EPOC y alteraciones endocrinometabólicas

Martín, María Jesús Chillón; Díez, Javier de Miguel; Moreno, Alicia Ferreira; Muñoz, Gema Sánchez

doi:10.1016/S0300-2896(09)72863-7

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La evolución clínica y el manejo terapéutico de la enfermedad pulmonar obstructiva crónica (EPOC) pueden verse afectados por la presencia de alguna comorbilidad, lo que además suele contribuir a empeorar el pronóstico. Entre las alteraciones endocrinometabólicas que pueden asociarse a la EPOC, se encuentran la diabetes mellitus, la osteoporosis, el síndrome metabólico o la malnutrición. Son diversos los posibles mecanismos etiopatogénicos que intervienen en la asociación entre EPOC y diferentes trastornos endocrinometabólicos, como el tabaco y la respuesta inflamatoria sistémica con intervención de diferentes citocinas, entre otros. Por otro lado, los glucocorticoides sistémicos a dosis altas utilizados en el tratamiento de la EPOC grave y de las agudizaciones, supone un factor importante en el riesgo de desarrollar ciertas alteraciones metabólicas, como la diabetes mellitus y la osteoporosis.

En el estudio del paciente con EPOC, es importante identificar los posibles trastornos endocrinometabólicos coexistentes, para aplicar medidas de corrección y de prevención. Por lo general, los pacientes se beneficiarán de la inclusión en un programa de rehabilitación respiratoria con ejercicio físico y una dieta equilibrada, además del tratamiento farmacológico oportuno en cada caso. También resultan fundamentales ciertas medidas, como evitar el tabaquismo, el sedentarismo, y realizar el tratamiento correcto de la EPOC.

Palabras clave:

Enfermedad pulmonar obstructiva crónica

Diabetes mellitus

Síndrome metabólico

Osteoporosis

Malnutrición

Dislipemia

Alteraciones endocrinometabólicas

Abstract

The clinical course and therapeutic management of chronic obstructive pulmonary disease (COPD) may be affected by the presence of comorbid diseases, which also usually worsen prognosis. Among the endocrinological and metabolic alterations that can be associated with COPD are diabetes mellitus, osteoporosis, metabolic syndrome and malnutrition. There are several possible etiopathogenic mechanisms that intervene in the association between COPD and distinct endocrine and metabolic disorders, such as smoking and systemic inflammation, influenced by distinct cytokines among other factors. The high-dose glucocorticosteroids used in the treatment of severe COPD and exacerbations are a major risk factor for the development of some metabolic alterations such as diabetes and osteoporosis.

Study of patients with COPD should identify the possible coexisting endocrinological and metabolic alterations in order to apply preventive measures and treatment. In general, patients benefit from being included in a respiratory rehabilitation program with physical exercise and a balanced diet, in addition to appropriate drug treatment in each case. Certain measures such as avoiding smoking and sedentariness are also essential in the correct treatment of COPD

Keywords:

Chronic obstructive pulmonary disease

Diabetes mellitus

Metabolic syndrome

Osteoporosis

Malnutrition

Dyslipidemia

Endocrine and metabolic alterations

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