No hay que confundir asma con alergia
Aunque no hay que confundir asma con alergia, la predisposición alérgica es uno de los principales factores de riesgo que favorecen la aparición de asma. En muchos casos, la enfermedad aparece como respuesta a determinados estímulos que producen alergia como pueden ser: el polen, los ácaros del polvo, los epitelios de animales, ciertos alimentos, etcétera. Según datos del Ministerio de Sanidad, las denominadas alergias estacionales afectan aproximadamente al 15% de la población.
Para poder hacerles frente, existen diferentes tratamientos y recomendaciones. Tal y como expone el doctor Manuel Rial, Médico Adjunto del Servicio de Alergia del Hospital Universitario A Coruña, “lo más eficaz es evitar o reducir en lo posible la exposición a alérgenos”. Según este especialista, existen una serie de recomendaciones para aquellos pacientes que padecen asma y se exponen a altos niveles polínicos.
- Mantener las ventanas cerradas por la noche. De ser posible, utilizar aire acondicionado con filtros.
- Si viaja en coche, mantener las ventanillas cerradas. Utilizar filtros para el aire acondicionado del automóvil.
- Permanecer el mayor tiempo posible en ambientes cerrados, evitando en la medida en que se pueda la exposición al aire libre especialmente en los días de viento.
- Disminuir las actividades al aire libre entre las 5-10 de la mañana (emisión de pólenes) y entre las 7-10 de la tarde (periodo de descenso del polen desde lo alto de la atmósfera, al enfriarse el aire).
- Ponerse gafas de sol y mascarilla facial que abarque boca y nariz al salir a la calle, especialmente si va a permanecer en ella durante largos periodos de tiempo.
- Evitar exponerse a espacios con césped.
- Si coge vacaciones durante períodos álgidos de polen, preferir zonas con menor concentración polínica como por ejemplo las playas.
- Evitar vestir prendas que han estado expuestas al exterior (por ej. Secadas al aire libre). Si ha estado en alguna zona con alto nivel de polen, múdese de ropa en cuanto le sea posible. El polen puede quedar adherido en las prendas o en el calzado.
- Utilice la medicación en forma adecuada.
Tal y como afirma el doctor Rial, “una persona con asma siempre debe buscar la valoración de un alergólogo. Sobre todo, en el caso de que el paciente relacione sus síntomas con un desencadenante alergénico”. Cada persona puede ser alérgica a sustancias diferentes. Sólo un profesional médico, mediante la realización de una serie de estudios complejos, puede determinar cuáles son las causas de la alergia de cada individuo. Sin embargo, “estas recomendaciones pueden ser de gran ayuda para todos aquellos pacientes con asma que se exponen a altos niveles polínicos, lo que les ayudará a sobrellevar mejor esta enfermedad”, señala el doctor Rial.
Más de 8 millones de españoles son alérgicos
La alergia, principalmente al polen, puede aparecer a cualquier edad, aunque es más frecuente en niños y adolescentes. Según datos de la Sociedad Española de Alergología e Inmunología Clínica (SEAIC), las enfermedades alérgicas por polen afectan en nuestro país a más de ocho millones de personas, siete de los cuales son alérgicos a gramíneas seguidos por alergia al olivo, arizónica, plátano de sombra, salsola y parietaria. Según datos de la SEAIC, este año, ciudades como Cuenca, Toledo, Ávila, Burgos, Segovia, Palencia, Cáceres y Badajoz han multiplicado entre 5 y 10 veces los niveles de polen de acumulados con respecto a 2018, por lo tanto, serán las provincias más afectadas.
Acerca del asma
El asma es una enfermedad crónica del aparato respiratorio, en la que los bronquios están inflamados y se obstruyen con el paso del aire, por su respuesta irritativa frente a distintos estímulos del ambiente, lo que da lugar a síntomas como tos, apretamiento en el pecho, pitos, falta de aire o ahogo.
El asma se caracteriza por síntomas que se prolongan o que se van repitiendo. Estos incluyen tos, sibilancias o “pitos” en el pecho y dificultad respiratoria. Mientras que la alergia es una reacción del organismo frente a sustancias externas, una reacción que se vuelve perjudicial para el propio organismo, y que causa diversos síntomas de enfermedad.
Nuevos tratamientos
La Sociedad Española de Neumología y Cirugía Torácica, SEPAR, recuerda la importancia de un buen diagnostico del asma que permita, a su vez, ofrecer al paciente el tratamiento más adecuado. “En la actualidad los tratamientos para tratar el asma son muy eficaces si se administran adecuadamente según las recomendaciones del neumólogo. Además, gracias a la investigación científica y la innovación, disponemos de nuevos tratamientos adaptados a los diferentes tipos de asma” explica el doctor Francisco Javier Álvarez, coordinador del Área de Asma de SEPAR. “Los neumólogos nos tenemos que plantear que la inmunoterapia es un tratamiento
más para los pacientes con clínica de rinitis y asma, ya que des de hace poco tiempo ya disponemos de suficientes evidencias científicas que demuestran el beneficio de este tratamiento en pacientes con patología alérgica no controlada con la medicación habitual” explica el doctor Joan Serra, miembro del comité ejecutivo del Área de Asma de SEPAR. “La diferencia de la inmunoterapia con los otros tratamientos es que no es únicamente sintomático, para controlar los síntomas, sino que actúa sobre la causa alérgica, sean ácaros, pólenes, epitelio de animales, etc. cuando son los desencadenantes de la enfermedad.”
La inmunoterapia es especialmente eficaz en los pacientes con rinitis o asma cuya causa sea alérgica y que debido a la intensidad de los síntomas no se controla bien con la medicación habitual. El doctor Serra señala que estos tratamientos son especialmente beneficiosos para pacientes jóvenes que empiezan a experimentar muchos síntomas nasales y conjuntivales, que al cabo de unos años son diagnosticados de asma y que a pesar de su medicación de alivio de síntomas no consiguen un buen control. Son tratamientos largos de 3- 5 años y que actualmente tienen pocos efectos adversos pero en cambio mejoran los síntomas de rinitis y sobre todo del asma, disminuyen las exacerbaciones del asma y permiten reducir la medicación.
Por otro lado, una alternativa terapéutica en pacientes con asma grave de difícil control cuando la enfermedad no se controla con broncodilatadores y corticoides inhalados a dosis elevadas, son los tratamientos monoclonales. “En el momento actual hay varios tratamientos disponibles por vía subcutánea o intravenosa aunque son fármacos de dispensación hospitalaria. En concreto tenemos disponible omalizumab, un fármaco que bloquea la Inmunoglobulina- E (IgE) y que se administra por vía subcutánea cada 2 o 4 semanas, dirigido a pacientes con asma grave alérgico, y para el asma grave eosinofílico están disponibles mepolizumab y benralizumab que se administran por vía subcutánea, y reslizumab por vía intravenosa que van a actuar reduciendo la cifra de eosinófilos, la principal célula implicada en la inflamación bronquial presente en este tipo de asma” expone la doctora Rocio García, neumóloga y también miembro del comité ejecutivo del Área de Asma de SEPAR. Están indicados en pacientes con mal control de síntomas, con exacerbaciones frecuentes y deterioro de la función pulmonar a pesar de tratamiento con glucocorticoides inhalados a dosis elevadas y broncodilatadores.
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