Exacerbation of chronic obstructive pulmonary disease. More than just forced expiratory volume and comorbidity

de la Fuente Aguado, J.

doi:10.1016/j.rceng.2019.06.006

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"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" => "Editorial" "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" => "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">1</a>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.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.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">2,3</a>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.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">4,5</a>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">6</a>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">7</a>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">8</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.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." "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-06-27" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "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." ] ] "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. Soriano" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Monograf Arch Bronconeumol" "fecha" => "2018" "volumen" => "5" "paginaInicial" => "00153" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guía española de la enfermedad pulmonar obstructiva crónica (GesEPOC) 2017 Tratamiento farmacológico en fase estable" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Miratvilles" 1 => "J.J. Soler-Cataluña" 2 => "M. Calle" 3 => "J. Molina" 4 => "P. Almagro" 5 => "J.A. Quintano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2017.03.018" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2017" "volumen" => "53" "paginaInicial" => "324" "paginaFinal" => "335" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28477954" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Global Strategy for the diagnosis, management, and prevention of chronic obstructive lung disease: the GOLD science committee report 2019" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Singh" 1 => "A. Agusti" 2 => "A. Anzueto" 3 => "P.J. Barnes" 4 => "J. Bourbeau" 5 => "B.R. Celli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/13993003.00164-2019" "Revista" => array:4 [ "tituloSerie" => "Eur Respir J" "fecha" => "2019" "volumen" => "53" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30705126" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influence of deprivation on health care use, health care costs, and mortality in COPD" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "P.F. Collins" 1 => "R.J. Stratton" 2 => "R.J. Kurukulaaratchy" 3 => "M. Elia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2147/COPD.S157594" "Revista" => array:6 [ "tituloSerie" => "Int J Chron Obstruct Pulmon Dis" "fecha" => "2018" "volumen" => "13" "paginaInicial" => "1289" "paginaFinal" => "1296" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29719384" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Social determinants of adherence to pulmonary rehabilitation for chronic obstructive pulmonary disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.R. Oates" 1 => "B.W. Hamby" 2 => "I. Stepanikova" 3 => "S.J. Knight" 4 => "S.P. Bhatt" 5 => "J. Hitchcock" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/15412555.2017.1379070" "Revista" => array:6 [ "tituloSerie" => "COPD" "fecha" => "2017" "volumen" => "14" "paginaInicial" => "610" "paginaFinal" => "617" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29020525" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cognitive impairment in COPD: should cognitive evaluation be part of respiratory assessment?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "V. Andrianopoulos" 1 => "R. Gloeckl" 2 => "I. Vogiatzis" 3 => "V. Andrianopoulos" 4 => "R. Gloeckl" 5 => "I. Vogiatzis" 6 => "K. Kenn" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Breathe (Sheff)" "fecha" => "2017" "volumen" => "13" "paginaInicial" => "e1" "paginaFinal" => "e9" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictores sociales y clínicos asociados con estancia hospitalaria prolongada en pacientes con agudización grave de EPOC" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "S. Fernández-García" 1 => "C. Represas-Represas" 2 => "A. Ruano-Raviña" 3 => "M. Botana-Rial" 4 => "C. Mouronte-Roibas" 5 => "C. Ramos-Hernández" 6 => "A. 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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.

Indexed in:

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

View more metrics

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Journal Information

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Vol. 220. Issue 2.

Pages 119-120 (March 2020)

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