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Vol. 47. Issue S2.
Importancia de la vía aérea distal (vía aérea pequeña) en el asma y en la EPOC
Pages 10-16 (April 2011)
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Vol. 47. Issue S2.
Importancia de la vía aérea distal (vía aérea pequeña) en el asma y en la EPOC
Pages 10-16 (April 2011)
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Fisiología y fisiopatología de la vía aérea pequeña en el asma
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María J. Álvarez Pueblaa,??
Corresponding author
mj.alvarez.puebla@cfnavarra.es

Autor para correspondencia.
, Francisco García Ríob
a Servicio de Alergología, Hospital Virgen del Camino, Pamplona, Navarra, España
b Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, España
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Resumen

Las vías aéreas pequeñas (VAP) son aquellas que tienen un diámetro interno menor de 2mm. Aunque en sujetos sanos su contribución a la resistencia total al flujo aéreo es discreta, en asmáticos podrían ser responsables del 50–90% de la resistencia total al flujo aéreo.

La reducción de los flujos mesoespiratorios e instantáneos ha constituido el principal instrumento para sospechar enfermedad de la VAP, aunque su notable variabilidad y la ausencia de un punto de corte suficientemente validado le resta aplicación clínica.

Los volúmenes pulmonares estáticos pueden aportar información indirecta sobre el estado de las vías aéreas más distales evidenciando dos consecuencias de su alteración: el atrapamiento aéreo y la hiperinsuflación dinámica.

Mientras que la determinación de las resistencias de las vías aéreas por pletismografía y de las resistencias del sistema respiratorio por interrupción al flujo resultan muy inespecíficas, la técnica de la oscilación forzada permite discriminar obstrucción de las VAP frente a las de mediano calibre. El patrón característico de obstrucción periférica comprende el descenso de la resistencia dependiente de la frecuencia, la disminución de la reactancia y el incremento de la frecuencia de resonancia.

El lavado de nitrógeno mediante respiración única o por reinhalación múltiple también proporciona información específica de las VAP, aunque la disponibilidad de este tipo de equipos es menor.

El análisis mediante modelos bicompartimentales del óxido nítrico exhalado permite la determinación de la concentración alveolar de óxido nítrico, que parece aportar información sobre la actividad inflamatoria en la VAP.

Keywords:
Asthma
Small airways
Forced oscillation
Nitric oxide
Nitrogen washout
Palabras clave:
Asma
Vías aéreas pequeñas
Oscilación forzada
Óxido nítrico
Lavado nitrógeno
Abstract

The small airways are those with an internal diameter of less than 2mm. The contribution of these airways to total airflow resistance is small in healthy individuals but can represent 50–90% of total airflow resistance in asthmatics. Suspicion of small airways disease has been based on reduction of midexpiratory and instantaneous flows, although wide variability in their values and the absence of a sufficiently validated cut-off point has limited their clinical application. Static pulmonary volumes can provide indirect evidence of the state of the most distal airways, revealing two effects of their alteration: air trapping and dynamic hyperinflation. While determination of airway resistance by plethysmography and of respiratory system resistance measured by flow interruption are highly non-specific, the forced oscillation technique allows obstruction of the small airways to be distinguished from that of medium-caliber airways. The characteristic pattern of peripheral obstruction includes a decrease in frequency-dependent resistance, reduced reactivity and an increase in resonance frequency. Single-or multiple-breath nitrogen washout can also provide specific information on the small airways, although the apparatus required is less frequently available. Analysis through bicompartmental models of exhaled nitric oxide allows alveolar nitric oxide concentrations to be determined, which seems to provide information on inflammatory activity in the small airways.

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Copyright © 2011. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología

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