Medicamentos beta-agonistas de larga acción: perfil de riesgo-beneficio en pacientes con asma
Long-acting beta agonists: a risk-benefit profile in patients with asthm
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Existe evidencia que muestra que pacientes asmáticos con exposición a broncodilatadores beta-agonistas de larga acción (BALA), en quienes no se garantiza el tratamiento controlador anti-inflamatorio simultáneo con corticoides inhalados (ICS), pueden presentar eventos de empeoramiento del asma muy infrecuentes, pero severos y potencialmente mortales. No es claro si este hallazgo puede ser debido a eventos adversos asociados con el mecanismo de acción de los BALA, o a enmascaramiento de la severidad del asma. No existe evidencia derivada de experimentos clínicos en seres humanos que sugiera que pacientes con exposición a BALA, en quienes se garantiza el tratamiento controlador anti-inflamatorio simultáneo con ICS, puedan presentar eventos severos de empeoramiento del asma potencialmente mortales. De igual forma, tampoco hay evidencia conclusiva de presencia de riesgo derivada de meta-análisis y de estudios observacionales. Desafortunadamente, tampoco existe evidencia conclusiva de ausencia de riesgo. El juicio de valor que se le asigna al balance de riesgo-beneficio de los BALA+CSI puede variar entre médicos, pacientes, reguladores, y epidemiólogos. Este balance ha sido discutido extensamente. En general, hay consenso que este balance está a favor de mantener disponible las combinaciones de BALA+CSI para los pacientes con
asma. En esta revisión se enuncian las principales recomendaciones con respecto a su utilización, basadas en la evidencia actual.
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