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is therefore a priority objective for any institution and for the entire healthcare system&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">If the head of an internal medicine department &#40;to which the oldest patients and those with the greatest comorbidity are admitted&#41; or the head of a pulmonology department &#40;with somewhat younger and less comorbid patients&#41; described the typical profile of a patient with COPD admitted to a Spanish hospital&#44; they would likely say that these patients are most often admitted during the winter months&#46; This colder season coincides with the peaks of viral respiratory diseases&#44; whose paradigm is influenza&#44; which occurs in patients with severe or highly severe COPD&#44; according to the reduction in forced expiratory volume and with frequent exacerbations and comorbidities such as heart failure&#46;</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&#8217;s general condition or of the gas exchange that motivated the hospitalization&#58; respiratory or systemic infections&#44; exposure to respiratory irritants or persistent smoking&#44; compliance with and understanding of the prescribed treatment&#44; expertise in handling respiratory devices&#44; vaccinations and regarding comorbidities such as heart failure&#44; ischemic heart disease&#44; venous thromboembolism disease and diabetes&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">However&#44; the psychological&#44; social and financial determinants are&#44; in most cases&#44; rarely evaluated and assessed&#44; despite the fact that these determinants are of paramount importance for establishing the care strategy&#44; planning healthcare resources and locating the resources for this increasingly numerous patient group&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">There are numerous social and psychological factors that interact&#44; causing a deleterious effect for patients with COPD&#46; Depression&#44; social isolation&#44; financial resources&#44; loneliness &#40;especially in males&#41;&#44; anxiety and insecurity associated with progressive functional limitation and&#44; lastly&#44; dependence and frailty associated with loss of mobility&#44; malnutrition and sarcopenia are all factors clearly related to poorer drug and rehabilitative treatment compliance&#44; longer hospitalization&#44; higher readmission rates and faster progression of the COPD&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;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 &#40;up to 3 times more prevalent than in the general population adjusted for age&#44; sex and educational level&#41; when performing neuropsychological tests&#44; in addition to the Mini Mental Test&#44; on elderly patients with severe COPD and comorbidity&#46; This mild cognitive impairment can affect &#40;in isolation or jointly&#41; various domains of the higher intellectual functions &#40;memory&#44; learning&#44; attention&#44; reaction speed&#44; visuospatial abilities and language&#41;&#44; creating an additional barrier for compliance&#44; given that it can cause problems in understanding and performing the drug or rehabilitative treatment and can interfere with the scheduled visits&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In this issue of the journal&#44; Fern&#225;ndez-Garc&#237;a et al&#46; from the Neumovigo workgroup&#44; with extensive and recognized experience in COPD research and innovation&#44; reveals that the comprehensive assessment of patients with severe COPD must include social factors to offer and ensure efficient high-quality care&#46; The authors show that a state of social risk&#47;problem&#44; as measured by the Gij&#243;n scale&#44; is associated with longer hospital stays and that a COPD Assessment Test score is its best predictor&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The study&#8217;s conclusions are added to the increasingly widespread recommendations of conducting comprehensive approach and care programs for patients with severe COPD&#44; which include a multidisciplinary assessment of the various aspects involved in patients with COPD&#44; integrating not only physicians&#44; nurses&#44; and physiotherapists but also psychologists and social workers&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Each hospitalization for ACOPDE is an opportunity to conduct these programs&#46; Nevertheless&#44; this recommendation should not be generalized to all patients with COPD for the sake of a cost-effective intervention or approach&#44; 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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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E. Martínez-Moragón, J. Delgado, S. Mogrovejo, T. Fernández-Sánchez

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