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El uso de corticoides sistémicos reduce las hospitalizaciones y mejora la función pulmonar al cabo de 6 a 12 h desde su administración en pacientes con crisis asmáticas. Sin embargo, a pesar de la considerable evidencia surgida de publicaciones durante la última década, los corticoides inhalados no se han considerado efectivos. El análisis de esta evidencia ha sido superficial, ya que se han obviado aspectos fundamentales relacionados con los mecanismos de acción y no se han distinguido los efectos antiinflamatorios de los denominados efectos no genómicos. Así pues, el objetivo de esta revisión es aclarar las bases biológicas de los efectos de los corticoides inhalados, analizar la mejor evidencia disponible con respecto a su uso en el tratamiento de las exacerbaciones asmáticas y las repercusiones terapéuticas que surgen de ella.
Palabras clave:
Corticoides
Fluticasona
Budesonida
Beclometasona
Asma aguda
The use of systemic corticosteroids reduces hospitalizations in patients suffering an asthma attack and improves lung function within 6 to 12 hours of administration. However, despite the considerable body of positive evidence published in the last decade, doubts remain in regard to the effectiveness of inhaled corticosteroids. Analysis of this evidence has been cursory; crucial data on the mechanism of action of corticosteroids have been overlooked and there has been a failure to distinguish between antiinflammatory effects and so-called nongenomic effects. This review considers the biological basis for the effects of inhaled corticosteroids and analyzes the best data available on the use and therapeutic implications of inhaled corticosteroids for the treatment of asthma exacerbations.
Key words:
Corticosteroids
Fluticasone
Budesonide
Beclomethasone
Acute asthma
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