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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic obstructive pulmonary disease &#40;COPD&#41; is a common&#44; preventable and treatable clinical entity characterized by persistent respiratory symptoms including dyspnea&#44; cough and expectoration&#44; along with chronic airflow restriction due to airway or alveolar disorders&#44; commonly caused by exposure to harmful gases and microparticles&#46; The main risk factor is cigarette smoke&#44; but exposure to biomass fuel and atmospheric contamination can be involved in the development of COPD&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Given that COPD only affects approximately 50&#37; of heavy smokers&#44; there must be individual factors that include genetic predisposition&#44; lung development disorders and age&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">COPD is a serious public health problem that affects up to 10&#37; of the population older than 45 years&#44; exceeding 50&#37; among heavy smokers and is the third leading cause of death worldwide&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In recent years&#44; research efforts have focused mainly on the following aspects&#58; establishing phenotypic groups that enable a more accurate adjustment of the prognosis and treatment&#59; a better understanding of the underlying pathophysiological process and of the factors that perpetuate it&#44; making the disease incurable once it has been established&#59; and changing the natural history of the disease by the presence of various comorbidities and adverse effects of the treatments&#46; Identifying and properly assessing the extrapulmonary manifestations of COPD is also essential&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">American Heart Association&#47;National Heart&#44; Lung and Blood Institute and Consensus Statement defines metabolic syndrome &#40;MS&#41; as the combination of 3 or more of the following risk factors&#58; abdominal obesity&#44; increased triglyceride levels&#44; reduced HDL-cholesterol levels&#44; arterial hypertension and increased fasting blood glucose levels&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> MS entails a notably increased cardiovascular risk&#44; which exceeds the merely additive&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">This issue of <span class="elsevierStyleSmallCaps">Revista Cl&#237;nica Espa&#241;ola</span> presents the study by Sep&#250;lveda et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> that assessed the impact of MS in patients with COPD by analyzing various markers related to oxidation processes&#44; as well as pulmonary function tests and symptom severity&#46; The study included 74 patients &#40;39 with COPD&#41; separated into 4 groups&#58; COPD with MS&#44; COPD without MS&#44; controls with MS and controls without MS&#46; The authors measured advanced oxidation protein products&#44; paraoxonase-1&#44; catalase activity&#44; sulfhydryl groups and lipid hydroperoxides&#46; The authors&#44; who mentioned their small sample size as a study limitation&#44; concluded that greater COPD severity &#40;according to the GOLD guidelines<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#41;&#44; greater impairment in pulmonary function tests and the combination with MS were related to increased oxidative stress&#44; indicating as well the presence of increased comorbidity assessed with the Charlson index&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Due to their anatomical characteristics&#44; the lungs are especially vulnerable to oxidative stress in the environment&#46; The lungs are also permanently exposed to endogenous sources due to mitochondrial respiration and mediators of the inflammatory response against viral and bacterial infections&#46; There are various environmental sources&#44; including tobacco smoke&#46; Once the pathological process of COPD has been established&#44; smoking cessation does not halt the increase in oxidative stress or the disease progression&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Reactive oxygen species of mitochondrial origin&#44; epithelial cells&#44; smooth muscle cells and various inflammatory cells are also involved in this process&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A recent study by Fischer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> emphasized the importance of the balance between oxidants and antioxidants and the role of tobacco in breaking this delicate equilibrium&#44; making it difficult to separate the direct impact of tobacco from that derived from the associated inflammatory response&#46; In a similar sense&#44; the study by Ye et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> concluded that serum modulator-1 levels of reactive oxygen species are high in patients with COPD and are associated with functional impairment&#44; inflammation and oxidative stress&#46; Sanders et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> highlighted the role of the receptor for advanced glycation end products&#44; a cell membrane receptor capable of recognizing ligands generated in tobacco combustion and that has been implicated in the pathogenesis of COPD&#46; Their study demonstrated that deletion or pharmacologic inhibition of the receptor for advanced glycation end products can prevent the development of tobacco-related emphysema&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">As part of this panoramic approach&#44; we should mention the recent study by Papakonstantinou et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> on the role of hyaluronic acid and its degradation products in the pulmonary pathophysiology and airway remodeling in COPD&#44; which found a direct correlation between serum hyaluronic acid levels and disease severity or the presence of exacerbations&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Equally important are the therapeutic implications of this oxidant&#47;antioxidant imbalance because we do not have treatments that can reverse or at least slow the progression of COPD&#46; In contrast to the behavior of the inflammatory component in asthma&#44; the response to inhaled steroids provides a scarce benefit for the inflammatory component of COPD&#46; Oral N-acetyl-cysteine also showed no net benefit on disease progression or the frequency of exacerbations&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In this scenario&#44; directing resources to the effective prevention of the disease and the development of effective drugs to reverse or at least stop the evolutionary process of the disease is essential&#46; It is also essential to further the studies on identifying those markers of oxidative process that could be useful in daily clinical practice as indicators of activity or prognostic factors&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Returning to the adverse effects in patients with COPD&#44; both in terms of the rate of oxidative stress and clinical manifestations&#44; attributable to the coexistence of MS &#40;the subject of the study under discussion&#41;&#44; the results of the study are supported by a similar study by D&#237;ez-Manglano et al&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> who found diagnostic criteria for MS in up to 60&#37; of patients with severe or highly severe COPD&#46; We can therefore conclude that the concomitant presence of the 2 diseases is&#44; 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Editorial
Chronic obstructive pulmonary disease and metabolic syndrome: traveling with bad companies
Enfermedad pulmonar obstructiva crónica y síndrome metabólico: viajar en mala compañía
F.R. López Andreua,
Corresponding author
frlopezandreu@gmail.com

Corresponding author.
, C. López Rodríguezb
a Servicio de Medicina Interna, Hospital General Universitario Reina Sofía, Murcia, Spain
b Servicio de Medicina Interna, Hospital General Universitario Reina Sofía, Murcia, Spain

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