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array:23 [ "pii" => "S0014256511700066" "issn" => "00142565" "doi" => "10.1016/S0014-2565(11)70006-6" "estado" => "S300" "fechaPublicacion" => "2011-03-01" "aid" => "70006" "copyright" => "Elsevier España S.L." "copyrightAnyo" => "2011" "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2011;211 Supl 2:3-12" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 502 "formatos" => array:2 [ "HTML" => 344 "PDF" => 158 ] ] "itemSiguiente" => array:18 [ "pii" => "S0014256511700078" "issn" => "00142565" "doi" => "10.1016/S0014-2565(11)70007-8" "estado" => "S300" "fechaPublicacion" => "2011-03-01" "aid" => "70007" "copyright" => "Elsevier España S.L." "documento" => "article" "crossmark" => 0 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2011;211 Supl 2:13-21" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 400 "formatos" => array:2 [ "HTML" => 275 "PDF" => 125 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Nuevos tratamientos en epoc</span>" "titulo" => "Complejidad de la EPOC. Tratamiento individualizado, nuevas aproximaciones, fenotipos, comorbilidades" "tienePdf" => "es" "tieneTextoCompleto" => 0 "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "13" "paginaFinal" => "21" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Complexity in chronic obstructive pulmonary disease. Individualized treatment, new approaches, phenotypes and comorbidities" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.C. Martín-Escudero" "autores" => array:1 [ 0 => array:2 [ "nombre" => "J.C." "apellidos" => "Martín-Escudero" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256511700078?idApp=WRCEE" "url" => "/00142565/00000211000000S2/v1_201302081053/S0014256511700078/v1_201302081053/es/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0014256511700054" "issn" => "00142565" "doi" => "10.1016/S0014-2565(11)70005-4" "estado" => "S300" "fechaPublicacion" => "2011-03-01" "aid" => "70005" "copyright" => "Elsevier España S.L." "documento" => "simple-article" "crossmark" => 0 "subdocumento" => "edi" "cita" => "Rev Clin Esp. 2011;211 Supl 2:1-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 306 "formatos" => array:2 [ "HTML" => 192 "PDF" => 114 ] ] "es" => array:9 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Nuevos tratamientos en epoc</span>" "titulo" => "Introducción" "tienePdf" => "es" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "1" "paginaFinal" => "2" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Introduction" ] ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Almagro Mena" "autores" => array:1 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Almagro Mena" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256511700054?idApp=WRCEE" "url" => "/00142565/00000211000000S2/v1_201302081053/S0014256511700054/v1_201302081053/es/main.assets" ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Nuevos tratamientos en epoc</span>" "titulo" => "Impacto de las exacerbaciones en la evolución de la EPOC" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "3" "paginaFinal" => "12" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J.J. Soler-Cataluña, M.A. Martínez-García, P. Catalán Serra, P. Román Sánchez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "J.J." "apellidos" => "Soler-Cataluña" "email" => array:1 [ 0 => "jjsoler@telefonica.net" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "M.A." "apellidos" => "Martínez-García" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Catalán Serra" ] 3 => array:2 [ "nombre" => "P." "apellidos" => "Román Sánchez" ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Unidad de Neumología, Servicio de Medicina Interna, Hospital General de Requena, Valencia, España" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Autor para correspondencia." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Impact of exacerbations on the clinical course of chronic obstructive pulmonary disease" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec18124" "palabras" => array:3 [ 0 => "EPOC" 1 => "Agudización" 2 => "Fenotipo" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec18125" "palabras" => array:3 [ 0 => "COPD" 1 => "Exacerbation" 2 => "Phenotype" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El curso clínico de la enfermedad pulmonar obstructiva crónica (EPOC) se ve salpicado con frecuencia por la presencia de exacerbaciones. Aunque no todos los pacientes sufren exacerbaciones y no todas estas descompensaciones tienen las mismas consecuencias, lo cierto es que en los últimos años hemos pasado a considerar estos episodios de inestabilidad clínica, especialmente si son repetidos, como elementos destacados en la historia natural de la enfermedad por cuanto generan una gran carga asistencial y enormes costes, impactan de forma negativa sobre la calidad de vida de los pacientes, contribuyen de forma decidida a la progresión multidimensional de la enfermedad y, finalmente, condicionan su pronóstico. El artículo revisa la evidencia científica actual acerca del impacto de la exacerbación sobre la evolución de la EPOC, analizando esta repercusión desde una perspectiva multidimensional. Además, introduce la necesidad de orientar el manejo de la EPOC hacia los fenotipos clínicos, destacando especialmente la importancia del fenotipo agudizador, un fenotipo clínico que se caracteriza por presentar repetidos episodios de agudización, que se asocia con frecuencia a la presencia de tos y expectoración crónica, infección bronquial latente y bronquiectasias, y que se caracteriza por presentar mayor morbimortalidad.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The clinical course of chronic obstructive pulmonary disease (COPD) is marked by frequent exacerbations. Not all patients suffer exacerbations and not all decompensations have the same consequences; however, in the last few years, these episodes of clinical instability – especially if recurrent – have come to be viewed as a major element in the natural history of the disease insofar as they generate heavy workload and high costs, síntonegatively affect patients’ quality of life, contribute to the multidimensional progression of the disease and, finally, affect its prognosis. The present article reviews the current scientific evidence on the impact of exacerbations on the clinical course of COPD and analyzes this impact from a multidimensional perspective. The need to base the management of COPD on clinical phenotypes is discussed, emphasizing the importance of the exacerbation phenotype, a clinical phenotype characterized by frequent exacerbations. This phenotype is often associated with the presence of cough and chronic expectoration, latent bronchial infection and bronchiectasis and leads to higher morbidity and mortality.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:65 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The natural history of chronic bronchitis and emphysema" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C.M. Fletcher" 1 => "R. Peto" 2 => "C. Tinker" 3 => "F.E. Speizer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "1976" "editorial" => "Oxford University Press" "editorialLocalizacion" => "New York, Toronto" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2." 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