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      "titulo" => "Complejidad de la EPOC&#46; Tratamiento individualizado&#44; nuevas aproximaciones&#44; fenotipos&#44; comorbilidades"
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    "titulo" => "Inhibidores de la PDE4&#58; roflumilast"
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            "entidad" => "Servicio de Neumolog&#237;a&#44; Hospital Universitario&#44; Guadalajara&#44; Espa&#241;a"
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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La enfermedad pulmonar obstructiva cr&#243;nica &#40;EPOC&#41; es un t&#233;rmino que engloba un grupo de trastornos caracterizados por la presencia de obstrucci&#243;n cr&#243;nica de las v&#237;as a&#233;reas&#46; Este amplio paraguas diagn&#243;stico incluye varios fenotipos cl&#237;nicos que se solapan y que responden de forma diferente a cada tipo de intervenci&#243;n terap&#233;utica&#46; Roflumilast es un f&#225;rmaco perteneciente a la nueva clase terap&#233;utica de los inhibidores de la fosfodiesterasa 4 &#40;PDE4&#41;&#46; Se puede considerar el primer f&#225;rmaco desarrollado para el tratamiento de un fenotipo espec&#237;fico de la EPOC &#40;EPOC asociada a bronquitis cr&#243;nica&#41;&#46; En modelos precl&#237;nicos&#44; roflumilast ha mostrado una potente acci&#243;n antiinflamatoria sobre una amplia variedad de c&#233;lulas y mediadores inflamatorios&#44; as&#237; como sobre otros mecanismos etiopatog&#233;nicos propios de la EPOC&#46; El presente documento revisa la evidencia generada durante el desarrollo cl&#237;nico de roflumilast&#44; con un &#233;nfasis especial en los estudios que valoran el f&#225;rmaco en el contexto similar a nuestra pr&#225;ctica cl&#237;nica habitual&#46;</p>"
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        "titulo" => "Abstract"
        "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Chronic obstructive pulmonary disease &#40;COPD&#41; encompasses a group of diseases characterized by chronic airway obstruction&#46; This broad diagnostic umbrella includes several clinical phenotypes that overlap and respond differently to each type of therapeutic intervention&#46; Roflumilast is a drug belonging to the new therapeutic class of phosphyldiesterase-4 &#40;PDE4&#41; inhibitors and can be considered the first drug to be developed for a specific COPD phenotype &#40;COPD associated with chronic bronchitis&#41;&#46; In preclinical models&#44; roflumilast has shown potent antiinflammatory action against a wide variety of cells and inflammatory mediators&#44; as well as against the etiopathogenic mechanisms of COPD&#46; The present article reviews the evidence generated during the clinical development of roflumilast&#44; with special emphasis on studies evaluating the drug in a context similar to that of routine clinical practice&#46;</p>"
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