Article information
Resumen
Una de las características inherentes a la enfermedad pulmonar obstructiva crónica (EPOC) es la existencia de exacerbaciones. Estos episodios de descompensación clínica, que anteriormente se consideraban epifenómenos de la enfermedad, son juzgados hoy como elementos clave en el curso natural de la EPOC por cuanto generan una gran carga asistencial y enormes costes, impactan de forma negativa sobre la calidad de vida de los pacientes, contribuyen de forma decidida a la progresión multidimensional de la enfermedad y, finalmente, condicionan su pronóstico. El artículo revisa la evidencia científica actual sobre el impacto multidimensional que ejerce la exacerbación de la EPOC. Sin embargo, esta repercusión debe ser matizada. No todos los pacientes sufren agudizaciones y no todas las exacerbaciones tienen las mismas consecuencias. La revisión pone el acento en la necesidad de estandarizar la propia definición de exacerbación y acotar conceptos como el de frecuencia, gravedad o duración del episodio. Estos aspectos condicionan finalmente las consecuencias de la propia exacerbación e introducen variables que pueden tener incluso connotaciones terapéuticas. De hecho, cada día existe una mayor necesidad de identificar fenotipos clínicos específicos y personalizar el tratamiento. En este sentido, el fenotipo “exacerbador” se postula como una diana terapéutica de especial relevancia.
Palabras clave:
EPOC Exacerbación Pronóstico Mortalidad Calidad de vida relacionada con la salud
Abstract
One of the inherent characteristics of chronic obstructive pulmonary disease (COPD) is the occurrence of exacerbations. These episodes of clinical decompensation, which used to be considered epiphenomena of the disease, are now viewed as key elements in the natural history of COPD. Exacerbations generate huge clinical workload and enormous costs, impair patients’ quality of life, make a decisive contribution to the multidimensional progression of the disease and affect prognosis. The present article reviews the current scientific evidence on the multifaceted impact of COPD exacerbations. However, the effects of exacerbations are not homogeneous. Not all patients suffer exacerbations and not all exacerbations have the same repercussions. This review highlights the need to standardize the definition of exacerbation, as well as that of concepts such as the frequency, severity, and duration of the episode. These factors influence the effect of the exacerbation itself and introduce variables that may affect treatment. Indeed, there is an increasing need to identify specific clinical phenotypes and personalize treatment. Consequently, an “exacerbating” phenotype is postulated as a therapeutic target of special importance.
Key words:
COPD Exacerbation Prognosis Mortality Health-related quality of life
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