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"apellidos" => "Doumas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256521001028" "doi" => "10.1016/j.rce.2021.04.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256521001028?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887421001016?idApp=WRCEE" "url" => "/22548874/0000022200000004/v1_202204130611/S2254887421001016/v1_202204130611/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "COPD: A preventable epidemic?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "233" "paginaFinal" => "234" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J.M. Varela-Aguilar, F.J. Medrano-Ortega" "autores" => array:2 [ 0 => array:3 [ "nombre" => "J.M." "apellidos" => "Varela-Aguilar" "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 1 => array:4 [ "nombre" => "F.J." "apellidos" => "Medrano-Ortega" "email" => array:1 [ 0 => "medrano@cica.es" ] "referencia" => array:6 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 4 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] 5 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Instituto de Biomedicina de Sevilla, Sevilla, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Grupo de Trabajo de EPOC de la Sociedad Española de Medicina Interna, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "EPOC: ¿una epidemia prevenible?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterised by persistent respiratory symptoms and limited airflow due to alveolar and/or airway abnormalities, generally caused by significant exposure to noxious particles and influenced by host factors, including abnormal lung development.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">COPD represents an important public health challenge and is a significant cause of morbidity and mortality and public health care costs. 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"><span class="elsevierStyleSup">2</span></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"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">3</span></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"><span class="elsevierStyleSup">4</span></a> though the results could be biased as it included an excessively young population (≥20 years).</p><p id="par0020" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">5</span></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"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">7</span></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.</p><p id="par0030" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">9</span></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.</p><p id="par0040" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">7</span></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"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">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"><span class="elsevierStyleSup">10</span></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"><span class="elsevierStyleSup">11</span></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.</p><p id="par0050" class="elsevierStylePara elsevierViewall">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.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "⋆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Varela-Aguilar JM, Medrano-Ortega FJ. 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