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Vol. 45. Núm. S4.
EPOC y comorbilidad: una visión global
Páginas 59-64 (Marzo 2009)
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Vol. 45. Núm. S4.
EPOC y comorbilidad: una visión global
Páginas 59-64 (Marzo 2009)
Acceso a texto completo
Comorbilidad infecciosa en la EPOC
Infectious comorbidity in COPD
Visitas
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Rafael Zalacain Jorge??
Autor para correspondencia
rafael.zalacainjorge@osakidetza.net

Autor para correspondencia.
, Ainhoa Gómez Bonilla
Servicio de Neumología, Hospital de Cruces, Baracaldo, Bizkaia, España
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Bibliografía
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Resumen

La infección respiratoria es la comorbilidad infecciosa más frecuente y característica de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC). Esta infección respiratoria origina 2 cuadros clínicos. El primero y más común se asociaría a una agudización, aunque no todas las agudizaciones son de causa infecciosa; su porcentaje estaría entre el 50 y el 70% de estos procesos. El segundo cuadro clínico correspondería a la presencia de una neumonía, ya que, como se sabe, la EPOC es la comorbilidad más frecuente asociada al desarrollo de una neumonía.

De los agentes infecciosos causantes de agudizaciones, el 50-60% de los casos corresponderían a bacterias, que son los microorganismos que más se han estudiado y cuyo papel con las últimas investigaciones cada día es más notorio. Dentro de las bacterias habría que destacar el hecho que cada vez se están aislando en agudizaciones un número mayor de casos de Pseudomonas aeruginosa y microorganismos más agresivos. Un segundo grupo que causa agudizaciones infecciosas serían los virus, que parece que pueden tener un papel relevante en estos procesos, aunque menos determinante que el de las bacterias. En muchos casos pueden predisponer a una infección bacteriana posterior.

La neumonía comunitaria (NAC) es una entidad muy común en pacientes con EPOC y es conocido que entre el 25 y el 50% de los pacientes que ingresan con una NAC tienen una EPOC. Pese a ello, la EPOC no se ha considerado un factor de riesgo de mala evolución en los pacientes con NAC, como quedó demostrado en el Pneumonia Severity Index, en el que la EPOC no estaba entre las comorbilidades asociadas a mortalidad a los 30 días. Aunque recientemente ha habido algunos estudios que sí la asociaban a una mayor mortalidad, este hecho todavía es cuestionable y esta posible mejor evolución podría deberse al empleo de corticoides sistémicos en la gran mayoría de estos cuadros.

Palabras clave:
Agudizaciones infecciosas
Bacterias
Virus
Neumonía
Abstract

Respiratory infection is the most frequent and characteristic infectious comorbidity in patients with chronic obstructive pulmonary disease (COPD) and can lead to two clinical scenarios. The first and most common is exacerbation, although not all exacerbations are caused by infections, which account for 50-70% of these processes. The second scenario is pneumonia, since COPD is the most frequent comorbidity associated with the development of pneumonia.

Of the infectious agents causing exacerbations, 50-60% of cases correspond to bacteria, which are the most widely studied microorganisms and whose role is becoming increasingly notorious. Among bacteria, a greater number of Pseudomonas aeruginosa and more aggressive microorganisms are being isolated in exacerbations. A second cause of infectious exacerbations are viruses, which seem to play an important role in these processes, although less so than bacteria. Viral infections seem to predispose many patients to a subsequent bacterial infection.

Community-acquired pneumonia (CAP) is highly common in patients with COPD and between 25 and 50% of patients hospitalized with this diagnosis have COPD. Nevertheless, COPD has not been considered as a risk factor for poor outcome in patients with CAP and the Pneumonia Severity Index (PSI) showed that COPD was not among the comorbidities associated with mortality at 30 days. Although some studies have recently associated COPD with increased mortality, this association is questionable and the possible improved outcome could be due to the use of systemic corticosteroids in most patients with COPD.

Keywords:
Infectious exacerbations
Bacteria
Virus
Pneumonia
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