Journal Information
Vol. 45. Issue S5.
Broncodilatación sostenida en EPOC: más allá del efecto respiratorio
Pages 35-39 (March 2009)
Share
Share
Download PDF
More article options
Vol. 45. Issue S5.
Broncodilatación sostenida en EPOC: más allá del efecto respiratorio
Pages 35-39 (March 2009)
Full text access
Enfermedad pulmonar obstructiva crónica: ¿qué hay más allá del índice BODE?
COPD: what is there beyond BODE index?
Visits
11518
Ciro Casanova Macarioa,
Corresponding author
casanovaciro@gmail.com

Autor para correspondencia.
, Juan Pablo de Torres Tajesb, Elizabeth Córdoba Lanusc
a Servicio de Neumología, Unidad de Investigación, Hospital Universitario La Candelaria, Santa Cruz de Tenerife, España
b Servicio de Neumología, Clínica Universitaria de Navarra, Pamplona, España
c Unidad de Investigación, Hospital Universitario La Candelaria, Santa Cruz de Tenerife, España
This item has received
Article information
Abstract
Bibliography
Download PDF
Statistics
Resumen

La enfermedad pulmonar obstructiva crónica (EPOC) es una enfermedad multidimensional, con una gran heterogeneidad fenotípica que no puede ser representada adecuadamente sólo con el volumen espiratorio forzado durante el primer segundo (FEV1). La evaluación de los pacientes con EPOC requiere de un análisis de múltiples variables que engloben la afectación respiratoria y extrapulmonar. Estas variables deben ser viables en la práctica clínica, no redundantes en su información e impactar en la evolución de la enfermedad. El índice BODE (FEV1, disnea, índice de masa corporal y prueba de la marcha de 6min) representa el ejemplo más evidente de este enfoque conceptual y su aceptación en la comunidad científica ha sido creciente en los últimos años. No obstante, otros aspectos de la enfermedad no incluidos en el índice BODE, como la hiperinsuflación pulmonar, las exacerbaciones y las comorbilidades, han demostrado ser relevantes dentro de la EPOC. Además, el desarrollo de las nuevas tecnologías podría permitir la incorporación de las técnicas de imagen y los marcadores biológicos (“biomarcadores”) para una mejor caracterización de la enfermedad y un manejo más específico e individualizado de los pacientes. No obstante, la ubicación de todos estos factores dentro del esquema de evaluación de una enfermedad de elevada prevalencia, como la EPOC, está aún por definir.

Palabras clave:
Biomarcadores
Enfermedad pulmonar obstructiva crónica
Hiperinsuflación pulmonar
Índice BODE
Abstract

Chronic obstructive pulmonary disease (COPD) is a multidimensional disease with wide phenotypic heterogeneity that is not adequately reflected by forced expiratory volume in 1 second (FEV1). Assessment of patients with COPD requires analysis of multiple variables that encompass respiratory and extrapulmonary involvement. These variables should be viable in clinical practice, should not provide duplicate information, and should have an effect on the course of the disease. The BODE index (FEV1, dyspnea, body mass index and the 6-minute walk test) is the most obvious example of this conceptual approach and its acceptance among the scientific community has grown in the last few years. Nevertheless, other aspects of the disease not included in the BODE index, such as pulmonary hyperinsufflation, exacerbations and comorbidities, have been shown to be important in COPD. Moreover, the development of new technologies could allow imaging techniques and biomarkers to be incorporated, which would in turn improve characterization of the disease and allow more specific and individually-tailored patient management. Nevertheless, the role of all these factors in the evaluation of a highly prevalent disease such as COPD remains to be defined.

Key words:
Biomarkers
Chronic obstructive pulmonary disease
Pulmonary hyperinsufflation
BODE index
Full text is only aviable in PDF
Bibliografía
[1.]
G. Peces-Barba, J.A. Barberá, A. Agusti, C. Casanova, A. Casas, J.L. Izquierdo, et al.
Guía de práctica clínica de diagnóstico y tratamiento de la Enfermedad Pulmonar Obstructiva Crónica. Normativa SEPAR-ALAT.
Arch Bronconeumol, 44 (2008), pp. 271-281
[2.]
K.F. Rabe, S. Hurd, A. Anzueto, P.J. Barnes, A.S. Buist, P. Calverley, et al.
Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for chronic obstructive pulmonary disease (GOLD). Workshop summary.
Am J Respir Crit Care Med, 176 (2007), pp. 532-555
[3.]
B.R. Celli, C. Cote, J.M. Marin, C. Casanova, M. Montes de Oca, R. Mendez, V. Pinto-Plata, H. Cabral.
The Body Mass Index, Airflow Obstruction, Dyspnea, Exercise Performance (BODE) Index in Chronic Obstructive Pulmonary Disease.
N Engl J Med, 350 (2004), pp. 1005-1012
[4.]
D.E. O’Donnell.
Hyperinflation, dyspnea, and exercise intolerance in chronic obstructive pulmonary disease.
Proc Am Thorac Soc, 3 (2006), pp. 180-184
[5.]
B. Celli, R. ZuWallack, S. Wang, S. Kesten.
Improvement in resting inspiratory capacity and hyperinflation with tiotropium in COPD patients with increased static lung volumes.
Chest, 124 (2003), pp. 1743-1748
[6.]
V. Pinto-Plata, G. Livnat, H. Cabral, P. Masdin, P. Linacre, C. Watson, et al.
Systemic Inflammatory Cytokines, Clinical and Physiologic Changes in Exacerbation of COPD.
[7.]
J.M. Marin, S.J. Carrizo, M. Gascon, A. Sanchez, B. Gallego, B.R. Celli.
Inspiratory capacity, dynamic hyperinflation, breathlessness and exercise performance during the 6-minute-walk test in chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 163 (2001), pp. 1395-1399
[8.]
P. Boschetto, S. Quintavalle, E. Zeni, S. Leprotti, A. Potena, L. Ballerin, et al.
Association between markers of emphysema and more severe obstructive chronic pulmonary disease.
Thorax, 61 (2006), pp. 1037-1042
[9.]
C. Casanova, C. Cote, J.P. de Torres, A. Aguirre-Jaime, J.M. Marín, V. Pinto-Plata, B.R. Celli.
The inspiratory to total lung capacity ratio predicts mortality in patients with COPD.
Am J Respir Crit Care Med, 171 (2005), pp. 591-597
[10.]
C. Casanova, B.R. Celli.
¿Debemos tener en cuenta la capacidad inspiratoria?.
Arch Bronconeumol, 43 (2007), pp. 245-247
[11.]
P.J. Barnes, B. Chowdhury, S.A. Kharitonov, H. Magnussen, C.P. Page, D. Postma, et al.
Pulmonary biomarkers in chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 174 (2006), pp. 6-14
[12.]
J. Vestbo, W. Anderson, H.O. Coxson, C. Crim, F. Dawber, L. Edwards, et al.
ECLIPSE investigators. Evaluation of COPD longitudinally to identify predictive subrrogate end-points (ECLIPSE).
Eur Respir J, 3 (2008), pp. 869-873
[13.]
P.J. Barnes.
Mediators of chronic obstructive pulmonary disease.
Pharmacol Rev, 56 (2004), pp. 515-548
[14.]
L.M. Fabbri, F. Luppi, B. Beghé, K.F. Rabe.
Complex chronic comorbidities of COPD.
Eur Respir J, 31 (2008), pp. 204-212
[15.]
P.J. Barnes, B.R. Celli.
Systemic manifestations and comorbidities of COPD.
Eur Respir J, 33 (2009), pp. 1165-1185
[16.]
V.M. Pinto-Plata, H. Mullerova, J.F. Toso, M. Feudjo-Tepie, J.B. Soriano, R.S. Vessey, et al.
C-reactive protein in patients with COPD, control smokers and non-smokers.
Thorax, 61 (2006), pp. 23-28
[17.]
J.P. De Torres, E. Cordoba-Lanus, C. Lopez-Aguilar, M. Muros de Fuentes, A. Montejo de Garcini, A. Aguirre-Jaime, et al.
C-reactive protein levels and clinically important predictive outcomes in stable COPD patients.
Eur Respir J, 27 (2006), pp. 902-907
[18.]
J.R. Hurst, G.C. Donaldson, W.R. Perera, T.M. Wilkinson, J.A. Bilello, G.W. Hagan, et al.
Use of plasma biomarkers at exacerbation of chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 174 (2006), pp. 867-874
[19.]
P. Joppa, D. Petrasova, B. Stancak, R. Tkacova.
Systemic inflammation in patients with COPD and pulmonary hypertension.
Chest, 130 (2006), pp. 326-333
[20.]
S.F. Man, J.E. Connett, N.R. Anthonisen, R.A. Wise, D.P. Tashkin, D.D. Sin.
C-reactive protein and mortality in mild to moderate chronic obstructive pulmonary disease.
Thorax, 61 (2006), pp. 849-853
[21.]
M. Dahl, J. Vestbo, P. Lange, S.E. Bojesen, A. Tybjaerg-Hansen, B.G. Nordestgaard.
C-reactive Protein as a Predictor of Prognosis in COPD.
Am J Respir Crit Care Med, 175 (2007), pp. 250-255
[22.]
D.D. Sin, S.F. Man, D.D. Marciniuk, G. Ford, M. FitzGerald, E. Wong, ABC (Advair, Biomarkers in COPD) Investigators, et al.
The effects of fluticasone with and without salmeterol on systemic biomarkers and inflammation in chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 177 (2008), pp. 1207-1214
[23.]
J.P. De Torres, V. Pinto-Plata, C. Casanova, H. Mullerova, E. Córdoba-Lanús, M. Muros de Fuentes, et al.
C-reactive protein levels and survival in patients with moderate to very severe COPD.
Chest, 133 (2008), pp. 1336-1343
[24.]
V. Pinto-Plata, J. Toso, K. Lee, D. Park, J. Bilello, H. Mullerova, et al.
Profiling serum biomarkers in patients with COPD: associations with clinical parameters.
[25.]
S.F. Man, L. Xing, J.E. Connett, N.R. Anthonisen, R.A. Wise, D.P. Tashkin, et al.
Circulating fibronectin to C-reactive protein ratio and mortality: a biomarker in COPD?.
Eur Respir J, 32 (2008), pp. 1451-1457
[26.]
B. Zethelius, L. Berglund, J. Sundstrom, E. Ingelsson, S. Basu, A. Larsson, et al.
Use of multiple biomarkers to improve the prediction of death from cardiovascular causes.
N Engl J Med, 358 (2008), pp. 2107-2116
[27.]
K. Ito, P.J. Barnes.
COPD as a disease of accelerated lung aging.
Chest, 135 (2009), pp. 173-180
[28.]
R. Rodriguez-Roisin, J.B. Soriano.
Chronic obstructive pulmonary disease with lung cancer and/or cardiovascular disease.
Proc Am Thorac Soc, 5 (2008), pp. 848-856
[29.]
N.R. Anthonisen, M.A. Skeans, R.A. Wise, J. Manfreda, R.E. Kanner, J.E. Connett.
The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial.
Ann Intern Med, 142 (2005), pp. 233-239
[30.]
F. Luppi, F. Franco, B. Beghé, L.M. Fabbri.
Treatment of chronic obstructive pulmonary disease and its comorbidities.
Proc Am Thorac Soc, 5 (2008), pp. 848-856
[31.]
E. Crisafulli, S. Costi, F. Luppi, G. Cirelli, C. Cilione, O. Coletti, et al.
Role of comorbidities in a cohort of patients with COPD undergoing pulmonary rehabilitation.
Thorax, 63 (2008), pp. 487-492
[32.]
K. Marquis, R. Debigaré, Y. Lacasse, P. LeBlanc, J. Jobin, G. Carrier, et al.
Midthigh muscle cross-sectional area is a better predictor of mortality than body mass index in patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 166 (2002), pp. 809-813
[33.]
J. Vestbo, E. Prescott, T. Almdal, M. Dahl, B.G. Nordestgaard, T. Andersen, et al.
Body mass, fat-free body mass, and prognosis in patients with chronic obstructive pulmonary disease from a random population sample: findings from the Copenhagen City Heart Study.
Am J Respir Crit Care Med, 173 (2006), pp. 79-83
[34.]
T.P. Ng, M. Niti, W.C. Tan, Z. Cao, K.C. Ong, P. Enq.
Depressive symptoms and chronic obstructive pulmonary disease: effect on mortality, hospital readmission, symptom burden, functional status, and quality of life.
Arch Intern Med, 167 (2007), pp. 60-67
[35.]
P. Almagro, E. Calbo, A. Ochoa de Echagüen, B. Barreiro, S. Quintana, J.L. Heredia, et al.
Mortality after hospitalization for COPD.
Chest, 12 (2002), pp. 1441-1448
[36.]
P.J. Barnes.
Future treatments for chronic obstructive pulmonary disease and its comorbidities.
Proc Am Thorac Soc, 5 (2008), pp. 857-864
[37.]
T.M.A. Wilkinson, I.S. Patel, M. Wilks, G.C. Donaldson, W.A. Wedzicha.
Airway bacterial load anf FEV1 decline in patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 167 (2003), pp. 1090-1095
[38.]
J.J. Soler-Cataluña, M.A. Martinez-Garcia, P. Roman Sánchez, E. Salcedo, M. Navarro, R. Ochando.
Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease.
Thorax, 60 (2005), pp. 925-931
[39.]
B.R. Celli, P.J. Barnes.
Exacerbations of chronic obstructive pulmonary disease.
Eur Respir J, 29 (2007), pp. 1224-1238
[40.]
J.M. Marin, S.J. Carrizo, C. Casanova, P. Martinez-Camblor, J.B. Soriano, A.G. Agusti, et al.
Prediction of risk of COPD exacerbation by the BODE index.
Respir Med, 103 (2009), pp. 373-378
[41.]
J.J. Soler-Cataluña, M.A. Martinez-Garcia, L.S. Sanchez, M.P. Tordera, P.R. Sanchez.
Severe exacerbations and BODE index: two independent risk factors for death in male COPD patients.
Respir Med, 103 (2009), pp. 692-699
[42.]
C.G. Cote, L.J. Dordelly, B.R. Celli.
Impact of COPD exacerbations on patiens-centered outcomes.
Chest, 13 (2007), pp. 696-704
[43.]
J.D. Newell Jr.
Quantitative computed tomography of lung parenchyma in chronic obstructive pulmonary disease: an overview.
Proc Am Thorac Soc, 5 (2008), pp. 915-918
[44.]
B.D. Patel, H.O. Coxson, S.G. Pillai, A.G. Agustí, P.M. Calverley, C.F. Donner, International COPD Genetics Network, et al.
Airway wall thickening and emphysema show independent familial aggregation in chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 178 (2008), pp. 500-505
[45.]
F.J. Martinez, J.L. Curtis, F. Sciurba, J. Mumford, N.D. Giardino, G. Weinmann, National Emphysema Treatment Trial Research Group, et al.
Sex differences in severe pulmonary emphysema.
Am J Respir Crit Care Med, 176 (2007), pp. 243-252
[46.]
Kim WJ, Silverman EK, Hoffman E, Criner GJ, Mosenifar Z, Sciurba FC, et al. CT metrics of airway disease and emphysema in severe COPD. Chest. 2009 (en prensa).
[47.]
G. Mair, J.J. Miller, D. McAllister, J. Maclay, M. Connell, J.T. Murchison, W. MacNee.
Computed tomographic emphysema distribution: relationship to clinical features in a cohort of smokers.
Eur Respir J, 33 (2009), pp. 536-542
[48.]
F.J. Martinez, G. Foster, J.L. Curtis, G. Criner, G. Weinmann, A. Fishman, NETT Research Group, et al.
Predictors of mortality in patients with emphysema and severe airflow obstruction.
Am J Respir Crit Care Med, 173 (2006), pp. 1326-1334
[49.]
H. Iwamoto, A. Yokoyama, I. Kitahara, N. Ishikawa, I. Haruta, K. Yamane, et al.
Airflow limitation in smokers is associated with subclinical atherosclerosis.
Am J Respir Crit Care Med, 179 (2009), pp. 35-40
[50.]
A. Briggs, M. Spencer, H. Wang, D. Mannino, D. Sin.
Development and validation of a prognostic index for health outcomes in chronic obstructive pulmonary disease.
Arch Intern Med, 168 (2008), pp. 71-79
[51.]
F.J. Martinez, M.K. Han, A.C. Andrei, R. Wise, S. Murray, J.L. Curtis, et al.
Longitudinal change in the BODE index predicts mortality in severe emphysema.
Am J Respir Crit Care Med, 178 (2008), pp. 491-499
[52.]
F. Cardoso, A.T. Tufanin, M. Colucci, O. Nascimiento, J.R. Jardim.
Replacement of the 6-min walk test with minimal oxygen consumption in the BODE index applied to patients with COPD: an equivalency study.
Chest, 132 (2007), pp. 477-482
[53.]
C.G. Cote, V. Pinto-Plata, J.M. Marín, H. Nekach, L.J. Dordelly, B.R. Celli.
The modified BODE index: validation with mortality in COPD.
Eur Respir J, 32 (2008), pp. 1269-1274
[54.]
C. Casanova, C. Cote, J.M. Marín, V. Pinto-Plata, J.P. De Torres, A. Aguirre-Jaíme, et al.
Distance and oxygen desaturation during six minute walk test as predictors of long-term mortality in patients with COPD.
Chest, 134 (2008), pp. 746-752
Copyright © 2009. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?