Hospital Gral.

de Chihuahua
“Dr. Salvador Zubirán Anchondo”

Crisis asmática o
exacerbación del asma

Dr. Castillo Flores Isaías Alberto

Médico residente de segundo grado
Medicina Interna
 Definición
• Episodio agudo o subagudo
• Empeoramiento progresivo
• Tos, disnea, sibilancias, opresión torácica
• Función basal pulmonar del paciente
• Inicio/debut

Camargo Jr. CA., Rachelefsky G., Schatz M. Managing asthma exacerbations in the ED: Summary of the National Asthma and
Prevention Program Expert Panel Report 3 Guidelines for the management of asthma exacerbations. Pro Am Thorac Soc. 2009. Vol
6:357-366
 Factores predisponentes
• Alérgenos
• Agentes ocupacionales
• Infecciones: virales y bacterianas
• Exposición al frío
• Ejercicio
• Consumo de AINE
• Poliposis nasal, sinusitis
• Menstruación
Camargo Jr. CA., Rachelefsky G., Schatz M. Managing asthma exacerbations in the ED: Summary of the National Asthma and
Prevention Program Expert Panel Report 3 Guidelines for the management of asthma exacerbations. Pro Am Thorac Soc. 2009. Vol
6:357-366
 Pacientes de alto riesgo

Camargo Jr. CA., Rachelefsky G., Schatz M. Managing asthma exacerbations in the ED: Summary of the National Asthma and
Prevention Program Expert Panel Report 3 Guidelines for the management of asthma exacerbations. Pro Am Thorac Soc. 2009. Vol
6:357-366
 Fisiopatología

National Asthma Education and Prevention program. Expert Panel Report 3: Guidelines for the diagnosis and Management of
Asthma. National Heart, Lung and Blood Institute. 2007
 Fisiopatología

National Asthma Education and Prevention program. Expert Panel Report 3: Guidelines for the diagnosis and Management of
Asthma. National Heart, Lung and Blood Institute. 2007
 Fisiopatología

Elliot I.&K. Reddel H. Severe and difficult-to-treat asthma in adults.N Engl Med 2017 Sept. 377(10):965-976 p.
 Fisiopatología

Elliot I.&K. Reddel H. Severe and difficult-to-treat asthma in adults.N Engl Med 2017 Sept. 377(10):965-976 p.
 Fenotipos asmaticos

Elliot I.&K. Reddel H. Severe and difficult-to-treat asthma in adults.N Engl Med 2017 Sept. 377(10):965-976 p.
Vargas Becerra MH. Fisiopatología del asma. Neumología y cirugía de torax. 2009.68 (S2):S111-S115.
 Gravedad de la crisis de asma

National Asthma Education and Prevention program. Expert Panel Report 3: Guidelines for the diagnosis and Management of
Asthma. National Heart, Lung and Blood Institute. 2007
 Gravedad de la crisis de asma

Smith SR, Baty JD, Hodge D 3rd. Validation of the pulmonary score: an asthma severity score for children.Acad Emerg Med. 2002
Feb:9(2):99-104
 Paraclínicos
• Espirometría
– Valorar gravedad
• Gasometría arterial
– Hipoxemia <60 mmHg
– Hipercapnia >45 mmHg
• Radiografía PA de Tórax
– Diagnóstico diferencial:
• Neumonía, neumotórax, atelectasias, ICC

Camargo Jr. CA., Rachelefsky G., Schatz M. Managing asthma exacerbations in the ED: Summary of the National Asthma and
Prevention Program Expert Panel Report 3 Guidelines for the management of asthma exacerbations. Pro Am Thorac Soc. 2009. Vol
6:357-366
 Tratamiento
• Objetivos
– Corrección de la hipoxemia
– Reversión rápida de la obstrucción
– Disminucion del trabajo respiratorio
– Evaluar la presencia de comorbilidades
– Disminuir recaídas y recurrencias
– Vigilancia de la función respiratoria

Camargo Jr. CA., Rachelefsky G., Schatz M. Managing asthma exacerbations in the ED: Summary of the National Asthma and
Prevention Program Expert Panel Report 3 Guidelines for the management of asthma exacerbations. Pro Am Thorac Soc. 2009. Vol
6:357-366
 Tratamiento
• Elementos del tratamiento
– Oxígeno
– β-2 Agonistas de acción corta
– Anticolinérgicos de acción corta
– Esteroides

Camargo Jr. CA., Rachelefsky G., Schatz M. Managing asthma exacerbations in the ED: Summary of the National Asthma and
Prevention Program Expert Panel Report 3 Guidelines for the management of asthma exacerbations. Pro Am Thorac Soc. 2009. Vol
6:357-366
Peng T., Lin S., Niu B., Wamg X., et al. Influence of physical properties of carrier of the performance of dry powder inhalers. Acta
Pharmaceutica Sinica B 2016. 6(4):308-318
Boshhiba AM, A. Urbanetz N. The influence of relative humidity of the carrier particle surface characteristics used in dry powder
inhalation formulation. Lybian Journal of Science and Technology . 2018. 7(1):44-53
Camargo Jr. CA., Rachelefsky G., Schatz M. Managing asthma exacerbations in the ED: Summary of the National Asthma and
Prevention Program Expert Panel Report 3 Guidelines for the management of asthma exacerbations. Pro Am Thorac Soc. 2009. Vol
6:357-366
 Dosis inicial:40-80 mg cada 12-24
horas IV o IM
1 mg/kg/dia o su equivalente en
dos dosis al dia (Maximo 50
mg/dia)
Dosis iniciales mayores (500 mg en
bolo) no son mas efectivas que
una dosis inicial de 125 mg
Continuar por 5 a 10 dias

Camargo Jr. CA., Rachelefsky G., Schatz M. Managing asthma exacerbations in the ED: Summary of the National Asthma and
Prevention Program Expert Panel Report 3 Guidelines for the management of asthma exacerbations. Pro Am Thorac Soc. 2009. Vol
6:357-366
 Tratamiento según gravedad

National Asthma Education and Prevention program. Expert Panel Report 3: Guidelines for the diagnosis and Management of
Asthma. National Heart, Lung and Blood Institute. 2007
Camargo Jr. CA., Rachelefsky G., Schatz M. Managing asthma exacerbations in the ED: Summary of the National Asthma and
Prevention Program Expert Panel Report 3 Guidelines for the management of asthma exacerbations. Pro Am Thorac Soc. 2009. Vol
6:357-366
Camargo Jr. CA., Rachelefsky G., Schatz M. Managing asthma exacerbations in the ED: Summary of the National Asthma and
Prevention Program Expert Panel Report 3 Guidelines for the management of asthma exacerbations. Pro Am Thorac Soc. 2009. Vol
6:357-366
Ventilación Mecánica
Ventilación Mecánica
 Ventilación mecánica no invasiva
• Mejora pruebas de funcionamiento pulmonar
• Uso intermitente por periodos cortos
• Son necesarios mas estudios
• Tratamiento razonable:
– Sin respuesta a tto. Farmacológico
– Sin indicaciones de VMI
– Sin contraindicaciones

Camargo Jr. CA., Rachelefsky G., Schatz M. Managing asthma exacerbations in the ED: Summary of the National Asthma and
Prevention Program Expert Panel Report 3 Guidelines for the management of asthma exacerbations. Pro Am Thorac Soc. 2009. Vol
6:357-366
 Heliox

Camargo Jr. CA., Rachelefsky G., Schatz M. Managing asthma exacerbations in the ED: Summary of the National Asthma and
Prevention Program Expert Panel Report 3 Guidelines for the management of asthma exacerbations. Pro Am Thorac Soc. 2009. Vol
6:357-366
Camargo Jr. CA., Rachelefsky G., Schatz M. Managing asthma exacerbations in the ED: Summary of the National Asthma and
Prevention Program Expert Panel Report 3 Guidelines for the management of asthma exacerbations. Pro Am Thorac Soc. 2009. Vol
6:357-366
 Pronóstico
• Mejoria dependiente de la gravedad
– 1-2 días: moderadas
– 3 o mas: graves
• Alta si:
– Sintomas minimos o ausentes
– FEV1 >70%
• Si respuesta rápida:
– Vigilar 30-60 min. para asegurar estabilidad
Camargo Jr. CA., Rachelefsky G., Schatz M. Managing asthma exacerbations in the ED: Summary of the National Asthma and
Prevention Program Expert Panel Report 3 Guidelines for the management of asthma exacerbations. Pro Am Thorac Soc. 2009. Vol
6:357-366
 Pronóstico
• Aumentar dosis de medicamentos de base
– 2 a 4 semanas
– Ir disminuyendo paulatinamente
• Cita de seguimiento 7 dias despues de
episodio
• Considerar a pacientes de alto riesgo

Camargo Jr. CA., Rachelefsky G., Schatz M. Managing asthma exacerbations in the ED: Summary of the National Asthma and
Prevention Program Expert Panel Report 3 Guidelines for the management of asthma exacerbations. Pro Am Thorac Soc. 2009. Vol
6:357-366
GRACIAS!!!!