide decreases the risk of severe exacerbations and improves asthma control in patients with mild persistent asthma of recent onset.
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              Tucson Children's Respiratory Study: 1980 to present.

              The Tucson Children's Respiratory Study (TCRS), begun in 1980, has followed 1246 subjects from birth together with their family members to delineate the complex interrelationships between a large number of potential risk factors, acute lower respiratory tract illnesses, and chronic lung disorders later in childhood and early adult life, especially asthma. Nine hundred seventy-four (78%) of the original subjects are still being followed. Among its numerous findings, the TCRS has (1) described various wheezing disorders (transient, nonatopic, atopic) and their characteristics; (2) developed an Asthma Predictive Index; (3) delineated the respiratory and atopic outcomes for children who had respiratory syncytial virus-related wheezing illnesses in infancy; and (4) evaluated a large number of risk factors for acute respiratory tract illnesses during the first 3 years of life. Future TCRS studies will focus on (1) factors in infancy and early childhood that relate to persistent asthma and atopy; (2) role of genetic factors in persistent asthma; and (3) determinants of lung function decline in early adult life.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                bmim
                Boletín médico del Hospital Infantil de México
                Bol. Med. Hosp. Infant. Mex.
                Instituto Nacional de Salud, Hospital Infantil de México Federico Gómez (México )
                1665-1146
                February 2009
                : 66
                : 1
                : 3-33
                Affiliations
                [1 ] Hospital Infantil de México Federico Gómez Mexico
                Article
                S1665-11462009000100002
                1af1da05-b19c-45e4-9cf5-94b37edce247

                http://creativecommons.org/licenses/by/4.0/

                History
                Categories
                Pediatrics

                Pediatrics
                Asthma,bronchial hyperreactivity,chronic disease,child,Asma,hiperreactividad bronquial,enfermedad crónica,niños

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