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Traducido por: Diego Sésar de Hoyos
Siglas y abreviaturas: ARA — antagonista(s) de los receptores de la angiotensina, ECA — ensayo clínico aleatorizado, EPOC — enfermedad pulmonar obstructiva crónica, ERGE — enfermedad por reflujo gastroesofágico, ERS — European Respiratory Society, IBP — inhibidor(es) de la bomba de protones, IECA — inhibidor(es) de la enzima convertidora de angiotensina, TC — tos crónica, TCI — tos crónica idiopática, TCR — tos crónica resistente (al tratamiento), TRPV1 (transient receptor potential cation channel subfamily V member 1) — receptor de potencial transitorio vaniloide tipo 1, UACS (upper airways cough syndrome) — síndrome de tos de las vías respiratorias superiores
Introducción
La tos crónica (TC) es un trastorno frecuente que afecta a un 7-11 % de los adultos en todo el mundo. Supone uno de los motivos principales de las consultas médicas, tanto en países desarrollados como en vías de desarrollo.1,2 En las personas adultas, el TC —definido como tos que persiste ≥8 semanas— es 2 veces más prevalente en las mujeres y normalmente se desarrolla entre los 60 y los 80 años.3 La tos resistente al tratamiento puede preocupar al paciente, provocar incontinencia urinaria, disfonía y aislamiento social y, como consecuencia, puede reducir su calidad de vida.4 El tratamiento de la TC puede suponer un reto para los médicos. Además, la mayoría de fármacos disponibles sin receta son ineficaces.5,6 Por lo tanto, es fundamental adoptar un enfoque integral hacia el diagnóstico y el tratamiento de la TC para optimizar la atención de los pacientes con este trastorno, que para ellos constituye una carga importante. La European Respiratory Society (ERS) ha creado un grupo de trabajo específico para la TC. El objetivo de este artículo es exponer la información más importante de las últimas guías de manejo.7
Resumen
La tos crónica (TC) afecta a aproximadamente un 10 % de la población general, principalmente a personas de 50-60 años, con el doble de prevalencia en mujeres que en hombres. En una persona adulta, la tos crónica se define como una tos persistente durante 8 o más semanas que no se consiga resolver con fármacos disponibles sin receta o fármacos utilizados para tratar las enfermedades concomitantes. Se trata de un trastorno que influye negativamente en la vida del paciente y tiene consecuencias físicas, sociales y psicológicas. El objetivo de este artículo es presentar la información más importante sobre el manejo de la TC que ha elaborado el grupo de trabajo de la European Respiratory Society. La valoración de los pacientes con TC debe comprender una anamnesis detallada y un examen clínico que ayuden a determinar las posibles causas. La influencia y la gravedad de la tos se pueden evaluar mediante cuestionarios clínicos. La tos puede deberse a alguna de estas causas: uso de inhibidores de la enzima convertidora de angiotensina, tabaquismo, asma, bronquitis eosinofílica no asmática, enfermedad por reflujo gastroesofágico y síndrome de tos de las vías respiratorias superiores. En muchos pacientes, la tos persiste a pesar del tratamiento adecuado de la enfermedad subyacente; en esta situación, se define como tos crónica resistente al tratamiento. En los casos en los que no es posible determinar la causa, se clasifica como tos crónica idiopática. Si el tratamiento de la enfermedad causante de la tos fracasara, se debe considerar el uso de un tratamiento neuromodulador: un opioide en dosis bajas, gabapentina, pregabalina o una terapia logopédica. No hay fármacos aprobados para el tratamiento de la TC, pero se están probando medicamentos nuevos dirigidos al receptor de purina P2X3 en ensayos de 2.a o 3.a fase.
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