Fármacos usados para tratar asma
Autor: Lígia Martins | Publicado: 2011-10-05T17:49:00-07:00

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&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Agonistas dos receptores β-adrenérgicos são broncodilatadores, inibem a liberação de TNF-α e outro mediadores pelos mastócitos, e ainda aumentam a eliminação de muco pelos cílios. Os agentes de ação curta, salbutamol e terbutalina, são usados para controlar os sintomas conforme a necessidade. E os agentes de ação mais longa, salmeterol e formoterol, são usados como terapia complementar em pacientes em que a asma não é devidamente controlada pelos glicocorticóides. Tanto os agentes de curta, quanto os de longa ação podem causar tremor, taquicardia e arritmia cardíaca.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; A aminofilia é uma xantina brocodilatadora, com ação antiasmática e estimulante sobre a respiração. Dada por via intravenosa na asma grave aguda, e é o fármaco de segunda escolha juntamente com esteróides, em pacientes não-responsivos aos agonistas dos receptores β-adrenérgicos. Os efeitos adversos são tremor, nervosismo, pode interferir no sono, vasodilatação generalizada, vasoconstricção nos vasos cerebrais e aumento da diurese; acima da dose terapêutica pode causar arritmia cardíaca e crises convulsivas.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Os antagonistas dos receptores muscarínicos, ipatrópio e tiotrópio, são usados como coadjuvante dos agonistas dos receptores β -adrenérgicos e esteróides, e para broncoespasmo precipitado por antagonistas dos receptores adrenérgicos β2. O tiotrópio é usado em alguns pacientes com doença pulmonar obstrutiva crônica.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Montelucaste e zafirlucaste são antagonistas dos receptores de cistenil-leucotrienos, que reduzem reações agudas à aspirina em pacientes sensíveis, inibem a asma induzida pelo exercício, diminuem respostas precoces e tardias a alérgenos inalatórios, relaxam as vias aéreas n asma leve e reduzem a eosínofilia do escarro.&nbsp; Mas causam cefaléia e distúrbios gastrintestinais, e raramente, associa-se à emergência da síndrome de Churg-Strauss.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Antagonistas dos receptores H1 de histamina são eficientes apenas na fase imediata da asma alérgica, ou se a asma for precipitada pela liberação aguda de histamina em pacientes alérgicos.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Os antiinflamatórios glicocorticóides: beclometasona, budesonida, fluticasona, mometasona e ciclesonida, são usados no tratamento da asma em conjunto com broncodilatadores. Eles diminuem a formação de citocinas, inibem a geração de vasodilatadores e o influxo de eosinófilos para o pulmão, diminuem a permeabilidade microvascular e reduzem indiretamente a liberação de mediadores dos eosinófilos.&nbsp; Após o tratamento a longo prazo reduzem o numero de mastócitos na mucosa respiratória. A prednisolona e hidrocortisona são usadas em casos de emergência.