Nuevos tratamientos en epoc
Complejidad de la EPOC. Tratamiento individualizado, nuevas aproximaciones, fenotipos, comorbilidades
Complexity in chronic obstructive pulmonary disease. Individualized treatment, new approaches, phenotypes and comorbidities
J.C. Martín-Escudero
Servicio de Medicina Interna, Hospital Universitario Río Hortega, Valladolid, España
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Tratamiento individualizado, nuevas aproximaciones, fenotipos, comorbilidades" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "13" "paginaFinal" => "21" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "J.C. Martín-Escudero" "autores" => array:1 [ 0 => array:3 [ "nombre" => "J.C." "apellidos" => "Martín-Escudero" "email" => array:1 [ 0 => "escudero@med.uva.es" ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Río Hortega, Valladolid, España" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Complexity in chronic obstructive pulmonary disease. Individualized treatment, new approaches, phenotypes and comorbidities" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec18126" "palabras" => array:3 [ 0 => "Enfermedad pulmonar obstructiva crónica" 1 => "Enfisema" 2 => "Bronquitis crónica" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec18127" "palabras" => array:3 [ 0 => "Chronic obstructive pulmonary disease" 1 => "Emphysema" 2 => "Chronic bronchitis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La definición actual y los estadios de gravedad de la enfermedad pulmonar obstructiva crónica (EPOC) están excesivamente centrados en criterios sólo espirométricos. La medición de la obstrucción crónica al flujo aéreo y su grado de reversibilidad no está exenta de complejidad. La riqueza de matices de su etiología asociada al tabaco, la heterogeneidad de esta enfermedad sistémica cuya víctima principal es el pulmón, no se puede expresar sólo con el volumen espiratorio forzado en el primer segundo (FEV<span class="elsevierStyleInf">1</span>). Esta simplificación ha resultado útil durante un tiempo, pero la pérdida de matices clínicos en los grandes estudios supone una dificultad para interpretar sus resultados y sus conclusiones pierden validez externa. Aceptar la complejidad de la EPOC requiere sustituir el enfoque analítico centrado en el FEV<span class="elsevierStyleInf">1</span> por una multiperspectiva que integre otros aspectos en el análisis de los pacientes EPOC reales. La identificación y agrupación en subgrupos clínicamente significativos o “fenotipos EPOC”, pueden orientar el tratamiento de una forma más eficaz. Los pacientes con EPOC parecen fallecer antes por causas cardiovasculares o neoplasias, y más tarde, si las superan, por causas respiratorias. La comorbilidad se debe considerar y tratar para mejorar la supervivencia de los pacientes con EPOC. Ya no parece recomendable un tratamiento de la EPOC basado en escalones de función pulmonar. Las diversas opciones terapéuticas deben individualizarse en función de otras características del paciente.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The current definition and severity stages of chronic obstructive pulmonary disease (COPD) focus excessively on spirometric criteria alone. Measurement of chronic airflow obstruction and its degree of reversibility is complex. The etiology of this disease cannot be fully explained in relation to smoking and the heterogeneity of this systemic disease septiemthat affects mainly the lung cannot be expressed through forced expiratory volume in 1 second (FEV<span class="elsevierStyleInf">1</span>) alone. This simplification was useful for a period but the loss of clinical subtlety in large studies hampers interpretation of their results and their conclusions lose external validity. Accepting the complexity of COPD requires substituting the analytic focus centered on FEV<span class="elsevierStyleInf">1</span> for a multifaceted approach that integrates other aspects in the analysis of real COPD patients. Identifying and classifying clinically significant subgroups or “COPD phenotypes” may help to guide treatment more efficiently. In patients with COPD, mortality due to cardiovascular diseases or malignancies occurs earlier than that due to respiratory causes; that is, deaths from COPD occur in patients not succumbing to cardiovascular diseases or cancer. To prolong survival in these patients, comorbidity should be evaluated and treated. COPD treatment based on severity measured by lung function can no longer be recommended. The various therapeutic options should be individualized according to the patient's other characteristics.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:28 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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