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there are numerous scenarios for the disease in which clinical ultrasonography can be of considerable use in the diagnosis&#44; prognostic stratification and approach to treatment for these patients&#46; In this article&#44; we summarize the most important aspects related to the usefulness of ultrasound in this disease&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Necessary knowledge for applying ultrasonography</span><p id="par0015" class="elsevierStylePara elsevierViewall">Although it seems logical that lung ultrasonography is the area of clinical ultrasonography most useful and applicable for assessing patients with COPD&#44; it is often possible to implement a multiorgan examination that includes echocardiography and vascular ultrasonography&#44; given that this is a systemic disease with numerous associated comorbidities of equal or greater importance than the disease itself&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Clinical scenarios</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Differential diagnosis of dyspnea of uncertain origin</span><p id="par0020" class="elsevierStylePara elsevierViewall">Dyspnea is a common manifestation in patients with cardiopulmonary diseases&#46; In this situation&#44; a rapid diagnostic approach is necessary for guiding an early therapeutic intervention&#44; especially for the most gravely ill patients&#46; The value of clinical ultrasonography in the differential diagnosis of dyspnea without a clear etiology is due to the technique&#8217;s high sensitivity and specificity and to the limitations of case histories&#44; physical examinations&#44; chest radiography&#44; natriuretic peptides and electrocardiography in determining the origin of this symptom&#44; especially in polypathological patients and for the diagnosis of heart failure&#44; pneumothorax&#44; pneumonia and pleural effusion&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">For the complete ultrasonography assessment of patients with dyspnea&#44; we need to perform at least one lung ultrasound and an echocardiogram&#46; In selected cases&#44; a simplified compression ultrasound of the legs should be performed&#46; With proper training&#44; this ultrasound assessment can be performed in less than 10<span class="elsevierStyleHsp" style=""></span>min&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The lungs are characterized by a mixture of air and fluid &#40;pus&#44; plasma&#41;&#46; The change in this equilibrium can be detected early and accurately with ultrasonography&#46; The interaction between air and water generates artifacts on which the interpretation of the lung ultrasound is based&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Applying the BLUE protocol&#44; developed by Daniel Lichtenstein for the differential diagnosis of patients with acute respiratory problems&#44;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> COPD exacerbations will result in a profile of A-lines with pleural sliding without posterolateral alveolar and&#47;or pleural syndrome&#46; This pattern has a sensitivity of 78&#37; and a specificity of 94&#37; for diagnosing COPD&#44; with an area under the curve of 0&#46;9 for patients with dyspnea of uncertain origin&#46; The negative predictive value of the absence of B-lines in the diagnosis of heart failure is 97&#37; &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">Figs&#46; 1 and 2</a>&#47;Appendix B Video 1&#44; Additional material&#41;&#46; In studies conducted on prehospital care&#44; the information provided by a lung ultrasound can be of considerable use and can even result in changes in the therapeutic approach in approximately 40&#37; of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Moreover&#44; echocardiography can add important information to the differential diagnosis of dyspnea&#44; especially if there are findings that clearly explain the symptoms as severe left ventricular dysfunction or significant valvular heart disease&#46; Integrating echocardiography with lung ultrasound enables clinicians to establish the etiological diagnosis of dyspnea with an accuracy of 90&#37;&#46; With the classical clinical assessment&#44; including complementary tests &#40;electrocardiogram&#44; chest radiography and laboratory tests with B-type natriuretic peptide &#91;BNP&#93;&#41;&#44; the accuracy is 64&#8211;80&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Coexistence of chronic obstructive pulmonary disease and heart failure</span><p id="par0045" class="elsevierStylePara elsevierViewall">The anatomical and functional relationship between the heart and lungs is so close that dysfunction in one can have consequences for the other&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The prevalence of heart failure &#40;HF&#41; in patients with COPD in the various series ranges from 7&#37; to 30&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The prevalence of left ventricular dysfunction in patients with COPD reported in the literature is 14&#8211;46&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Diagnosing the presence of concomitant HF in patients with COPD is challenging because the signs and symptoms overlap&#44; sharing risk factors&#44; examination and clinical presentation&#46; Exertional dyspnea&#44; night-time cough&#44; fatigue and paroxysmal nocturnal dyspnea are common in the two diseases&#46; The physical examination&#44; even with the aid of chest radiography&#44; is often incapable of reliably diagnosing HF in patients with COPD exacerbation&#46; In fact&#44; 20&#37; of patients with negative radiographs have HF&#44; given that the cardiothoracic index can remain normal in an insufflated chest&#44; and pulmonary edema can be masked by radiolucent vascular remodeling&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#8211;14</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Treatment for HF can affect the clinical course of COPD and vice versa&#46; In fact&#44; there are studies that have analyzed the repercussion of inhaled beta-2 agonists and corticosteroids on the prognosis of HF&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">To differentiate these 2 conditions&#44; the use of natriuretic peptides has been suggested&#46; A BNP level &#60;100<span class="elsevierStyleHsp" style=""></span>pg&#47;mL or a NT-ProBNP level &#60;300<span class="elsevierStyleHsp" style=""></span>pg&#47;mL could reasonably rule out the presence of HF&#46; BNP levels of 100&#8211;500<span class="elsevierStyleHsp" style=""></span>pg&#47;mL could be due to the presence of HF or to the presence of cor pulmonale&#46; BNP levels &#62;500<span class="elsevierStyleHsp" style=""></span>pg&#47;mL or NT-ProBNP levels &#62;900<span class="elsevierStyleHsp" style=""></span>pg&#47;mL are highly suggestive of the presence of concomitant HF&#46;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16&#44;17</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Conversely&#44; COPD is a frequent comorbidity in patients with HF&#44; with up to a third of such patients having COPD&#46; Ten percent of patients hospitalized for HF have COPD&#46; The prevalence is especially high in patients with HF with preserved ejection fraction&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;18</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The best strategy for detecting the coexistence of HF and COPD is yet to be determined&#46; It is therefore essential in the near future to assess the usefulness of clinical ultrasonography in this situation&#44; especially if the absence of B-lines and left ventricular dysfunction is detected&#44; which allows us to rule out the presence of HF with high reliability and thereby prevent the implementation of an unnecessary diuretic therapy with potentially deleterious effects&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Detecting the etiology of exacerbations</span><p id="par0075" class="elsevierStylePara elsevierViewall">Acute COPD exacerbations are the leading cause of hospitalization for these patients&#44; and the most common causes are bacterial and viral respiratory infections &#40;50&#8211;70&#37;&#41;&#46; A third of patients present a pneumonic infiltrate and approximately 30&#37; have no obvious trigger&#46; Exacerbations worsen the quality of life with the passage of time&#44; and their recurrence increases mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Clinical ultrasonography is a sensitive and specific tool for diagnosing pneumonia&#44; with 85&#37; sensitivity &#40;much higher than that of a simple radiological study&#41; and 95&#37; specificity&#44; which is similar to that of radiography&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> The presence of a pneumonic infiltrate affects the prognosis of patients with COPD&#44; especially if there is associated pleural effusion&#59; its early detection is therefore important&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Approximately 16&#37; of patients with COPD exacerbation of no clear origin present a pulmonary thromboembolism&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> Multiorgan ultrasonography has a sensitivity of 90&#37; and a specificity of 86&#46;2&#37; for detecting pulmonary thromboembolisms &#40;the sensitivity and specificity of lung ultrasound is 60&#46;9&#37; and 95&#37;&#44; respectively&#59; that of echocardiography is 32&#46;7&#37; and 90&#46;9&#37;&#59; and that of leg ultrasonography is 52&#46;7&#37; and 97&#46;6&#37;&#44; respectively&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> Establishing screenings for pulmonary thromboembolisms through clinical ultrasonography for these patients is limited by the difficulty in obtaining similar results in real life to those described in the literature&#44; especially in detecting pulmonary infarctions &#40;Appendix B Video 2&#44; Additional Material&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Although pneumothorax is a less common cause of exacerbation&#44; lung ultrasonography detects this condition&#44; if the absence of pleural sliding is detected&#44; although this absence can occur in patients with COPD and emphysema without pneumothorax&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">It is therefore reasonable to consider using clinical ultrasonography to search for signs that guide the etiology of the exacerbation through multiorgan ultrasonography &#40;lung&#44; echocardiography and vascular ultrasonography of the legs&#41;&#44; especially in patients who have no obvious trigger&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Detection of pulmonary hypertension and right ventricular dysfunction</span><p id="par0100" class="elsevierStylePara elsevierViewall">The prevalence of pulmonary hypertension &#40;PHT&#41; in patients with COPD varies between 20&#37; and 90&#37;&#44; depending on the series&#46; PHT progression in patients with COPD is slow&#44; and an increase of 1&#46;5&#8211;2&#46;8<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>Hg per year in systolic pulmonary arterial pressure has been reported&#46; PHT is caused by numerous factors&#44; including hypoxia&#44; hyperinflation&#44; vascular remodeling and a decrease in the vascular bed&#46; Patients with PHT have a higher rate of hospitalizations and greater morbidity and mortality&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#8211;27</span></a> Right ventricular dysfunction is also associated with greater mortality and reduced exercise capacity&#44; which can be improved with respiratory rehabilitation&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">The case history and examination are of little use in the diagnosis of cor pulmonale&#46; Exertional dyspnea and fatigue are frequently present in patients with COPD&#44; regardless of the presence of PHT&#44; because these symptoms depend more on airflow obstruction and hyperinflation&#46; In the physical examination&#44; classical signs such as reinforcement of the second lung sound&#44; the third heart sound gallop and the pansystolic murmur of tricuspid regurgitation are uncommon due mainly to the hyperinflation and the fact that the degree of PHT is lower than in other etiologies&#46; The presence of leg edema in patients with COPD is not synonymous with the presence of right heart failure and ventricular dysfunction and could be due to the presence of secondary hyperaldosteronism produced by kidney failure&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Clinical ultrasonography helps detect&#44; in a relatively easy manner&#44; the presence of right ventricular dilation and dysfunction by estimating the diameter of the right ventricle in the apical 4-chamber plane and subjectively assessing the ventricular function or by using tricuspid annular plane systolic excursion&#46; There are also indirect signs of the presence of PHT&#44; such as the detection of a dilated but uncollapsed inferior vena cava and the presence of significant tricuspid regurgitation&#46; However&#44; assessing pulmonary pressure by estimating the velocity of the tricuspid regurgitation jet is not simple &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#47;Appendix B Video 3&#44; Additional material&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Evaluating the cardiovascular risk</span><p id="par0115" class="elsevierStylePara elsevierViewall">Cardiovascular comorbidities are one of the systemic manifestations with greatest impact on the morbidity and mortality of patients with COPD&#46; These factors also substantially contribute to the disease progression&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">It is unclear whether this fact is due simply to the higher prevalence of classical cardiovascular risk factors &#40;arterial hypertension&#44; diabetes mellitus&#44; low physical activity and dyslipidemia&#41; or whether there is a specific pathophysiological connection&#46; A number of authors have proposed low-grade systemic inflammation as a possible etiological pathway linking COPD and atherosclerosis&#59; however&#44; recent data indicate that sustained systemic inflammation is produced only in a proportion of patients with COPD and cardiovascular disease&#46; COPD is much more complex&#44; and other factors can be involved&#44; including biological &#40;hypoxemia&#44; endothelial dysfunction&#44; increased platelet activation&#44; arterial stiffness&#41;&#44; mechanical&#47;functional &#40;reduced forced expiratory volume in one second&#44; emphysema&#44; hyperinflation&#41;&#44; neurohumoral &#40;excess sympathetic nerve activity&#41; and genetic factors &#40;metalloproteinase polymorphisms&#44; telomere shortening&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> There are several studies with large patient cohorts that have identified a cardiovascular phenotype in COPD that progresses with a different clinical outcome and prognosis&#46; In fact&#44; patients with frequent exacerbations have an increased risk of developing an acute myocardial infarction&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">Independent studies have shown a greater risk of subclinical atherosclerosis in patients with COPD with the consequent associated cardiovascular risk&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> It is also widely known that the presence of carotid and femoral plaques have an incremental value to the SCORE scale for assessing coronary risk&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Left ventricle hypertrophy is a pivotal factor in cardiovascular events&#44; and treatment to prevent left ventricle hypertrophy has been shown to considerably reduce cardiovascular morbidity and mortality&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">The prevalence of abdominal aorta aneurysms in patients with COPD is 3&#46;7&#37;&#46; If the analysis is limited to men older than 65 years&#44; the prevalence increases to 6&#46;7&#37;&#44; which is much higher than in the general population with these characteristics&#46; A number of risk factors have been identified that significantly increase the risk of aneurysms and that are shared with the general population&#44; such as a history of coronary artery disease and the presence of peripheral arterial disease &#40;present in 10&#37; of the patients&#41;&#46; Selective detection in this population could therefore be considered&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">35&#44;36</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">From all of the above&#44; clinical ultrasonography could be a highly useful instrument for evaluating the cardiovascular risk of patients with COPD by detecting subclinical atherosclerosis &#40;carotid and femoral plaques&#41;&#44; evaluating left ventricle hypertrophy and selectively detecting abdominal aorta aneurysms&#46; It is appropriate to perform this multiorgan examination on all patients with COPD whose cardiovascular risk is low to moderate&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Diaphragmatic muscle ultrasonography</span><p id="par0145" class="elsevierStylePara elsevierViewall">A relatively new aspect in the assessment of patients with COPD is the use of ultrasonography to determine the presence of diaphragmatic dysfunction&#46; This assessment is based on estimating the thickness and inspiro-expiratory excursion of the diaphragm &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; Although there are various protocols&#44; a &#60;20&#37; change in thickness between inspiration and expiration is considered to confirm the presence of diaphragmatic dysfunction&#46; Assessing diaphragmatic thickening has utility in COPD exacerbations by identifying patients with a greater risk of non-invasive ventilation failure and a poor short-term prognosis&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">37&#44;38</span></a> However&#44; the thickening fraction has not shown the capacity for detecting patients with a greater risk of exacerbations&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> Reduced diaphragmatic mobility is associated with hypercapnia&#44; obstruction and hyperinflation&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a></p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">Finally&#44; it is worth mentioning the potential usefulness of measuring the area of the rectus femoris muscle as a surrogate marker of muscle dysfunction and frailty&#46; This measurement could therefore be useful as a prognostic tool for indicating a greater risk of hospital readmission&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a></p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Existing evidence</span><p id="par0155" class="elsevierStylePara elsevierViewall">As previously mentioned&#44; the literature regarding the implementation of clinical ultrasonography in patients with COPD is limited&#46; An ideal field for the clinical study of internists who treat these patients is therefore open&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Limitations</span><p id="par0160" class="elsevierStylePara elsevierViewall">One of the fundamental limitations of the ultrasound assessment of patients with COPD is the poor acoustic window for performing echocardiography&#44; due mainly to chest hyperinflation&#46; Approximately 20&#37; of patients with emphysema have a very poor window&#44; which precludes obtaining appropriate images for interpretation&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Areas for future development</span><p id="par0165" class="elsevierStylePara elsevierViewall">As has been mentioned&#44; performing a systematic ultrasound examination can be of considerable use for patients with COPD to assess the various clinical scenarios and associated comorbidities&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflicts of interest</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "identificador" => "xres1321545"
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          "titulo" => "Background"
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          "titulo" => "Necessary knowledge for applying ultrasonography"
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          "titulo" => "Clinical scenarios"
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              "identificador" => "sec0020"
              "titulo" => "Differential diagnosis of dyspnea of uncertain origin"
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            1 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Coexistence of chronic obstructive pulmonary disease and heart failure"
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            2 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Detecting the etiology of exacerbations"
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              "titulo" => "Detection of pulmonary hypertension and right ventricular dysfunction"
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              "titulo" => "Evaluating the cardiovascular risk"
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              "titulo" => "Diaphragmatic muscle ultrasonography"
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          "titulo" => "Existing evidence"
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          "titulo" => "Limitations"
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          "identificador" => "sec0060"
          "titulo" => "Areas for future development"
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          "identificador" => "sec0065"
          "titulo" => "Conflicts of interest"
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        10 => array:1 [
          "titulo" => "References"
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    "fechaRecibido" => "2019-06-19"
    "fechaAceptado" => "2019-07-11"
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            0 => "COPD"
            1 => "Point of care ultrasound"
            2 => "Pulmonary ultrasonography"
            3 => "Heart failure"
            4 => "COPD exacerbation"
            5 => "Cardiovascular risk"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Chronic obstructive pulmonary disease &#40;COPD&#41; is a highly prevalent disease and one of the most common reasons for hospitalization in internal medicine departments&#46; COPD also has significant associated morbidity and mortality&#46; In recent years&#44; multiorgan clinical ultrasonography &#40;pulmonary&#44; cardiac and vascular&#41; has emerged as a tool of considerable usefulness in managing patients with COPD in numerous situations&#44; including the differential diagnosis of dyspnoea of uncertain origin&#44; the assessment of the aetiology in episodes of exacerbation&#44; detecting concomitant heart failure or associated pulmonary hypertension and as support in managing cardiovascular risk factors such as subclinical atherosclerosis&#46; This study summarises the most important evidence regarding this approach and proposes future scenarios for the use of ultrasonography that will help improve the diagnosis&#44; prognostic estimations and the selection of the optimal treatment for this type of patient&#46;</p><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Res&#250;men</span></p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La EPOC es una enfermedad con una elevada prevalencia y representa uno de los motivos m&#225;s frecuentes de ingreso en los servicios de Medicina Interna&#46; Adem&#225;s&#44; presenta una importante morbimortalidad asociada&#46; En los &#250;ltimos a&#241;os la ecograf&#237;a cl&#237;nica multi&#243;rgano &#40;pulmonar&#44; cardiaca y vascular&#41;&#44; ha surgido como una herramienta de gran utilidad en el manejo de estos pacientes en m&#250;ltiples situaciones&#46; Entre ellas podemos destacar el diagn&#243;stico diferencial de la disnea de origen incierto&#44; la evaluaci&#243;n de la etiolog&#237;a en los episodios de exacerbaci&#243;n&#44; la detecci&#243;n de insuficiencia cardiaca concomitante o de hipertensi&#243;n pulmonar asociada y como apoyo en el manejo de algunos factores de riesgo cardiovascular como la ateroesclerosis subcl&#237;nica&#46; En este trabajo se resumen las evidencias m&#225;s importantes al respecto y se plantean escenarios futuros en el uso de los ultrasonidos que permitan mejorar el diagn&#243;stico&#44; la estimaci&#243;n pron&#243;stica y la selecci&#243;n del tratamiento &#243;ptimo en este tipo de pacientes&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Torres Macho J&#44; Garc&#237;a de Casasola G&#44; L&#243;pez Garc&#237;a F&#46; Ecograf&#237;a cl&#237;nica en la enfermedad pulmonar obstructiva cr&#243;nica&#46; Rev Clin Esp&#46; 2020&#59;220&#58;190&#8211;196&#46;</p>"
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            "apendice" => "<p id="par0180" class="elsevierStylePara elsevierViewall">The following are Supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia><elsevierMultimedia ident="upi0010"></elsevierMultimedia><elsevierMultimedia ident="upi0015"></elsevierMultimedia></p>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Video 1&#46; Lung ultrasound signs in the differential diagnosis of dyspnea of uncertain origin&#46; A-lines&#58; Equidistant horizontal hyperechogenic lines that start at the pleural line&#46; This pattern is compatible with normality&#46; B-lines&#58; Vertical lines that start at the pleural line and reach the distal area of the lungs&#44; which change with respiratory movements&#46; They appear when there is alveolar-interstitial opacification&#46; PLAPS&#58; In the posterolateral pulmonary region&#44; we can observe an ultrasound bronchogram compatible with pneumonic infiltrate&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">BLUE protocol adapted from Lichtenstein et al&#46; Pattern A means that the A-lines predominate&#46; Pattern B indicates the diffuse predominance of B-lines&#46; Pattern A&#47;B means that the A-lines predominate in one lung field while B-lines predominate in the other&#46; Pattern C indicates anterior alveolar consolidation&#46; PLAPS&#58; posterolateral alveolar or pleural syndrome&#46; &#42; Depending on whether the lung point sign is observed&#46;</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Abbreviations&#58; COPD&#44; chronic obstructive pulmonary disease&#59; DVT&#44; deep vein thrombosis&#59; PLAPS&#44; posterolateral alveolar or pleural syndrome&#46;</p>"
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Vol. 220. Issue 3.
Pages 190-196 (April 2020)
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Vol. 220. Issue 3.
Pages 190-196 (April 2020)
Special article
Clinical ultrasonography in chronic obstructive pulmonary disease
Visits
8
J. Torres Machoa,
Corresponding author
jtorresmacho@gmail.com

Corresponding author.
, G. García de Casasolaa, F. López Garcíab
a Grupo de Trabajo de Ecografía Clínica, Sociedad Española de Medicina Interna, Servicio de Medicina Interna, Hospital Universitario Infanta Cristina, Parla, Madrid, Spain
b Grupo de Trabajo de EPOC, Sociedad Española de Medicina Interna, Servicio de Medicina Interna, Hospital General Universitario de Elche, Elche, Alicante, Spain
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Abstract

Chronic obstructive pulmonary disease (COPD) is a highly prevalent disease and one of the most common reasons for hospitalization in internal medicine departments. COPD also has significant associated morbidity and mortality. In recent years, multiorgan clinical ultrasonography (pulmonary, cardiac and vascular) has emerged as a tool of considerable usefulness in managing patients with COPD in numerous situations, including the differential diagnosis of dyspnoea of uncertain origin, the assessment of the aetiology in episodes of exacerbation, detecting concomitant heart failure or associated pulmonary hypertension and as support in managing cardiovascular risk factors such as subclinical atherosclerosis. This study summarises the most important evidence regarding this approach and proposes future scenarios for the use of ultrasonography that will help improve the diagnosis, prognostic estimations and the selection of the optimal treatment for this type of patient.

Resúmen

La EPOC es una enfermedad con una elevada prevalencia y representa uno de los motivos más frecuentes de ingreso en los servicios de Medicina Interna. Además, presenta una importante morbimortalidad asociada. En los últimos años la ecografía clínica multiórgano (pulmonar, cardiaca y vascular), ha surgido como una herramienta de gran utilidad en el manejo de estos pacientes en múltiples situaciones. Entre ellas podemos destacar el diagnóstico diferencial de la disnea de origen incierto, la evaluación de la etiología en los episodios de exacerbación, la detección de insuficiencia cardiaca concomitante o de hipertensión pulmonar asociada y como apoyo en el manejo de algunos factores de riesgo cardiovascular como la ateroesclerosis subclínica. En este trabajo se resumen las evidencias más importantes al respecto y se plantean escenarios futuros en el uso de los ultrasonidos que permitan mejorar el diagnóstico, la estimación pronóstica y la selección del tratamiento óptimo en este tipo de pacientes.

Keywords:
COPD
Point of care ultrasound
Pulmonary ultrasonography
Heart failure
COPD exacerbation
Cardiovascular risk

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