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Vol. 46. Issue S3.
Las mil caras de la EPOC
Pages 28-31 (June 2010)
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Vol. 46. Issue S3.
Las mil caras de la EPOC
Pages 28-31 (June 2010)
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EPOC y neumonía
Chronic obstructive pulmonary disease and pneumonia
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64839
Arturo Huerta
Corresponding author
ahuerta@clinic.ub.es

Autor para correspondencia.
, Rebeca Domingo, Néstor Soler
Servicio de Neumología, Institut Clínic del Tòrax, Hospital Clínic-IDIBAPS, CIBER de Respiratorio 06/06/0028, Universidad de Barcelona, Barcelona, España
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La enfermedad pulmonar obstructiva crónica (EPOC) es una enfermedad crónica cuyo coste sanitario va aumentando alrededor del mundo. Otra enfermedad respiratoria que causa altos costes y morbilidad es la neumonía adquirida en la comunidad (NAC). El crecimiento constante de la población en el que ambas enfermedades confluyen (NAC y EPOC) hace que sea importante analizar las características clínicas. Se sabe que diversos factores celulares contribuyen a que la expresión clínica sea diferente, mientras unos harán clínica de agudización de EPOC, otros harán clínica de neumonía. El uso de nuevos biomarcadores (procalcitonina, proadrenomedulina y copeptina) ayudan a la diferenciación entre uno y otro cuadro clínico. Para poder disminuir la morbimortalidad es importante que se sigan las guías clínicas (en relación con el tratamiento antibiótico), que se deben prescribir a pacientes con NAC y EPOC. Para prevenirlo, también existen medidas como la vacuna antineumocócica, cuyo papel en la prevención de la NAC neumocócica debe estudiarse más. Esta revisión trata de aclarar algunos de los puntos anteriormente mencionados sobre estas dos enfermedades.

Palabras clave:
Neumonía
EPOC
Agudización
Abstract

Chronic obstructive pulmonary disease (COPD) is a chronic disease causing increasing healthcare costs worldwide. Another respiratory disease causing high costs and morbidity is community-acquired pneumonia (CAP). Because of the constant growth in the population with both diseases (CAP and COPD), analyzing their clinical characteristics is important. Several cellular factors are known to contribute to differences in clinical expression: some lead to COPD exacerbations while others lead to symptoms of pneumonia. The use of new biomarkers (procalcitonin, pro-adrenomedullin and copeptin) help to distinguish among these clinical pictures. To decrease morbidity and mortality, clinical guidelines on antibiotic therapy must be followed and this therapy should be prescribed to patients with CAP and COPD. There are also prevention measures such as the pneumococcal vaccine whose role in the prevention of pneumococcal CAP should be further studied. The present review aims to elucidate some of the above-mentioned issues.

Keywords:
Pneumonia
COPD
Exacterbation
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Bibliografía
[1.]
M. Miravitlles, C. Murio, T. Guerrero, R. Gisbert.
Costs of chronic bronchitis and COPD: a 1-year follow-up study.
Chest, 123 (2003), pp. 784-791
[2.]
D. Mapel, M. Schum, M. Yood, J. Brown, D. Miller, K. Davis.
Pneumonia among COPD patients using inhaled corticosteroids and long-acting bronchodilators.
Prim Care Respir J, (2010),
[3.]
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
[4.]
H. Cabello, A. Torres, R. Celis, M. El-Ebiary, B.J. Puig de la, A. Xaubet, et al.
Bacterial colonization of distal airways in healthy subjects and chronic lung disease: a bronchoscopic study.
Eur Respir J, 10 (1997), pp. 1137-1144
[5.]
A. Marin, E. Monso, M. Garcia, J. Sauleda, A. Noguera, J. Pons, et al.
Variability and effects of bronchial colonisation in patients with moderate COPD.
Eur Respir J, 35 (2010), pp. 295-302
[6.]
F.W. Ko, M. Ip, P.K. Chan, S.S. Ng, S.S. Chau, D.S. Hui.
A one-year prospective study of infectious etiology in patients hospitalized with acute exacerbations of COPD and concomitant pneumonia.
Respir Med, 102 (2008), pp. 1109-1116
[7.]
T.M. File Jr, S.V. Monte, J.J. Schentag, J.A. Paladino, K.P. Klugman, B. Lavin, et al.
A disease model descriptive of progression between chronic obstructive pulmonary disease exacerbations and community-acquired pneumonia: roles for underlying lung disease and the pharmacokinetics/pharmacodynamics of the antibiotic.
Int J Antimicrob Agents, 33 (2009), pp. 58-64
[8.]
P. Gutierrez, D. Closa, R. Piner, O. Bulbena, R. Menendez, A. Torres.
Macrophage activation in exacerbated chronic obstructive pulmonary disease with and without community- acquired pneumonia.
[9.]
M.J. Fine, T.E. Auble, D.M. Yealy, B.H. Hanusa, L.A. Weissfeld, D.E. Singer, et al.
A prediction rule to identify low-risk patients with community-acquired pneumonia.
N Engl J Med, 336 (1997), pp. 243-250
[10.]
A. Torres, J. Dorca, R. Zalacain, S. Bello, M. El-Ebiary, L. Molinos, et al.
Community-acquired pneumonia in chronic obstructive pulmonary disease: a Spanish multicenter study.
Am J Respir Crit Care Med, 154 (1996), pp. 1456-1461
[11.]
M.I. Restrepo, E.M. Mortensen, J.A. Pugh, A. Anzueto.
COPD is associated with increased mortality in patients with community-acquired pneumonia.
Eur Respir J, 28 (2006), pp. 346-351
[12.]
C. Daubin, J.J. Parienti, S. Fradin, A. Vabret, M. Ramakers, N. Terzi, et al.
Procalcitonin levels and bacterial aetiology among COPD patients admitted to the ICU with severe pneumonia: a prospective cohort study.
BMC Infect Dis, 9 (2009), pp. 157
[13.]
B. Muller, N. Morgenthaler, D. Stolz, P. Schuetz, C. Muller, R. Bingisser, et al.
Circulating levels of copeptin, a novel biomarker, in lower respiratory tract infections.
Eur J Clin Invest, 37 (2007), pp. 145-152
[14.]
Y.W. Cheng, T.H. Ye.
Changes of plasma adrenomedullin level during the process from chronic bronchitis to chronic cor-pulmonale.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao, 26 (2004), pp. 195-197
[15.]
D. Justo, S. Lachmi, N. Saar, E. Joffe, L. Atzmony, N. Mashav, et al.
C-reactive protein velocity following antibiotics in patients with chronic obstructive pulmonary disease exacerbation and community acquired pneumonia.
Eur J Intern Med, 20 (2009), pp. 518-521
[16.]
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
[17.]
C. Crim, P.M. Calverley, J.A. Anderson, B. Celli, G.T. Ferguson, C. Jenkins, et al.
Pneumonia risk in COPD patients receiving inhaled corticosteroids alone or in combination: TORCH study results.
Eur Respir J, 34 (2009), pp. 641-647
[18.]
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
[19.]
M.B. Drummond, E.C. Dasenbrook, M.W. Pitz, D.J. Murphy, E. Fan.
Inhaled corticosteroids in patients with stable chronic obstructive pulmonary disease: a systematic review and meta-analysis.
JAMA, 300 (2008), pp. 2407-2416
[20.]
D.D. Sin, D. Tashkin, X. Zhang, F. Radner, U. Sjobring, A. Thoren, et al.
Budesonide and the risk of pneumonia: a meta-analysis of individual patient data.
[21.]
S.I. Rennard, D.P. Tashkin, J. McElhattan, M. Goldman, S. Ramachandran, U.J. Martin, et al.
Efficacy and tolerability of budesonide/formoterol in one hydrofluoroalkane pressurized metered-dose inhaler in patients with chronic obstructive pulmonary disease: results from a 1-year randomized controlled clinical trial.
[22.]
G.T. Ferguson, A. Anzueto, R. Fei, A. Emmett, K. Knobil, C. Kalberg.
Effect of fluticasone propionate/salmeterol (250/50 microg) or salmeterol (50 microg) on COPD exacerbations.
Respir Med, 102 (2008), pp. 1099-1108
[23.]
L.A. Mandell, R.G. Wunderink, A. Anzueto, J.G. Bartlett, G.D. Campbell, N.C. Dean, et al.
Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults.
Clin Infect Dis, 44 (2007), pp. S27-S72
[24.]
R. Menendez, A. Torres, R. Zalacain, J. Aspa, J.J. Martin Villasclaras, L. Borderias, et al.
Risk factors of treatment failure in community acquired pneumonia: implications for disease outcome.
Thorax, 59 (2004), pp. 960-965
[25.]
I. Alfageme, R. Vazquez, N. Reyes, J. Munoz, A. Fernandez, M. Hernandez, et al.
Clinical efficacy of anti-pneumococcal vaccination in patients with COPD.
Thorax, 61 (2006), pp. 189-195
[26.]
T.A. Lee, F.M. Weaver, K.B. Weiss.
Impact of pneumococcal vaccination on pneumonia rates in patients with COPD and asthma.
J Gen Intern Med, 22 (2007), pp. 62-67
[27.]
S. Schembri, S. Morant, J.H. Winter, T.M. MacDonald.
Influenza but not pneumococcal vaccination protects against all-cause mortality in patients with COPD.
Thorax, 64 (2009), pp. 567-572
[28.]
J.G. Schenkein, M.H. Nahm, M.T. Dransfield.
Pneumococcal vaccination for patients with COPD: current practice and future directions.
Chest, 133 (2008), pp. 767-774
[29.]
J. Rello, A. Rodriguez, A. Torres, J. Roig, J. Sole-Violan, J. Garnacho-Montero, et al.
Implications of COPD in patients admitted to the intensive care unit by community-acquired pneumonia.
Eur Respir J, 27 (2006), pp. 1210-1216
[30.]
A. Lindberg, Z. Szalai, T. Pullerits, E. Radeczky.
Fast onset of effect of budesonide/formoterol versus salmeterol/fluticasone and salbutamol in patients with chronic obstructive pulmonary disease and reversible airway obstruction.
Respirology, 12 (2007), pp. 732-739
[31.]
A. Ek, K. Larsson, S. Siljerud, L. Palmberg.
Fluticasone and budesonide inhibit cytokine release in human lung epithelial cells and alveolar macrophages.
Allergy, 54 (1999), pp. 691-699
[32.]
R.E. Jonkers, T.A. Bantje, R. Aalbers.
Onset of relief of dyspnoea with budesonide/formoterol or salbutamol following methacholine-induced severe bronchoconstriction in adults with asthma: a double-blind, placebo-controlled study.
Respir Res, 7 (2006), pp. 141
Copyright © 2010. Sociedad Española de Neumología y Cirugía Torácica
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