Efecto de la rhDNasa sobre la obstrucción bronquial irreversible en adultos con asma grave

background: in some asthma patients airway obstruction can not be reverted by bronchodilator and/ or corticosteroid treatment. this irreversible obstruction has been attributed to the remodeling process of airways, but other mechanisms such as mucus plugging have not been explored. objective: to evaluate if rhdnase, an enzyme extensively used to fluidize the mucus in cystic fibrosis, improves spirometric variables and quality of life of asthmatic patients. patients and methods: ten adult patients (6 females) with severe corticosteroid-dependent asthma received daily nebulizations of 2.5 mg rhdnase during 14-28 days. spirometries were performed at least at weekly intervals to evaluate the forced vital capacity (fvc), forced expiratory flow at the first second (fev1, the fev1/fvc ratio and peak expiratory flow (pef). changes in spirometric variables were assessed by regression analysis. an asthma quality of life questionnaire was applied before and at the end of treatment. results: spirometric variables did not change in most patients. however, pulmonary function improved in one patient, according to the statistically significant ascending slopes in fvc, fev1 and fev1/fvc. although other subjects also had ascending (2 patients) or descending (2 patients) slopes, these changes only occurred in one spirometric variable. as a group, there was a trend for improvement in quality of life. conclusions: although rhdnase does not modify the irreversible bronchial obstruction in most patients with severe asthma, a small proportion of them might obtain some beneficial effect