Editorial
Exacerbation of chronic obstructive pulmonary disease. More than just forced expiratory volume and comorbidity
Exacerbación en la enfermedad pulmonar obstructiva crónica. Algo más que el volumen espiratorio forzado y la comorbilidad
J. de la Fuente Aguado
Servicio de Medicina Interna, Hospital Povisa, Vigo, Pontevedra, Spain
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Only those variables with statistical significance are shown in the graph. The reference categories appear between parentheses. <span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>363 patients. m, months. *Factor studied as continuous variable.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "E. Martínez-Moragón, J. Delgado, S. Mogrovejo, T. Fernández-Sánchez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "E." "apellidos" => "Martínez-Moragón" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Delgado" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Mogrovejo" ] 3 => array:2 [ "nombre" => "T." "apellidos" => "Fernández-Sánchez" ] 4 => array:1 [ "colaborador" => "On behalf of the grupo de investigación STEP" ] 5 => array:1 [ "colaborador" => "The authors would like to thank the following participating researchers for their collaboration ordered alphabetically" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S001425651930150X" "doi" => "10.1016/j.rce.2019.05.004" "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/S001425651930150X?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887419302577?idApp=WRCEE" "url" => "/22548874/0000022000000002/v1_202002180732/S2254887419302577/v1_202002180732/en/main.assets" ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Exacerbation of chronic obstructive pulmonary disease. More than just forced expiratory volume and comorbidity" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "119" "paginaFinal" => "120" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "J. de la Fuente Aguado" "autores" => array:1 [ 0 => array:3 [ "nombre" => "J." "apellidos" => "de la Fuente Aguado" "email" => array:1 [ 0 => "jfuente@povisa.es" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Interna, Hospital Povisa, Vigo, Pontevedra, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Exacerbación en la enfermedad pulmonar obstructiva crónica. Algo más que el volumen espiratorio forzado y la comorbilidad" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic obstructive pulmonary disease (COPD) is one of the main reasons for hospitalization in the Spanish healthcare system. More than 70,000 discharges are generated in public Spanish hospitals every year due to acute COPD exacerbations (ACOPDE), a significant proportion of which occur in internal medicine departments.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Hospitalization for ACOPDE, in addition to worsening patients’ clinical deterioration and with the resulting increase in morbidity and mortality, results in high resource consumption and a loss of opportunity. Reducing hospital stays, readmissions and emergency department visits and consultations, both in the primary care and hospital setting, is therefore a priority objective for any institution and for the entire healthcare system.</p><p id="par0015" class="elsevierStylePara elsevierViewall">If the head of an internal medicine department (to which the oldest patients and those with the greatest comorbidity are admitted) or the head of a pulmonology department (with somewhat younger and less comorbid patients) described the typical profile of a patient with COPD admitted to a Spanish hospital, they would likely say that these patients are most often admitted during the winter months. This colder season coincides with the peaks of viral respiratory diseases, whose paradigm is influenza, which occurs in patients with severe or highly severe COPD, according to the reduction in forced expiratory volume and with frequent exacerbations and comorbidities such as heart failure.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The standard systematic procedure during hospitalization is to explore all causes related to the deterioration of the patient’s general condition or of the gas exchange that motivated the hospitalization: respiratory or systemic infections, exposure to respiratory irritants or persistent smoking, compliance with and understanding of the prescribed treatment, expertise in handling respiratory devices, vaccinations and regarding comorbidities such as heart failure, ischemic heart disease, venous thromboembolism disease and diabetes.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">However, the psychological, social and financial determinants are, in most cases, rarely evaluated and assessed, despite the fact that these determinants are of paramount importance for establishing the care strategy, planning healthcare resources and locating the resources for this increasingly numerous patient group.</p><p id="par0030" class="elsevierStylePara elsevierViewall">There are numerous social and psychological factors that interact, causing a deleterious effect for patients with COPD. Depression, social isolation, financial resources, loneliness (especially in males), anxiety and insecurity associated with progressive functional limitation and, lastly, dependence and frailty associated with loss of mobility, malnutrition and sarcopenia are all factors clearly related to poorer drug and rehabilitative treatment compliance, longer hospitalization, higher readmission rates and faster progression of the COPD.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">That situation is especially relevant in light of the increasingly numerous studies that have demonstrated the high prevalence of mild cognitive impairment (up to 3 times more prevalent than in the general population adjusted for age, sex and educational level) when performing neuropsychological tests, in addition to the Mini Mental Test, on elderly patients with severe COPD and comorbidity. This mild cognitive impairment can affect (in isolation or jointly) various domains of the higher intellectual functions (memory, learning, attention, reaction speed, visuospatial abilities and language), creating an additional barrier for compliance, given that it can cause problems in understanding and performing the drug or rehabilitative treatment and can interfere with the scheduled visits.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In this issue of the journal, Fernández-García et al. from the Neumovigo workgroup, with extensive and recognized experience in COPD research and innovation, reveals that the comprehensive assessment of patients with severe COPD must include social factors to offer and ensure efficient high-quality care. The authors show that a state of social risk/problem, as measured by the Gijón scale, is associated with longer hospital stays and that a COPD Assessment Test score is its best predictor.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The study’s conclusions are added to the increasingly widespread recommendations of conducting comprehensive approach and care programs for patients with severe COPD, which include a multidisciplinary assessment of the various aspects involved in patients with COPD, integrating not only physicians, nurses, and physiotherapists but also psychologists and social workers.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Each hospitalization for ACOPDE is an opportunity to conduct these programs. Nevertheless, this recommendation should not be generalized to all patients with COPD for the sake of a cost-effective intervention or approach, and the target patients who could benefit from this approach are those who are older, with fewer financial resources, those living alone and those with numerous comorbidities.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The Spanish healthcare system, which so ensures the application of pharmacological measures of limited efficacy in advanced disease stages, should include care for psychosocial aspects in its portfolio of healthcare services, given that these aspects significantly affect the quality of life of these patients and can help optimize the use of healthcare resources.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-06-27" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: de la Fuente Aguado J. Exacerbación en la enfermedad pulmonar obstructiva crónica. Algo más que el volumen espiratorio forzado y la comorbilidad. Rev Clin Esp. 2020;220:119–120.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Las enfermedades respiratorias en España a la luz del CMBD de RECALAR" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "I. Alfageme" 1 => "A. Fernández Villar" 2 => "B.J. 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| 2023 March | 5 | 3 | 8 |
