COPD: A preventable epidemic?

Varela-Aguilar, J.M.; Medrano-Ortega, F.J.

doi:10.1016/j.rceng.2022.02.001

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In 2019 it was estimated that 212 million patients were diagnosed with COPD around the world with over 3.2 million deaths each year, representing the third cause of death (6% of deaths) and the sixth in terms of disease burden.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> The projections indicate that the burden of COPD will increase in coming decades due to continuous exposure to the disease’s risk factors and to population ageing.<a class="elsevierStyleCrossRef" href="#bib0015">3</a>COPD is the most prevalent non-communicable respiratory disease and has reached pandemic levels. The data on the real prevalence of COPD varies broadly due to differences in diagnostic and inclusion criteria and significant geographic variability, with a prevalence of diagnosed cases that ranges from 6% in Europe to 1.6% in sub-Saharan Africa.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> A good example of this is the study published by Wang et al. that was conducted in the vast Shanxi province (China), where a prevalence of 6.4% was observed,<a class="elsevierStyleCrossRef" href="#bib0020">4</a> though the results could be biased as it included an excessively young population (≥20 years).Fortunately, we currently have data that enables us to estimate the prevalence of COPD more accurately, such as the Burden of Obstructive Lung Diseases (BOLD) program that uses a standardised methodology to evaluate the prevalence and risk factors of COPD in individuals over the age of 40 across the world.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> According to BOLD, the number of real cases of COPD in 2010 was estimated to be 384 million, with a global prevalence of 11.7%.<a class="elsevierStyleCrossRef" href="#bib0030">6</a>In Spain, recent data from the EPISCAN II study show a prevalence of 11.8% in patients over the age of 40, with significant regional differences and a predominance in males (14.6%) over females (9.4%). This latter group is increasingly growing as it progressively adopts smoking habits.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> This prevalence is higher than that of other diseases such as diabetes mellitus and yet, we continue to fail to pay enough attention to our respiratory health.The two basic pillars in the fight against this epidemic are interventions to prevent risk factors and early diagnosis of the disease. The main risk factors for COPD are smoking, presence of respiratory symptoms (wheezing, asthma and/or chronic bronchitis) and a history of sinusitis or nasal polyps.<a class="elsevierStyleCrossRef" href="#bib0040">8</a>In our setting, prevention should be focused on fighting smoking. According to the European Health Survey, in Spain, 16.4% of females and 23.3% of males smoke on a daily basis.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> The strategy should be focused around preventing starting smoking and helping current smokers to stop smoking. For this reason, the current anti-smoking law from 2010 needs to be revised to help stop tobacco use.In terms of early diagnosis, the significant underdiagnosis of COPD is a crucial issue, estimated to be around 74.7% in Spain according to the EPISCAN II data.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> This means that up to 70% of COPD patients are diagnosed in advanced stages of the disease when the possibility to improve prognosis is much more limited.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>To reduce underdiagnosis, our GesEPOC national guidelines continue to recommend the use of screening questionnaires and spirometry in adults over 35 years, smokers, or ex-smokers with respiratory symptoms.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> However, it is necessary to evaluate new strategies regarding both the use of simpler screening methods than spirometry and a definition of the target population for screening. For the former, this includes the use of questionnaires, portable spirometers, or peak flow meters as well as more innovative techniques, such as analysing breathing sounds recorded by smartphones, which are already being implemented in initiatives to anticipate diagnosis and treatment of this disease such as the ANTES multi-centre strategy.<a class="elsevierStyleCrossRef" href="#bib0055">11</a> Regarding the latter, advances must be made in the analysis of the cost effectiveness of screening in diseases like ischaemic heart disease, diabetes, or sinusitis, where the prevalence of COPD is very high and screening opportunistic.In short, if we want to make progress in the fight against COPD, we must strengthen measures to reduce tobacco use and once and for all define strategies that enable hidden cases of the disease to come to the surface." 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Revista Clínica Española (English Edition)

ISSN: 2254-8874

Revista Clínica Española published its first issue in 1940 and is the body of expression of the Spanish Society of Internal Medicine (SEMI).
The journal fully endorses the goals of updating knowledge and facilitating the acquisition of key developments in internal medicine applied to clinical practice. Revista Clínica Española is subject to a thorough double blind review of the received articles written in Spanish or English. Ten issues are published each year, including mostly originals, reviews and consensus documents.

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Current Contents / Clinical Medicine , JCR / SCI-Expanded, Index Medicus / Medline y Excerpta Medica / EMBASE

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Impact factor

The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two preceding years.

© Clarivate Analytics, Journal Citation Reports 2022

Impact factor 2023

2.3

Citescore

CiteScore measures average citations received per document published.

Citescore 2023

0.7

SJR

SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact.

SJR 2023

0.162

SNIP

SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field.

SNIP 2023

0.211

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Vol. 222. Issue 4.

Pages 233-234 (April 2022)

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