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Discordance in treatment of chronic obstructive pulmonary disease following GesEPOC guideline vs. GOLD
Discordancia del tratamiento de la enfermedad pulmonar obstructiva crónica según la guía GesEPOC vs. GOLD
J.M. Figueira Gonçalvesa,
, R. Golpeb,c, C. Esteband,e, M. Acosta-Sorensena, I. Veigab, I. Guzmán-Peraltab
Corresponding author
a Servicio de Neumología y Cirugía Torácica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
b Servicio de Neumología, Hospital Universitario Lucus Augusti, Lugo, Spain
c Grupo C039 Biodiscovery HULA-USC, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, A Coruña, Spain
d Servicio de Neumología, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
e Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
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This document mentions the option of starting treatment for all groups with a single bronchodilator (1 BD), reserving dual bronchodilation (2 BD) for the most symptomatic cases in group D, and allowing for alternating use of inhaled corticosteroid long-acting beta-2 agonists (ICS-LABA) in cases with a high eosinophil count<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In contrast, GesEPOC classifies patients as low risk or high risk using post-bronchodilator FEV<span class="elsevierStyleInf">1</span> in addition to the GOLD criteria and recommends treatment with 1 BD exclusively in the former. The indication for the remaining cases is 2 BD or ICS-LABA, with the latter the therapy of choice for patients with ACO phenotype (asthma-COPD overlap)<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>. These differences could lead to, depending on the algorithm applied, the same patient receiving different initial treatments. Nevertheless, this possibility has not been studied.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of the study was to: 1) evaluate agreement between initial treatment assigned according to GesEPOC and GOLD, and 2) analyse the degree of interobserver agreement when applying each of the documents.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">A simulation study was performed. To do this, a database of real patients referred to a specialized consultation unit for COPD was used. From said database, we selected subjects who presented the following variables at their first assessment: FEV<span class="elsevierStyleInf">1</span>% obtained following the bronchodilator test; patient classification as exacerbators (≥2 exacerbations treated with steroids and/or antibiotics in ambulatory care or one exacerbation that required hospital admission in the year prior to the initial visit) or non-exacerbators (if none of the previous premises were met); degree of baseline dyspnoea according to the modified Medical Research Council scale (mMRC); blood eosinophilia (two hemograms with ≥300 eosinophils/μL in the five years prior to the initial visit was considered valid) or any of the other two ACO criteria permitted by GesEPOC<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The database was provided to four investigators with the request that they blindly classify and treat each patient as if they were naïve patients according to one of the algorithms (two used GOLD and two GesEPOC). None of them had been responsible for providing medical care to the selected patients. According to GesEPOC, the researchers classified the patients into high risk (in the presence of any of the following criteria: FEV<span class="elsevierStyleInf">1</span>% < 50%, mMRC > 2, ≥2 moderate exacerbations or at least one severe exacerbation in the past year) or low risk (must meet the following three criteria: FEV<span class="elsevierStyleInf">1</span>% ≥ 50%, mMRC 0–2, and ≤1 moderate exacerbation in the previous year)<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>. On the other hand, depending on the GOLD A, B, C, or D recommendations, the patients were labelled according to the degree of dyspnoea and the presence of exacerbations. Patients would be included in groups A–B if they presented <2 moderate exacerbations in the previous year, or in groups C–D in the case of ≥2 moderate exacerbations or at least one severe exacerbation in the previous year. Likewise, patients with an mMRC dyspnoea grade ≤1 would be included in the A<span class="elsevierStyleGlyphsbnd"></span>C groups, or in the B<span class="elsevierStyleGlyphsbnd"></span>D groups if they suffered from dyspnoea mMRC ≥ 2<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>.</p><p id="par0035" class="elsevierStylePara elsevierViewall">With the aim of simplifying the choice of bronchodilator therapy (LABA, long-acting anticholinergics, or short-acting bronchodilators) and facilitating analysis, we decided to limit treatments to three categories: 1) use of 1 BD; 2) use of 2 BD; and 3) ICS-LABA.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Following GOLD, patients in groups A, B, and C were indicated for treatment with 1 BD. Group D was indicated for 1 BD, except in those cases of dyspnoea mMRC > 2 for which the recommended treatment was 2 BD, or, in the case of peripheral eosinophil count in blood ≥300 cel/μL, which assigned them ICS-LABA<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>. In the case of GesEPOC, 1 BD was indicated for low risk patients and 2 BD for high risk patients, with the exception of those who met any ACO criteria, in which case ICS-LABA was indicated<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>.</p><p id="par0045" class="elsevierStylePara elsevierViewall">To evaluate the agreement between the classifications made with each document, as well as among the indicated treatments, the overall Cohen’s Kappa coefficient was calculated.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The study was approved by the Ethics Committee of Nuestra Señora de Candelaria University Hospital (Tenerife).</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">A total of 467 patients were included: mean age 69.2 ± 9.2 years, FEV<span class="elsevierStyleInf">1</span>/FVC: 52.3 ± 11.4%, FEV<span class="elsevierStyleInf">1</span>%: 55.5 ± 15.5% and FVC%: 76.9 ± 16.7%. The distribution of the groups (GesEPOC and GOLD) is shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> and in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1A</a>.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">According to GOLD, 92.5% of patients started therapy with 1 BD vs. 49.3% in GesEPOC. Regarding the use of ICS-LABA, 4.9% of patients were indicated for said treatment according to GOLD vs. 22.3% of GesEPOC (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 1B</a>). The interobserver agreement for classification according to GOLD and GesEPOC was very good (Kappa: 0.99, 95% CI: 0.99–1.00, and Kappa: 0.99, 95% CI: 0.98–1.00, respectively). The interobserver agreement for initial treatment according to GOLD and GesEPOC was very good (Kappa: 0.95, 95% CI: 0.90–1.00, and Kappa: 0.99, 95% CI: 0.97–1.00, respectively). Agreement between the initial treatment recommended by GOLD and GesEPOC was poor (Kappa: 0.17, 95% CI: 0.12–0.23).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0065" class="elsevierStylePara elsevierViewall">Our study reveals that: 1) there is poor agreement between the two documents when it comes to initial treatment for patients with COPD, and 2) the interobserver agreement was very good when classifying and treating according to both documents.</p><p id="par0070" class="elsevierStylePara elsevierViewall">GesEPOC is a clinical practice guideline that combines recommendations based on GRADE methodology with expert opinion, while GOLD is based on expert recommendations following review of the scientific literature. Both documents differ in terms of the criteria used for choosing initial treatment<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a>. Decision-making in GOLD is based on symptomatology and the presence of exacerbations while that of GesEPOC uses, in addition the aforementioned, post-bronchodilator FEV<span class="elsevierStyleInf">1</span>. This leads to the possibility that the same patient could receive different treatments according to the algorithm selected. Therefore, we observed poor agreement between the two therapeutic algorithms. In the case of GOLD, 1 BD is shown as the primary initial treatment compared to that recommended by GesEPOC (92.5 vs. 49.3%, respectively).</p><p id="par0075" class="elsevierStylePara elsevierViewall">In addition, there is lower indication for ICS-LABA according to GOLD as compared to the GesEPOC guideline (4.9 vs. 22.3%, respectively). The GOLD guideline principally recommends ICS-LABA as initial treatment in symptomatic subjects with a history of exacerbations and who present with a high peripheral eosinophil count in blood1. However, GesEPOC uses broader criteria in which, in addition to eosinophilia or the presence of exacerbations, a history of bronchial asthma or marked airflow obstruction reversibility are considered<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The current evidence focuses the use of ICS in COPD patients on reducing exacerbations<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a>, with the patients who benefit the most being those with an eosinophil count ≥300 cel/μL<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6–8</span></a>. Considering that GesEPOC suggests ICS-LABA for high risk ACO patients, it is possible that its indication encompasses subjects without exacerbations, with these patients assigned to said risk group either due to FEV<span class="elsevierStyleInf">1</span> or due to dyspnoea. This would justify the elevated proportion of patients who are recommended to start ICS-LABA according to GesEPOC as compared to GOLD. Likewise, the higher use of 2 BD in the GesEPOC guideline may be because the therapeutic algorithm takes FEV<span class="elsevierStyleInf">1</span> into consideration, thereby promoting, unlike GOLD, more intense bronchodilator therapy<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a>. On the other hand, both documents meet the aim of reducing variability in treatment according to the observer, which determines the simplicity of interpretation.</p><p id="par0085" class="elsevierStylePara elsevierViewall">In terms of limitations, we must mention that the COPD Assessment Test (CAT) was not used, which could have modified our results. This was simplified in an attempt to facilitate treatment analysis. The definition of eosinophilia used in our study was an arbitrary criterion since GOLD and GesEPOC do not define how many tests are necessary<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a>. The study was focused on first treatments rather than treatment escalation.</p><p id="par0090" class="elsevierStylePara elsevierViewall">In conclusion, there is poor agreement between GOLD and GesEPOC when indicating initial treatment for COPD patients. Studies comparing the clinical impact of both algorithms are needed.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicts of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">Juan Marco Figueira Gonçalves has received speaking fees or funding for attending conferences from Laboratorio Esteve, Mundipharma, AstraZeneca, Boehringer Ingelheim, Ferrer, Menarini, Rovi, GlaxoSmithKline, Chiesi, Novartis and Gebro Pharma.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Rafael Golpe has received speaking fees or funding for attending conferences from Laboratorio Esteve, Mundipharma, AstraZeneca, Boehringer Ingelheim, Ferrer, Menarini, Rovi, GlaxoSmithKline, Chiesi, Novartis and Gebro Pharma.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Cristóbal Esteban has received speaking fees or research funding from GlaxoSmithKline, Menarini and AstraZeneca.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The other authors declare that they do not have any conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1646193" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1466596" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1646192" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1466595" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-12-14" "fechaAceptado" => "2021-01-27" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1466596" "palabras" => array:3 [ 0 => "Chronic obstructive pulmonary disease" 1 => "Guidelines" 2 => "Treatment" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1466595" "palabras" => array:3 [ 0 => "Enfermedad pulmonar obstructiva crónica" 1 => "Normativa" 2 => "Tratamiento" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Pharmacological treatment of chronic obstructive pulmonary disease in Spain is usually chosen according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) or Spanish guidelines for chronic obstructive pulmonary disease (GesEPOC). The main objective of this study was to evaluate the degree of concordance between treatment for newly diagnosed chronic obstructive pulmonary disease patients according to GOLD and GesEPOC.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Simulation study. The following variables were used: FEV<span class="elsevierStyleInf">1</span>%, exacerbations, dyspnoea at first evaluation, blood eosinophilia, personal history of asthma, and degree of bronchodilator reversibility. Four investigators classified and assigned a treatment to each patient (2 using GOLD criteria and the other 2 using GesEPOC). Global Kappa index was calculated.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The database included 467 patients. Agreement between treatment decided using GOLD and GesEPOC was poor (Kappa: 0.17, 95% CI: 0.12–0.23).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">There is a poor agreement between GOLD and GesEPOC recommendations for initial chronic obstructive pulmonary disease treatment.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">En España, el tratamiento farmacológico de la enfermedad pulmonar obstructiva crónica se basa en la <span class="elsevierStyleItalic">Global Initiative for Chronic Obstructive Lung Disease</span> (GOLD) y la Guía española de la enfermedad pulmonar obstructiva crónica (GesEPOC). El objetivo principal de este estudio fue evaluar la concordancia entre los tratamientos de inicio asignados por GOLD y GesEPOC.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Estudio de simulación. Se emplearon las siguientes variables: FEV<span class="elsevierStyleInf">1</span>%, exacerbaciones, disnea inicial, eosinofilia en sangre, antecedente de asma y grado de reversibilidad en la prueba broncodilatadora. Cuatro neumólogos clasificaron/asignaron un tratamiento a cada paciente (2 de ellos según GOLD y 2 según GesEPOC). Se calculó el coeficiente Kappa de Cohen global.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 467 pacientes. La concordancia entre el tratamiento recomendado por GOLD y GesEPOC fue pobre (Kappa: 0,17, IC 95%: 0,12–0,23).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Existe una pobre concordancia entre GOLD y GesEPOC a la hora de iniciar tratamiento en los pacientes con enfermedad pulmonar obstructiva crónica.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Figueira Gonçalves JM, Golpe R, Esteban C, Acosta-Sorensen M, Veiga I, Guzmán-Peralta I. Discordancia del tratamiento de la enfermedad pulmonar obstructiva crónica según la guía GesEPOC vs. GOLD. Rev Clin Esp. 2021;221:536–539.</p>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1577 "Ancho" => 2157 "Tamanyo" => 457327 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Correlation between groups classified according to GOLD and GesEPOC.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1A" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table 1" "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">GesEPOC: Spanish Guidelines for Management of Chronic Obstructive Pulmonary Disease; GOLD: Global Initiative for Chronic Obstructive Lung Disease.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">GesEPOC (no. of patients) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="4" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">GOLD (no. of patients)</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">A (238) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">B (95) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">C (69) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">D (65) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Low risk (230) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">165 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">High risk (237) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2803003.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Correlation between groups classified according to GesEPOC and GOLD.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 1B" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table 1" "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">1 BD: single bronchodilation; 2 BD: dual bronchodilation; GesEPOC: Spanish Guidelines for Management of Chronic Obstructive Pulmonary Disease; GOLD: Global Initiative for Chronic Obstructive Lung Disease; ICS-LABA: inhaled corticosteroid-long-acting β2-agonist.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">GOLD, n (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">GesEPOC, n (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 BD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">432 (92.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">230 (49.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 BD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (2.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">133 (28.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ICS-LABA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 (4.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">104 (22.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2803002.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Distribution of treatments according to GOLD vs. GesEPOC recommendations.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:2 [ "titulo" => "Global initiative for chronic obstructive lung disease [Internet]" "serieFecha" => "2020" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spanish Guidelines for Management of Chronic Obstructive Pulmonary Disease (GesEPOC) 2017. Pharmacological treatment of stable phase" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Miravitlles" 1 => "J.J. Soler-Cataluña" 2 => "M. Calle" 3 => "J. Molina" 4 => "P. Almagro" 5 => "J.A. Quintano" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Bronconeumol." "fecha" => "2017" "volumen" => "53" "paginaInicial" => "324" "paginaFinal" => "335" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P.M. Calverley" 1 => "J.A. Anderson" 2 => "B. Celli" 3 => "G.T. Ferguson" 4 => "C. Jenkins" 5 => "P.W. Jones" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa063070" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med." "fecha" => "2007" "volumen" => "356" "paginaInicial" => "775" "paginaFinal" => "789" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17314337" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Once-daily single-inhaler triple versus dual therapy in patients with COPD" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.A. Lipson" 1 => "F. Barnhart" 2 => "N. Brealey" 3 => "J. Brooks" 4 => "G.J. Criner" 5 => "N.C. Day" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1713901" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med." "fecha" => "2018" "volumen" => "378" "paginaInicial" => "1671" "paginaFinal" => "1680" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29668352" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comparative efficacy of inhaled corticosteroid and long-acting beta agonist combinations in preventing COPD exacerbations: a Bayesian network meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Y. Oba" 1 => "N.A. Lone" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2147/COPD.S48492" "Revista" => array:6 [ "tituloSerie" => "Int J Chron Obstruct Pulmon Dis." "fecha" => "2014" "volumen" => "9" "paginaInicial" => "469" "paginaFinal" => "479" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24872685" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of inhaled corticosteroids on exacerbation of asthma-COPD overlap according to different diagnostic criteria" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "Y.S. Jo" 1 => "Y.I. Hwang" 2 => "K.H. Yoo" 3 => "T.H. Kim" 4 => "M.G. Lee" 5 => "S.H. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "J Allergy Clin Immunol Pract." "fecha" => "2020" "volumen" => "8" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Blood eosinophil count, a marker of inhaled corticosteroid effectiveness in preventing COPD exacerbations in post-hoc RCT and observational studies: systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T.H. Harries" 1 => "V. Rowland" 2 => "C.J. Corrigan" 3 => "I.J. Marshall" 4 => "L. McDonnell" 5 => "V. Prasad" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12931-019-1268-7" "Revista" => array:5 [ "tituloSerie" => "Respir Res." "fecha" => "2020" "volumen" => "21" "paginaInicial" => "3" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31900184" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Triple therapy <span class="elsevierStyleItalic">versus</span> single and dual long-acting bronchodilator therapy in COPD: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Cazzola" 1 => "P. Rogliani" 2 => "L. Calzetta" 3 => "M.G. Matera" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/13993003.01675-2018" "Revista" => array:4 [ "tituloSerie" => "Eur Respir J." "fecha" => "2018" "volumen" => "52" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30385603" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical benefit of fixed-dose dual bronchodilation with glycopyrronium and indacaterol once daily in patients with chronic obstructive pulmonary disease: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C.S. Ulrik" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2147/COPD.S60362" "Revista" => array:6 [ "tituloSerie" => "Int J Chron Obstruct Pulmon Dis." "fecha" => "2014" "volumen" => "9" "paginaInicial" => "331" "paginaFinal" => "338" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24729699" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An evaluation of single and dual long-acting bronchodilator therapy as effective interventions in maintenance therapy-naïve patients with COPD" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Singh" 1 => "A.D. D’Urzo" 2 => "J.F. Donohue" 3 => "E.M. Kerwin" 4 => "E. Molins" 5 => "F. Chuecos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2147/COPD.S217710" "Revista" => array:6 [ "tituloSerie" => "Int J Chron Obstruct Pulmon Dis." "fecha" => "2019" "volumen" => "14" "paginaInicial" => "2835" "paginaFinal" => "2848" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31827323" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000022100000009/v3_202201140544/S2254887421001284/v3_202201140544/en/main.assets" "Apartado" => array:4 [ "identificador" => "1903" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Brief Original" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000022100000009/v3_202201140544/S2254887421001284/v3_202201140544/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887421001284?idApp=WRCEE" ]
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