Journal Information
Vol. 46. Issue S8.
EPOC: ¿cómo mejorar la atención al paciente?
Pages 8-14 (November 2010)
Share
Share
Download PDF
More article options
Vol. 46. Issue S8.
EPOC: ¿cómo mejorar la atención al paciente?
Pages 8-14 (November 2010)
Full text access
Impacto de las agudizaciones e ingresos en la EPOC
Impact of exacerbations and admissions in chronic obstructive pulmonary disease
Visits
5851
Aurelio Arnedillo Muñoz
UGC de Neumología y Alergia, Hospital Universitario Puerta del Mar, Cádiz, España
This item has received
Article information
Abstract
Bibliography
Download PDF
Statistics
Resumen

En la historia natural de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) hay períodos de incremento de los síntomas, que conocemos como agudizaciones de la EPOC (AEPOC), que en ocasiones precisan de ingreso hospitalario. Aunque todavía hay debate en cuanto a su definición, y ello ha generado una falta de homogenidad en los múltiples estudios realizados, estas agudizaciones repercuten de manera muy negativa en los pacientes, y producen un deterioro clínico y de la función pulmonar a largo plazo. También conllevan una disminución de la calidad de vida, que se ve afectada a medio y largo plazo, y un coste sociosanitario elevado, especialmente durante los ingresos hospitalarios. Finalmente, las AEPOC incrementan la mortalidad de los pacientes tanto a corto plazo, durante el ingreso hospitalario, como después de la hospitalización. Por todo lo anterior, prevenir las AEPOC se ha convertido en uno de los objetivos fundamentales en estos pacientes.

Palabras clave:
Agudizaciones de la EPOC
Hospitalizaciones
Función pulmonar
Calidad de vida
Carga económica
Mortalidad
Abstract

During the natural history of patients with chronic obstructive pulmonary disease (COPD), an increase in symptom severity can occur, called exacerbated COPD (ECOPD), sometimes requiring hospital admission. Although there is ongoing debate on the definition of ECOPD –leading to a lack of homogeneity in the numerous studies performed– exacerbations negatively affect patients, producing clinical and pulmonary function deterioration in the long term. Exacerbations also decrease quality of life in the medium- and long-term and have a high social and health cost, especially during hospital admission. Finally, ECOPD increases mortality in patients in the short-term, during hospital admission, and after discharge. In view of all of the above, prevention of ECOPD has become one of the main objectives in these patients.

Keywords:
COPD exacerbations
Hospitalizations
Pulmonary function
Quality of life
Economic burden
Mortality
Full text is only aviable in PDF
Bibliografía
[1.]
Global Initiative for Chronic Obstructive Lung Disease Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. Updated December 2009. Disponible en: www.goldcopd.org
[2.]
R. Rodríguez-Roisin.
Toward a consensus definition for COPD exacerbation.
Chest, 117 (2000), pp. 398s-401s
[3.]
R. Pauwels, P. Calverley, A.S. Buist, S. Rennard, Y. Fucuchi, E. Stahl, et al.
COPD exacerbations: the importance of a standard definition.
Respir Med, 98 (2004), pp. 99-107
[4.]
J.R. Hurst, J.A. Wedzicha.
What is (and what is not) a COPD exacerbation: thoughs from the new GOLD guidelines.
Thorax, 62 (2007), pp. 198-199
[5.]
P. Almagro, E. Calbo, A. Ochoa de Echaguen, B. Barreiro, S. Quintana, J.L. Heredia, et al.
Mortality after hospitalization for COPD.
Chest, 121 (2002), pp. 1441-1448
[6.]
H. Gunen, S.S. Hacievliyagil, F. Kosar, L.C. Mutlu, G. Gulbas, E. Pehlivan, et al.
Factors affecting survival of hospitalized patients with COPD.
Eur Respir J, 26 (2005), pp. 234-241
[7.]
J. Garcia-Aymerich, E. Monso, R.M. Marrades, J. Escarrabill, M.A. Félez, J. Sunyer, et al.
Risk factors for hospitalization for a chronic obstructive pulmonary disease exacerbation: EFRAM Study.
Am J Respir Crit Care Med, 164 (2001), pp. 1002-1007
[8.]
L. Langsetmo, R.W. Platt, P. Ernst, J. Bourbeau.
Underreporting Exacerbation of Chronic Obstructive Pulmonary Disease in a Longitudinal Cohort.
Am J Respir Crit Care Med, 177 (2008), pp. 396-401
[9.]
Guía de práctica clínica de diagnóstico y tratamiento de la Enfermedad Pulmonar Obstructiva Crónica. SEPAR-ALAT. Updated 2009. Disponible en: www.separ.es
[10.]
C.G. Cote, L.J. Dordelly, B.R. Celli.
Impact of COPD exacerbations on patient-centered outcomes.
Chest, 131 (2007), pp. 696-704
[11.]
A. Anzueto, I. Leimer, S. Kesten.
Impact of frequency of COPD exacerbations on pulmonary function, health status and clinical outcomes.
Int J COPD, 4 (2009), pp. 245-251
[12.]
D.K. Kirsten, C. Taube, B. Lehnigk, R.A. Jörres, H. Magnussen.
Exercise training improves recovery in patients with COPD after an acute exacerbation.
Respir Med, 92 (1998), pp. 1191-1198
[13.]
G.C. Donaldson, T.A.R. Seemungal, A. Bhowmik, J.A. Wedzicha.
Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease.
Thorax, 57 (2002), pp. 847-852
[14.]
M. Miravitlles, C. Espinosa, E. Fernandez-Laso, J.A. Martos, J.A. Maldonado, M. Gallego.
Relationship between bacterial flora in sputum and functional impairment in patients with acute exacerbations of COPD.
Chest, 116 (1999), pp. 40-46
[15.]
P.W. Jones, P.J. Wijkstra.
Quality of life in patients with chronic obstructive pulmonary disease.
Eur Respir Mon, 38 (2006), pp. 375-386
[16.]
S.D. Aaron, K.L. Vandemheen, J.J. Clinch, J. Ahuja, R.J. Brison, G. Dickinson, et al.
Measurement of short-term changes in dyspnea and disease-specific quality of life following an acute COPD exacerbation.
Chest, 121 (2002), pp. 688-696
[17.]
T.A. Seemungal, G.C. Donaldson, E.A. Paul, J.C. Bestall, D.J. Jeffries, J.A. Wedzicha.
Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 157 (1998), pp. 1418-1422
[18.]
M. Miravitlles, M. Ferrer, A. Pont, R. Zalacain, J.L. Alvarez-Sala, F. Masa, IMPAC Study Group, et al.
Effect of exacerbations on quality of life in patients with chronic obstructive pulmonary disease: a 2 year follow up study.
Thorax, 59 (2004), pp. 387-395
[19.]
S. Spencer, P.W. Jones.
Time course of recovery of health status following an nfective exacerbation of chronic bronchitis.
Thorax, 58 (2003), pp. 589-593
[20.]
C. Esteban, J.M. Quintana, J. Moraza, M. Aburto, M. Egurrola, P.P. España, et al.
Impact of hospitalisations for exacerbations of COPD on health-related quality of life.
Respir Med, 103 (2009), pp. 1201-1208
[21.]
S.F. Fan, J.R. Curtis, S.P. Tu, M.B. McDonell, S.D. Fihn.
Using quality of life to predict hospitalizations and mortality in patients with chronic obstructive pulmonary disease.
Chest, 122 (2002), pp. 429-436
[22.]
S. Spencer, P.M. Calverley, P.S. Burge, P.W. Jones.
Impact of preventing exacerbations on deterioration of health status in COPD.
Eur Respir J, 23 (2004), pp. 698-702
[23.]
M. Miravitlles, J.B. Soriano, F. Garcia-Rio, L. Muñoz, 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
[24.]
D. Halpin, M. Miravitlles.
Chronic Obstructive Pulmonary Disease. The disease and its burden to society.
Proc Am Thorac Soc, 3 (2006), pp. 619-623
[25.]
H.S. Ruchlin, E.J. Dasbach.
An economic overview of chronic obstructive pulmonary disease.
Pharmacoeconomics, 19 (2001), pp. 623-642
[26.]
D.E. Hilleman, N. Dewan, M. Malesker, M. Friedman.
Pharmacoeconomic evaluation of COPD.
Chest, 118 (2000), pp. 1278-1285
[27.]
C.R. Regueiro, M.B. Hamel, R.B. Davis, N. Desbiens, J.r. ConnorsAF, R.S. Phillips.
A comparison of generalist and pulmonologist care for patients hospitalized with severe chronic obstructive pulmonary disease: resource intensity, hospital costs, and survival. SUPPORT Investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment).
Am J Med, 105 (1998), pp. 366-372
[28.]
National Heart, Lung, and Blood Institute. Chronic obstructive pulmonary disease. Bethesda, MD: National Heart, Lung, and Blood Institute; 2004. Disponible en: http://www.nhlbi.nih.gov/health/public/lung/other/copd_fact.pdf
[29.]
European Respiratory Society and European Lung Foundation.
Chronic obstructive pulmonary disease. European Lung White Book.
European Respiratory Society, (2003),
[30.]
E.F. Wouters.
Economic analysis of the Confronting COPD survey: an overview of results.
Respir Med, 97 (2003), pp. S3-14
[31.]
M. Britton.
The burden of COPDin the UK: results from the Confronting COPD survey.
Respir Med, 97 (2003), pp. S71-S79
[32.]
R.A. Pauwels, K.F. Rabe.
Burden and clinical features of chronic obstructive pulmonary disease (COPD).
[33.]
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
[34.]
J.F. Masa, V. Sobradillo, C. Villasante, C. Jiménez-Ruíz, L. Fernández-Fau, J.L. Viejo, et al.
Costes de la EPOC en España. Estimación a partir de un estudio epidemiológico poblacional.
Arch Bronconeumol, 40 (2004), pp. 72-79
[35.]
J. Vestbo.
Socioeconomic burden of chronic obstructive pulmonary disease.
Eur Respir Mon, 38 (2006), pp. 463-469
[36.]
F. Andersson, S. Borg, S.A. Jansson, A.C. Jonsson, A. Ericsson, C. Prütz, et al.
The costs of exacerbations in chronic obstructive pulmonary disease (COPD).
Respir Med, 96 (2002), pp. 700-708
[37.]
J.B. Oostenbrink, M.P. Rutten-van Mölken.
Resource use and risk factors in high-cost exacerbations of COPD.
Respir Med, 98 (2004), pp. 883-891
[38.]
D.H. Au, E.M. Udris, S.D. Fihn, M.B. McDonell, J.R. Curtis.
Differences in health care utilization at the end of life among patients with chronic obstructive pulmonary disease and patients with lung cancer.
Arch Intern Med, 166 (2006), pp. 326-331
[39.]
R. Dal Negro.
Optimizing economic outcomes in the management of COPD.
Int J Chron Obstruct Pulmon Dis, 3 (2008), pp. 1-10
[40.]
A.F. Connors, N.V. Dawson, C. Thomas, F.E. Harrell Jr., N. Desbiens, W.J. Fulkerson, et al.
Outcomes following acute exacerbation of severe chronic obstructive lung disease.
Am J Respir Crit Care Med, 154 (1996), pp. 959-967
[41.]
P. Ranieri, A. Bianchetti, A. Margiotta, A. Virgillo, E.M. Clini, M. Trabucchi.
Predictors of 6-month mortality in elderly patients with mild chronic obstructive pulmonary disease discharged from a medical ward after acute nonacidotic exacerbation.
J Am Geriatr Soc, 56 (2008), pp. 909-913
[42.]
K.H. Groenewegen, A.M.W.J. Schols, E. Wouters.
Mortality and mortality-related factors after hospitalization for acute exacerbation of COPD.
Chest, 124 (2003), pp. 459-467
[43.]
J.J. Soler-Cataluña, M.A. Martínez-García, P. Román 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
[44.]
T.A. Seemungal, J.R. Hurst, J.A. Wedzicha.
Exacerbation rate, health status and mortality in COPD–a review of potential interventions.
Int J Chron Obstruct Pulmon Dis, 4 (2009), pp. 203-223
[45.]
L. Fuso, R.A. Incalzi, R. Pistelli, R. Muzzolon, S. Valente, G. Pagliari, et al.
Predicting mortality of patients hospitalized for acutely exacerbated chronic obstructive pulmonary disease.
Am J Med, 98 (1995), pp. 272-277
[46.]
I. Solanes, P. Casan, M. Sangenís, N. Calaf, B. Giraldo, R. Güell.
Factores de riesgo de mortalidad en la EPOC.
Arch Bronconeumol, 43 (2007), pp. 445-449
[47.]
M.L. Nevins, S.K. Epstein.
Predictors of outcome for patients with COPD requiring invasive mechanical ventilation.
Chest, 119 (2001), pp. 1840-1849
[48.]
S.P. Patil, J.A. Krishnan, N. Lechtzin, G.B. Diette.
In-hospital mortality following acute exacerbations of chronic obstructive pulmonary disease.
Arch Intern Med, 163 (2003), pp. 1180-1186
[49.]
R.D. Rieves, D. Bass, R.R. Carter, J.E. Griffith, J.R. Norman.
Severe COPD and acute respiratory failure. Correlates for survival at the time of tracheal intubation.
Chest, 104 (1993), pp. 854-860
[50.]
H. Gunen, S.S. Hacievliyagil, F. Kosar, L.C. Mutlu, G. Gulbas, E. Pehlivan, et al.
Factors affecting survival of hospitalised patients with COPD.
Eur Respir J, 26 (2005), pp. 234-241
[51.]
R.G. Pinckney, R. O’Brien, J.F. Piccirillo, B. Littenberg.
Evaluation of co-morbidity indices in patients admittedfor chronic obstructive pulmonary disease.
Monaldi Arch Chest Dis, 61 (2004), pp. 209-212
[52.]
S. Yang, K.L. Tan, A. Devanand, S. Fook-Chong, P. Eng.
Acute exacerbation of COPD requiring admission to the intensive care unit.
Respirology, 9 (2004), pp. 543-549
[53.]
M.G. Seneff, D.P. Wagner, R.P. Wagner, J.E. Zimmerman, W.A. Knaus.
Hospital and 1-year survival of patients admitted to intensive care units with acute exacerbation of chronic obstructive pulmonary disease.
JAMA, 274 (1995), pp. 1852-1857
[54.]
W.C. Tan.
Factors associated with outcomes of acute exacerbations of chronic obstructive pulmonary disease.
COPD, 1 (2004), pp. 225-247
[55.]
N. Roche, M. Zureik, D. Soussan, F. Neukirch, D. Perrotin, Urgence BPCO (COPD Emergency) Scientific Committee.
Predictors of outcomes in COPD exacerbation cases presenting to the emergency department.
Eur Respir J, 32 (2008), pp. 953-961
[56.]
M. Sanjaume, P. Almagro, M. Rodríguez-Carballeira, B. Barreiro, J.L. Heredia, J. Garau.
Mortalidad posthospitalaria en pacientes reingresadores por EPOC. Utilidad del índice BODE.
Rev Clin Esp, 209 (2009), pp. 364-370
[57.]
P.M.A. Calverley, J.A. Anderson, B.R. 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
[58.]
D.P. Tashkin, B. Celli, S. Senn, D. Burkhart, S. Kesten, S. Menjoge, UPLIFT Study Investigators, et al.
A 4-year trial of tiotropium in chronic obstructive pulmonary disease.
N Engl J Med, 359 (2008), pp. 1543-1554
[59.]
T. Welte, M. Miravitlles, P. Hernandez, G. Eriksson, S. Peterson, T. Polanowski, et al.
Efficacy and tolerability of Budesonida/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
Article options
Tools

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