Avaliação da inflamação das vias aéreas. Vias áreas superiores e compartimento broncopulmonar

 

Luísa Geraldes 1

Ana Todo-Bom 2

Carlos Loureiro 2

 

 

Resumo

Faz-se uma revisão sobre métodos de avaliação da inflamação nas vias aéreas que contribuam para o diagnóstico, terapêutica e prognóstico de patologias como a rinossinusite e a asma. Serão também considerados métodos susceptíveis de fornecer informação relevante sobre inflamação na DPOC.

A inflamação crónica das vias aéreas condiciona fenómenos obstrutivos objectivados na função respiratória basal, na hiperreactividade brônquica e nasal e em quadros clínicos de dificuldade respiratória. A tomografia computorizada informa sobre as dimensões do lúmen, a espessura das paredes brônquicas e os índices de densidade pulmonar, alterações que decorrem da inflamação e remodelação das vias aéreas.

Um processo inflamatório localizado nas vias respiratórias é susceptível de ser detectado por modificações em marcadores sistémicos de inflamação.

Os métodos directos recorrem a análise imunoistoquímica de tecidos e de fluidos em condições basais ou após estimulação. Os eosinófilos aumentam em biópsias, lavados nasais e broncoalveolares na asma e na rinite e modificam-se com a terapêutica. Ocorrem alterações nas proteínas e expressão de RNAm de mediadores envolvidos na activação celular.

A expectoração induzida identifica inflamação eosinofílica que se relaciona inversamente com a função ventilatória.

Em cada ciclo respiratório o ar é enriquecido em compostos voláteis produzidos no decurso da respiração celular. A FENO é o biomarcador mais estudado e os seus níveis estão elevados na asma.

No condensado do ar expirado identificam-se espécies reactivas de oxigénio, derivados de membrana, citocinas e quimiocinas pró-inflamatórias.

Se a avaliação não invasiva da inflamação for fidedigna e reprodutível, será imprescindível na monitorização das doenças das vias aéreas.

Palavras-chave: Asma, exames auxiliares de diagnóstico, inflamação, rinite.

 

 

Airways inflammation evaluation. Upper and lower airways 

Abstract

It is done a review of evaluation methods of the inflammation in upper airways and bronchi used for diagnosis, therapeutic approach and prognosis of pathologies like rhinosinusitis and asthma. It is also analysed methods that supply relevant information of inflammation in COPD.

The chronic inflammation of the airways is associated to respiratory distress, obstruction in basal lung function tests and to bronchial and nasal hyperreactivity.

Computerized tomography informs about lumen dimensions, bronchial walls thickness and pulmonary density. These changes are associated to inflammation and to remodelling of the airways.

Localized inflammation in respiratory tract can be detected by modifications of systemic inflammatory markers.

The direct evaluation of inflammatory airways changes are based on immune, histological and chemical analysis of lung tissue obtained by biopsies and by fluids recoil in basal conditions or after stimulation. The eosinophils are increased in biopsies and in nasal and bronchoalveolar lavage in asthma and rhinitis and can change with therapy. Proteins and mRNA expression of cellular activation mediators are also observed.

The induced sputum identifies eosinophilic inflammation that is inversely associated with lung function parameters. In each respiratory cycle the air is enriched in organic volatile compounds produced by cellular breathing. FENO is the bio marker more deeply studied in asthma and its increase is well documented in this disorder. In the exhaled air condensed, reactive oxygen species, membrane mediators, cytokines, and chemokines are identified.

If the non invasive evaluation of inflammation became reliable and reproducible it will be indispensable in monitoring the airways diseases.

Key-words: Asthma, evaluation methods, inflammation, rhinitis.

 

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1 Interna do 5.º ano da especialidade de Imunoalergologia dos HUC

2 Assistente Hospitalar Graduado em Imunoalergologia dos HUC

 

Correspondência/Correspondence to:

Serviço de Imunoalergologia

Departamento de Ciências Pneumológicas e Alergológicas dos Hospitais da Universidade de Coimbra

Av. Bissaya Barreto e Praceta Prof. Mota Pinto

3000-075 Coimbra

 

Recebido para publicação/received for publication: 08.12.12

Aceite para publicação/accepted for publication: 09.01.12