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ASMA – Perfil De Uma Patologia Crónica Multifactorial

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ASMA – Perfil De Uma Patologia Crónica Multifactorial Universidade do Algarve Faculdade de Ciências e Tecnologia ASMA – Perfil de uma Patologia Crónica Multifactorial. Processo Inflamatório e Abordagem Farmacoterapêutica Dissertação submetida à Faculdade de Ciências e Tecnologia da Universidade do Algarve, por Aléxis Pedro Marcos, para conclusão do Mestrado Integrado em Ciências Farmacêuticas Faro, 2011 ASMA – Perfil de uma Patologia Crónica Multifactorial. Processo Inflamatório e Abordagem Farmacoterapêutica II Universidade do Algarve Faculdade de Ciências e Tecnologia ASMA – Perfil de uma Patologia Crónica Multifactorial. Processo Inflamatório e Abordagem Farmacoterapêutica Dissertação submetida à Faculdade de Ciências e Tecnologia da Universidade do Algarve, por Aléxis Pedro Marcos, para conclusão do Mestrado Integrado em Ciências Farmacêuticas Trabalho realizado sob orientação do Prof. João Pedro Fidalgo Rocha (FFUL) Faro, 2011 ASMA – Perfil de uma Patologia Crónica Multifactorial. Processo Inflamatório e Abordagem Farmacoterapêutica AGRADECIMENTOS A toda a minha a minha família, aos que estão e aos que já partiram e que desde a minha infância me acompanharam ao longo da vida. À minha mãe, Zélia, por me ter ensinado o Caminho da rectidão e do bom senso, ao meu padrasto, Francisco e aos meus dois irmãos Micael e Édi, por todos os dias me darem as razões para me manter firme e perseverante. À minha namorada, Célia que ao longo destes 5 anos de curso sempre seguiu a meu lado e me deu a força necessária para aqui chegar. Ao meu orientador, Professor João Rocha, pela disponibilidade e ajuda no desenvolvimento e estruturação desta monografia. Ao Doutor Ulisses Brito, que se disponibilizou para analisar criticamente este trabalho e me facultou vário material de estudo fundamental para a progressão do mesmo. A todos os meus verdadeiros amigos, porque o são. II ASMA – Perfil de uma Patologia Crónica Multifactorial. Processo Inflamatório e Abordagem Farmacoterapêutica RESUMO Fundamentado numa pesquisa bibliográfica exaustiva, o presente trabalho pretende identificar os vários fenótipos da asma que afectam a população, assim como os mecanismos celulares e moleculares que conduzem ao processo de inflamação crónica e de remodelação brônquica característicos desta patologia. Hoje a terapêutica farmacológica da asma, encontra-se dirigida à prevenção de exacerbações pelo controlo da inflamação ou à reversibilidade da obstrução brônquica resultante das mesmas. Assim com a ambição de definir um tratamento mais eficiente que eventualmente leve à cura, vários imunomoduladores têm sido desenvolvidos, sobre os quais recairá alguma da atenção neste estudo. Entre Março e Setembro de 2011, foi recolhida informação bibliográfica, recorrendo a livros, artigos e bases de dados online, procurando sempre as fontes com informação mais actual e fidedigna disponível. Depois de investigados os vários intervenientes nos processos de inflamação e remodelação brônquicas e a forma como interagem entre si, avaliaram-se algumas das novas moléculas disponíveis para o tratamento da asma, actualmente em fase de ensaios clínicos. Alguns destes fármacos revelam-se promissores no tratamento de alguns fenótipos específico de asma. Considerada uma doença bastante complexa e heterogénea, é agora perceptível que a asma, não é apenas determinada por uma resposta linfocitária Th2, mas reflecte antes uma constante mudança na resposta imunitária, que compreende uma complexa rede de sinais efectores e regulatórios entre as células estruturais e diversos leucócitos. Assim a contínua busca de novos tratamentos passará pela modulação conjunta de vários mediadores, com o objectivo de alterar algumas das redes de sinalização que em última análise conduzem à inflamação crónica. Palavras Chave: Asma; Asma extrínseca; Citocinas; Hiperreactividade brônquica; Imunomoduladores; Inflamação crónica; Linfócitos Th2; Remodelação Brônquica III ASMA – Perfil de uma Patologia Crónica Multifactorial. Processo Inflamatório e Abordagem Farmacoterapêutica ABSTRACT Based on an exhaustive bibliographic research, this work aims to identify the different asthma phenotypes which affect the main population, as well as, the cellular and molecular mechanisms underlying the inflammatory and airway remodeling processes, that commonly define this chronic disorder. The current pharmacological approaches for asthma treatment lies on exacerbations prevention by inflammation control, and the reversibility of airflow obstruction. Therefore, aspiring for novel and more efficient therapies, several immunomodulators have been developed, which will be further discussed in this work. From March to September of 2011, a bibliographic research was carried out, using books, reviews and original articles, as well as online databases. Always looking for the most actualized and reliable information available. After a thorough investigation on the several intervenients of inflammatory and airway remodeling processes, and how they interact with each other, some of the newest available molecules, for asthma treatment, which are currently on clinical trials, were assessed. Some of these new approaches have revealed themselves very promising in the treatment of some specific asthma phenotypes. Considered a highly heterogeneous, and complex disease, it is now clear that asthma is not only determined by a Th2 lymphocyte response, but instead reflects a constantly changing immune response that features complex regulatory and effector network between the microenvironment of structural cells and several leukocytes. Thus the continuous search for new treatments will rely on the concerted modulation of several mediators, aiming to disrupt some of the networks that ultimately lead to chronic inflammation. Key Words: Airway Remodeling; Asthma; Bronchial hyperresponsiveness; Chronic Inflammation; Cytokines; Extrinsic Asthma; Immunomodulators; Th2 Lymphocytes IV ASMA – Perfil de uma Patologia Crónica Multifactorial. Processo Inflamatório e Abordagem Farmacoterapêutica ÍNDICE ÍNDICE DE FIGURAS .................................................................................................... VII ÍNDICE DE QUADROS .................................................................................................. VII LISTA DE ACRÓNIMOS E ABREVIATURAS ...................................................................VIII I- INTRODUÇÃO ............................................................................................................ 1 II-CORPO DO TEXTO ..................................................................................................... 3 1 ASMA – Definição e Evolução Histórica do conceito .............................................................. 3 1.1 CATEGORIAS DA ASMA .................................................................................................... 5 1.1.1 Asma Extrínseca ou Atópica ...................................................................................... 6 1.1.2 Asma Intrínseca ou Não Atópica ............................................................................... 7 1.1.3 Outras Categorias ..................................................................................................... 7 2 ETIOLOGIA ............................................................................................................................ 9 2.1 FACTORES DO HOSPEDEIRO E ASMA DE INCIDÊNCIA NA INFÂNCIA .................................. 9 2.1.1 Atopia e Predisposição Genética ............................................................................... 9 2.1.2 Hiperreactividade brônquica................................................................................... 10 2.1.3 Género e Etnia ........................................................................................................ 11 2.2 FACTORES AMBIENTAIS E ASMA DE INCIDÊNCIA EM ADULTOS ...................................... 12 2.2.1 Alergenos ............................................................................................................... 12 2.2.2 Sensibilizadores Ocupacionais – Asma Oupacional .................................................. 13 2.2.3 Infecções ................................................................................................................ 14 2.2.4 Fumo de Tabaco ..................................................................................................... 15 3 EPIDEMIOLOGIA .................................................................................................................. 17 3.1 PREVALÊNCIA ................................................................................................................ 17 3.2 MORTALIDADE .............................................................................................................. 19 3.3 MORBILIDADE ............................................................................................................... 21 3.4 IMPACTO ECONÓMICO .................................................................................................. 22 4 MECANISMOS DA INFLAMAÇÃO NA ASMA ........................................................................ 24 4.1 INFLAMAÇÃO ................................................................................................................ 25 4.2 ASMA EXTRÍNSECA – RESPOSTA PRECOCE ..................................................................... 27 4.2.1 IgE e Adenosina ...................................................................................................... 28 4.2.2 Mastócitos ............................................................................................................
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