Journal Information
Vol. 46. Issue S8.
EPOC: ¿cómo mejorar la atención al paciente?
Pages 2-7 (November 2010)
Download PDF
More article options
Vol. 46. Issue S8.
EPOC: ¿cómo mejorar la atención al paciente?
Pages 2-7 (November 2010)
Full text access
EPOC y asma
Chronic obstructive pulmonary disease and asthma
Borja G. Cosíoa,b,??
Corresponding author

Autor para correspondencia.
, Federico Fiorentinob, Sergio Scriminib
a Ciber De Enfermedades Respiratorias, Hospital Universitario Son Dureta, Palma De Mallorca, España
b Servicio De Neumología, Hospital Universitario Son Dureta, Palma de Mallorca, España
Article information
Download PDF

La enfermedad pulmonar obstructiva crónica y el asma son dos enfermedades inflamatorias muy prevalentes, caracterizadas por obstrucción del flujo aéreo, que tienen diferentes mecanismos patogénicos y diferentes grados de respuesta al tratamiento antiinflamatorio. Sin embargo, en la práctica clínica aparecen con frecuencia presentaciones clínicas que solapan ambas enfermedades y que no están claramente representadas en los ensayos clínicos. Estos pacientes pueden tener una pérdida acelerada de la función pulmonar y un pronóstico peor, por lo que es importante su identificación temprana. Biomarcadores, como la hiperreactividad bronquial o el óxido nítrico en aire exhalado, han mostrado resultados desiguales. Su caracterización fenotípica nos permitiría individualizar y optimizar el tratamiento con corticosteroides inhalados.

Palabras clave:
Corticosteroides inhalados

Chronic obstructive pulmonary disease and asthma are both highly prevalent inflammatory diseases characterized by airway obstruction with distinct pathogenic mechanisms and different degrees of response to antiinflammatory therapy. However, forms of presentation that show overlap between both diseases and which are not clearly represented in clinical trials are frequently encountered in clinical practice. These patients may show accelerated loss of pulmonary function and have a worse prognosis. Therefore their early identification is essential. Biomarkers such as bronchial hyperreactivity or nitric oxide in exhaled air have yielded discrepant results. Phenotypic characterization will allow treatment with inhaled corticosteroids to be individually tailored and optimized.

Inhaled corticosteroids
Full text is only aviable in PDF
WHO. Chronic Obstructive Pulmonary Disease. Fact sheet 315. November 2009. Disponible en: http://www who int/mediacentre/factsheets/fs315/en/index html 2010
WHO. Asthma. Fact sheet 307. May 2008. Disponible en: http://www who int/mediacentre/factsheets/fs307/en/index html 2008
M. Miravitlles, J.B. Soriano, F. Garcia-Rio, L. Munoz, E. Duran-Tauleria, G. Sanchez, et al.
Prevalence of COPD in Spain: impact of undiagnosed COPD on quality of life and daily life activities.
Thorax, 64 (2009), pp. 863-868
I. Carvajal-Uruena, L. Garcia-Marcos, R. Busquets-Monge, M. Morales Suarez-Varela, N. Garcia de Andonin, J. Batlles-Garrido, et al.
Variaciones geográficas en la prevalencia de síntomas de asma en los niños y adolescentes españoles. International Study of Asthma and Allergies in Childhood (ISAAC) fase III España.
Arch Bronconeumol, 41 (2005), pp. 659-666
J. Martínez-Moratalla, E. Almar, J. Sunyer, J. Ramos, A. Pereira, F. Payo, et al.
Estudio Europeo del Asma. Identificación y tratamiento de individuos con criterios epidemiológicos de asma en adultos jóvenes de cinco áreas españolas.
Arch Bronconeumol, 35 (1999), pp. 223-228
V. Sobradillo, M. Miravitlles, C.A. Jiménez, R. Gabriel, J.L. Viejo, J.F. Masa, et al.
Estudio IBERPOC en España: prevalencia de síntomas respiratorios habituales y de limitación crónica al flujo aéreo.
Arch Bronconeumol, 35 (1999), pp. 159-166
P.J. Barnes.
Mechanisms in COPD: differences from asthma.
Chest, 117 (2000), pp. 10S-40S
P.J. Barnes, K.F. Chung, C.P. Page.
Inflammatory mediators of asthma: an update.
Pharmacol Rev, 50 (1998), pp. 515-596
M. Tracey, A. Villar, L. Dow, D. Coggon, F.C. Lampe, S.T. Holgate.
The influence of increased bronchial responsiveness, atopy, and serum IgE on decline in FEV1. A longitudinal study in the elderly.
Am J Respir Crit Care Med, 151 (1995), pp. 656-662
P.J. Barnes.
Immunology of asthma and chronic obstructive pulmonary disease.
Nat Rev Immunol, 8 (2008), pp. 183-192
A. Papi, M. Romagnoli, S. Baraldo, F. Braccioni, I. Guzzinati, M. Saetta, et al.
Partial reversibility of airflow limitation and increased exhaled NO and sputum eosinophilia in chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 162 (2000), pp. 1773-1777
C.E. Brightling, W. Monteiro, R. Ward, D. Parker, M.D. Morgan, A.J. Wardlaw, et al.
Sputum eosinophilia and short-term response to prednisolone in chronic obstructive pulmonary disease: a randomised controlled trial.
Lancet, 356 (2000), pp. 1480-1485
E.D. Bateman, S.S. Hurd, P.J. Barnes, J. Bousquet, J.M. Drazen, M. Fitzgerald, et al.
Global strategy for asthma management and prevention: GINA executive summary.
Eur Respir J, 31 (2008), pp. 143-178
V.M. Keatings, A. Jatakanon, Y.M. Worsdell, P.J. Barnes.
Effects of inhaled and oral glucocorticoids on inflammatory indices in asthma and COPD.
Am J Respir Crit Care Med, 155 (1997), pp. 542-548
P.S. Burge, P.M. Calverley, P.W. Jones, S. Spencer, J.A. Anderson, T.K. Maslen.
Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial.
BMJ, 320 (2000), pp. 1297-1303
J. Vestbo, T. Sorensen, P. Lange, A. Brix, P. Torre, K. Viskum.
Long-term effect of inhaled budesonide in mild and moderate chronic obstructive pulmonary disease: a randomised controlled trial.
Lancet, 353 (1999), pp. 1819-1823
R.A. Pauwels, C.G. Lofdahl, L.A. Laitinen, J.P. Schouten, D.S. Postma, N.B. Pride, et al.
Long-term treatment with inhaled budesonide in persons with mild chronic obstructive pulmonary disease who continue smoking. European Respiratory Society Study on Chronic Obstructive Pulmonary Disease.
N Engl J Med, 340 (1999), pp. 1948-1953
Effect of inhaled triamcinolone on the decline in pulmonary function in chronic obstructive pulmonary disease.
N Engl J Med, 343 (2000), pp. 1902-1909
S.V. Culpitt, W. Maziak, S. Loukidis, J.A. Nightingale, J.L. Matthews, P.J. Barnes.
Effect of high dose inhaled steroid on cells, cytokines, and proteases in induced sputum in chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 160 (1999), pp. 1635-1639
S.V. Culpitt, D.F. Rogers, P. Shah, C. De Matos, R.E. Russell, L.E. Donnelly, et al.
Impaired inhibition by dexamethasone of cytokine release by alveolar macrophages from patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 167 (2003), pp. 24-31
P.J. Barnes, K. Ito, I.M. Adcock.
Corticosteroid resistance in chronic obstructive pulmonary disease: inactivation of histone deacetylase.
B.G. Cosio, B. Mann, K. Ito, E. Jazrawi, P.J. Barnes, K.F. Chung, et al.
Histone acetylase and deacetylase activity in alveolar macrophages and blood mononocytes in asthma.
Am J Respir Crit Care Med, 170 (2004), pp. 141-147
P.J. Barnes.
Theophylline in chronic obstructive pulmonary disease: new horizons.
Proc Am Thorac Soc, 2 (2005), pp. 334-339
P.J. Barnes.
Theophylline: new perspectives for an old drug.
Am J Respir Crit Care Med, 167 (2003), pp. 813-818
K. Ito, S. Lim, G. Caramori, B. Cosio, K.F. Chung, I.M. Adcock, et al.
A molecular mechanism of action of theophylline: Induction of histone deacetylase activity to decrease inflammatory gene expression.
Proc Natl Acad Sci USA, 99 (2002), pp. 8921-8926
L.M. Fabbri, M. Romagnoli, L. Corbetta, G. Casoni, K. Busljetic, G. Turato, et al.
Differences in airway inflammation in patients with fixed airflow obstruction due to asthma or chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 167 (2003), pp. 418-424
P. Calverley, R. Pauwels, J. Vestbo, P. Jones, N. Pride, A. Gulsvik, et al.
Combined salmeterol and fluticasone in the treatment of chronic obstructive pulmonary disease: a randomised controlled trial.
P.M. Calverley, J.A. Anderson, B. Celli, G.T. Ferguson, C. Jenkins, P.W. Jones, et al.
Salmeterol and fluticasone propionate and survival in chronic obstructive pulmonary disease.
N Engl J Med, 356 (2007), pp. 775-789
W. Szafranski, A. Cukier, A. Ramirez, G. Menga, R. Sansores, S. Nahabedian, et al.
Efficacy and safety of budesonide/formoterol in the management of chronic obstructive pulmonary disease.
Eur Respir J, 21 (2003), pp. 74-81
N.C. Thomson, M. Shepherd, M. Spears, R. Chaudhuri.
Corticosteroid insensitivity in smokers with asthma: clinical evidence, mechanisms, and management.
Treat Respir Med, 5 (2006), pp. 467-481
American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 152 (1995), pp. S77-S121
J.B. Soriano, K.J. Davis, B. Coleman, G. Visick, D. Mannino, N.B. Pride.
The proportional Venn diagram of obstructive lung disease: two approximations from the United States and the United Kingdom.
Chest, 124 (2003), pp. 474-481
P.G. Gibson, J.L. Simpson.
The overlap syndrome of asthma and COPD: what are its features and how important is it?.
Thorax, 64 (2009), pp. 728-735
M. Weatherall, J. Travers, P.M. Shirtcliffe, S.E. Marsh, M.V. Williams, M.R. Nowitz, et al.
Distinct clinical phenotypes of airways disease defined by cluster analysis.
Eur Respir J, 34 (2009), pp. 812-818
N.G. Orie, H.J. Slutter, K. De Vrie, G.J. Tammeling.
Chronic nonspecific respiratory diseases.
Ned Tijdschr Geneeskd, 105 (1961), pp. 2136-2139
R.E. Kanner, J.E. Connett, M.D. Altose, A.S. Buist, W.W. Lee, D.P. Tashkin, et al.
Gender difference in airway hyperresponsiveness in smokers with mild COPD. The Lung Health Study.
Am J Respir Crit Care Med, 150 (1994), pp. 956-961
R.A. Wise, R.E. Kanner, P. Lindgren, J.E. Connett, M.D. Altose, P.L. Enright, et al.
The effect of smoking intervention and an inhaled bronchodilator on airways reactivity in COPD: the Lung Health Study.
Chest, 124 (2003), pp. 449-458
M.H. Brutsche, S.H. Downs, C. Schindler, M.W. Gerbase, J. Schwartz, M. Frey, et al.
Bronchial hyperresponsiveness and the development of asthma and COPD in asymptomatic individuals: SAPALDIA cohort study.
Thorax, 61 (2006), pp. 671-677
J.J. Hospers, D.S. Postma, B. Rijcken, S.T. Weiss, J.P. Schouten.
Histamine airway hyper-responsiveness and mortality from chronic obstructive pulmonary disease: a cohort study.
Lancet, 356 (2000), pp. 1313-1317
G. Peces-Barba, J.A. Barbera, A. Agusti, C. Casanova, A. Casas, J.L. Izquierdo, et al.
Guía clínica SEPAR-ALAT de diagnóstico y tratamiento de la EPOC.
Arch Bronconeumol, 44 (2008), pp. 271-281
J.A. Wedzicha, P.M. Calverley, T.A. Seemungal, G. Hagan, Z. Ansari, R.A. Stockley.
The prevention of chronic obstructive pulmonary disease exacerbations by salmeterol/fluticasone propionate or tiotropium bromide.
Am J Respir Crit Care Med, 177 (2008), pp. 19-26
S. Singh, A.V. Amin, Y.K. Loke.
Long-term use of inhaled corticosteroids and the risk of pneumonia in chronic obstructive pulmonary disease: a meta-analysis.
Arch Intern Med, 169 (2009), pp. 219-229
S. Suissa, R. McGhan, D. Niewoehner, B. Make.
Inhaled corticosteroids in chronic obstructive pulmonary disease.
Proc Am Thorac Soc, 4 (2007), pp. 535-542
C.E. Brightling, S. McKenna, B. Hargadon, S. Birring, R. Green, R. Siva, et al.
Sputum eosino philia and the short term response to inhaled mometasone in chronic obstructive pulmonary disease.
Thorax, 60 (2005), pp. 193-198
R. Leigh, M.M. Pizzichini, M.M. Morris, F. Maltais, F.E. Hargreave, E. Pizzichini.
Stable COPD: predicting benefit from high-dose inhaled corticosteroid treatment.
Eur Respir J, 27 (2006), pp. 964-971
D.F. Smith, D.O. Toft.
Steroid receptors and their associated proteins.
Mol Endocrinol, 7 (1993), pp. 4-11
J.F. Dummer, M.J. Epton, J.O. Cowan, J.M. Cook, R. Condliffe, C.E. Landhuis, et al.
Predicting corticosteroid response in chronic obstructive pulmonary disease using exhaled nitric oxide.
Am J Respir Crit Care Med, 180 (2009), pp. 846-852
L. Lehtimaki, H. Kankaanranta, S. Saarelainen, I. Annila, T. Aine, R. Nieminen, et al.
Bronchial nitric oxide is related to symptom relief during fluticasone treatment in COPD.
Eur Respir J, 35 (2010), pp. 72-78
J.K. Sont, L.N. Willems, E.H. Bel, J.H. Van Krieken, J.P. Vandenbroucke, P.J. Sterk.
Clinical control and histopathologic outcome of asthma when using airway hyperresponsiveness as an additional guide to long-term treatment. The AMPUL Study Group.
Am J Respir Crit Care Med, 159 (1999), pp. 1043-1051
T. Welte, M. Miravitlles, P. Hernandez, G. Eriksson, S. Peterson, T. Polanowski, et al.
Efficacy and tolerability of budesonide/formoterol added to tiotropium in patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 180 (2009), pp. 741-750
Copyright © 2010. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología

Subscribe to our newsletter

Article options

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