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Vol. 45. Issue S5.
Broncodilatación sostenida en EPOC: más allá del efecto respiratorio
Pages 14-20 (March 2009)
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Vol. 45. Issue S5.
Broncodilatación sostenida en EPOC: más allá del efecto respiratorio
Pages 14-20 (March 2009)
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Impacto de los estudios de eficacia y mortalidad (TORCH y UPLIFT) en el tratamiento broncodilatador de la EPOC
Impact of efficacy and mortality studies (TORCH and UPLIFT) in bronchodilator treatment of chronic obstructive pulmonary disease
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Juan José Soler-Cataluña??
Corresponding author
jjsoler@telefonica.net

Autor para correspondencia.
, Miguel Ángel Martínez García
Unidad de Neumología, Servicio de Medicina Interna, Hospital General de Requena, Valencia, España
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Resumen

Los estudios TORCH y UPLIFT son, probablemente, los ensayos clínicos más ambiciosos jamás realizados en la enfermedad pulmonar obstructiva crónica (EPOC). Desafortunadamente, los objetivos principales no se cumplieron. Comparado con placebo, la terapia combinada de salmeterol y fluticasona no redujo de forma significativa la mortalidad por todas las causas, y el tiotropio tampoco consiguió enlentecer el deterioro de la función pulmonar a lo largo de 4 años. Sin embargo, el análisis cuidadoso de los resultados minimiza la desilusión inicial e invita al optimismo moderado por cuanto ambos ensayos muestran una disminución en el número de exacerbaciones, una mejora en la calidad de vida relacionada con la salud (CVRS) y, en líneas generales, un buen perfil de seguridad a lo largo del tiempo. Además, se observan algunas señales beneficiosas en términos de supervivencia. Este aspecto abre nuevas expectativas por cuanto sugiere que más allá de la función pulmonar existen otras dianas terapéuticas de importancia pronóstica. Analizados en su conjunto, el estudio UPLIFT y el TORCH confirman y enfatizan el papel pivotal de los broncodilatadores de acción prolongada en el manejo de la EPOC. Los corticoides inhalados, administrados en monoterapia, aunque reducen exacerbaciones y mejoran la CVRS, no parecen aportar beneficios sobre la supervivencia y, por el contrario, incrementan el riesgo de efectos secundarios. No obstante, cuando se asocian al tratamiento broncodilatador, parecen potenciar sus beneficios.

Palabras clave:
Enfermedad pulmonar obstructiva crónica
Mortalidad
Salmeterol/propionato de fluticasona
Tiotropio
Abstract

The TORCH and UPLIFT studies are probably the most ambitious clinical trials performed to date in chronic obstructive pulmonary disease (COPD). Unfortunately, the main objectives were not achieved. Compared with placebo, combination therapy with salmeterol and fluticasone did not significantly reduce all-cause mortality, nor did tiotropium slow lung function deterioration over 4 years. However, careful analysis of the results reduces the initial disappointment to a minimum and leads to moderate optimism, as both trials showed a decrease in the number of exacerbations, improvement in health-related quality of life (HRQoL) and, in general, a good safety profile throughout the studies. Moreover, some benefits on survival were noted. This latter observation opens new horizons as it suggests that, apart from lung function, there are other therapeutic targets with prognostic importance. When analyzed overall, the UPLIFT and TORCH studies confirm and highlight the key role of prolonged action bronchodilators in the management of COPD. Although inhaled corticosteroids, administered in monotherapy, reduce exacerbations and improve HRQoL, these drugs show no benefit on survival and increase the risk of adverse effects. Nevertheless, when inhaled corticosteroids are associated with bronchodilator treatment, their benefits seem to be enhanced.

Keywords:
Chronic obstructive pulmonary disease
Mortality
Salmeterol/fluticasone propionate
Tiotropium
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Copyright © 2009. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología

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