Asma metabólica: evidências atuais e perspectivas terapêuticas

Mara M. R. Félix, Érica A. O. C. Jordão, Fábio C. Kuschnir

Resumo


Asma e obesidade estão associadas tanto do ponto de vista epidemiológico como fisiopatológico. Estudos longitudinais indicam que, de modo geral, a obesidade precede a asma e que o risco relativo de asma aumenta com a obesidade. Além disso, a redução de peso em obesos asmáticos resulta em declínio da gravidade da doença. O chamado “fenótipo obeso” da asma na infância apresenta características diferenciadas de função pulmonar, hiperreatividade brônquica, além de inflamação não eosinofílica das vias aéreas e um pior controle dos sintomas com corticosteroides inalatórios. Mais recentemente, tem sido observada também a associação entre asma e síndrome metabólica (SM) e seus componentes como a resistência insulínica, hiperglicemia e a hipertensão arterial, independentemente do índice de massa corporal. Nestes casos, a disfunção oxidativa do epitélio brônquico e a inflamação sistêmica relacionada à SM parecem contribuir para a patogênese da asma. Neste artigo de revisão, são discutidas as evidências científicas atuais acerca dos mecanismos fisiopatológicos da associação entre a asma e os componentes da SM, além de perspectivas futuras no manejo dos pacientes com essas doenças crônicas não transmissíveis de alta prevalência e morbidade na infância e adolescência.

Descritores: Asma; Obesidade; Síndrome metabólica; Infância.


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