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Vol. 46. Issue S10.
Nuevos enfoques en el tratamiento de la EPOC
Pages 14-18 (December 2010)
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Vol. 46. Issue S10.
Nuevos enfoques en el tratamiento de la EPOC
Pages 14-18 (December 2010)
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Hacia un tratamiento individualizado e integrado del paciente con EPOC
Toward personalized and integrated treatment of patients with COPD
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Julio Ancocheaa,
Corresponding author
j.ancochea@separ.es

Autor para correspondencia.
, Teresa Gómez Garcíab, Javier de Miguel Díezb
a Servicio de Neumología, Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IP), Madrid, España
b Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, España
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El concepto de enfermedad pulmonar obstructiva crónica (EPOC) es amplio y genérico. En la práctica clínica y en investigación, la definición de EPOC se basa en la medida de la limitación al flujo aéreo mediante espirometría. Sin embargo, hoy sabemos que la EPOC incluye una compleja variedad de manifestaciones celulares, anatómicas, funcionales y clínicas que pueden permitir definir diferentes fenotipos de la enfermedad. Por otra parte, la gravedad de la EPOC no sólo depende de la función pulmonar valorada mediante espirometría, sino también de otras variables como la sintomatología clínica, las exacerbaciones y la presencia de complicaciones y comorbilidades, aspectos que contribuyen a definir estos diferentes fenotipos. La heterogeneidad fenotípica puede afectar a la respuesta del paciente al tratamiento y a la evolución de la EPOC. Ésta es, pues, una enfermedad compleja en la que es preciso realizar una valoración integral y multidimensional para así establecer un tratamiento más individualizado e integrado.

Palabras clave:
Enfermedad pulmonar obstructiva crónica
Tratamiento individualizado
Fenotipos
Abstract

The concept of chronic obstructive pulmonary disease (COPD) is broad and generic. In clinical practice and research, the definition of COPD is based on the extent of airflow obstruction measured through spirometry. However, it is currently known that this disease encompasses a complex variety of cellular, anatomical, functional and clinical manifestations that could allow distinct COPD phenotypes to be defined. Moreover, the severity of COPD depends not only on pulmonary function evaluated through spirometry but also on other variables such as clinical symptoms, exacerbations and the presence of complications and comorbidities, which contribute to distinguishing among the distinct phenotypes. Phenotypic heterogeneity may affect treatment response and the clinical course of the disease. COPD is, therefore, a complex entity requiring comprehensive and multidimensional evaluation to establish more personalized and integrated treatment.

Keywords:
Chronic obstructive pulmonary disease
Individualized treatment
Phenotypes
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Bibliografía
[1.]
G. Peces-Barba, J.A. Barberá, A. Agustí, C. Casanova, A. Casas, J.L. Izquierdo.
Guía clínica SEPAR-ALAT de diagnóstico y tratamiento de la EPOC.
Arch Bronconeumol, 44 (2008), pp. 271-281
[2.]
B.R. Celli, W. MacNee.
Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper.
Eur Respir J, 23 (2004), pp. 932-946
[3.]
J. Vestbo, W. Anderson, H.O. Coxson, C. Crim, F. Dawber, L. Edwards, et al.
Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE).
Eur Respir J, 31 (2008), pp. 869-873
[4.]
B.R. Celli, C.G. Cote, J.M. Marin, C. Casanova, M. Montes de Oca, R.A. Méndez, et al.
The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease.
N Engl J Med, 350 (2004), pp. 1005-1012
[5.]
P.W. Jones, G. Harding, P. Berry, I. Wiklund, W.H. Chen, N. Kline Leidy.
Development and first validation of the COPD assessment test.
Eur Respir J, 34 (2009), pp. 648-654
[6.]
K. Nishimura, T. Izumu, M. Tsukino, T. Oga.
Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD.
Chest, 121 (2002), pp. 1434-1440
[7.]
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
[8.]
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
[9.]
G.J. Manzini, M. Etminan, B. Zhang, L.E. Levesque, M. FtizGerald, J.M. Brophy.
Reduction of morbidity and mortiality by statins, angiotensin-converting enzyme inhibitors, and angiotensin receptors blockers in patients with chronic obstructive pulmonary disease.
J Am Coll Cardiol, 47 (2006), pp. 2557-2560
[10.]
Estrategia en EPOC del Sistema Nacional de Salud. Madrid: Ministerio de Sanidad y Política Social; 2009.
[11.]
J.J. Soler Cataluña, M.A. Martínez-García, L. Sánchez Sánchez, M. Perpiñá Tordera, P. Román Sánchez.
Severe exacerbations and BODE index: two independent risk factors for death in male COPD patients.
Respir Med, 103 (2009), pp. 692-699
[12.]
M.A. Puhan, J. García-Aymerich, M. Frey, G. Ter Riet, J.M. Antó, A.G. Agust, et al.
Expansion of the prognostic assessment of patients with chronic obstructive pulmonary disease: the updated BODE index and the ADO index.
[13.]
A.C. Dornhorst.
Respiratory insufficiency.
Lancet, 268 (1955), pp. 1183-1187
[14.]
P. De Lucas-Ramos, S. López, S. Lucero, C. Juárez, J.M. Rodríguez.
Fenotipos de la EPOC.
Rev Patol Resp, 12 (2009), pp. 176-182
[15.]
J. García-Aymerich, A. Agustí, J. Barberá, J. Belda, E. Farrero, A. Ferrer, et al.
La heterogeneidad fenotípica de la EPOC.
Arch Bronconeumol, 45 (2009), pp. 129-138
[16.]
J. García-Aymerich, F.P. Gómez, J.M. Antó.
Caracterización fenotípica y evolución de la EPOC en el estudio PAC-COPD: diseño y metodología.
Arch Bronconeumol, 45 (2009), pp. 4-11
[17.]
D.E. O’Donnell, S. Aaron, J. Bourbeau, P. Hernández, D. Marciniuk, M. Balter, et al.
Canadian Thorathic Society recommendations for management of chronic obstructive pulmonary disease – 2007 update.
Can Respir J, 14 (2007), pp. 5B-32B
[18.]
J. Bourbeau, M. Julien, F. Maltais.
Reduction of hospital utilization in patients with chronic obstructive pulmonary disease: a disease-specific self-management intervention.
Arch Intern Med, 163 (2003), pp. 585-591
[19.]
M. Miravitlles.
Tratamiento individualizado de la EPOC: una propuesta de cambio.
Arch Bronconeumol, 45 (2009), pp. 27-34
[20.]
M. Rutten-van Mölken, J.B. Oostenbrink, M. Miratvilles, B.U. Monk.
Modelling the 5 year cost-effectiveness of tiotropium, salmeterol and ipratropium for the treatment of COPD in Spain.
Eur J Health Econ, 8 (2007), pp. 123-135
[21.]
K.F. Rabe, W. Timmer, A. Sagkriotis, K. Viel.
Comparison of a combination of tiotropium plus formoterol to salmeterol plus fluticasone in moderate COPD.
Chest, 134 (2008), pp. 255-262
[22.]
B.R. Celli, N.E. Thomas, J.A. Anderson, G.T. Ferguson, C.R. Jerkins, P.W. Jones, et al.
Effect of pharmacotherapy on rate of decline of lung function in chronic obstructive pulmonary disease: Results from the TORCH study.
Am J Respir Crit Care Med, 178 (2008), pp. 332-338
[23.]
C.R. Jenkins, P.W. Jones, P.M. Calverley, B. Celli, J.A. Anderson, G.T. Ferguson, et al.
Efficacy of salmeterol/fluticasone propionate by GOLD stage of chronic obstructive pulmonary disease: analysis from the randomized, placebo-controlled TORCH study.
Respir Res, 10 (2009), pp. 59
[24.]
E.R. Bleecker, A. Emmett, G. Crater, K. Knobil, C. Kalberg.
Lung function and symptom improvement with fluticasone propionate/salmeterol and ipratropium bromide/albuterol in COPD: response by beta-agonist reversibility.
Pulm Pharmacol Ther, 21 (2008), pp. 682-688
[25.]
M. Miratvilles.
Nuevos tratamientos en la enfermedad pulmonar obstructiva crónica.
Med Clin (Barc), 125 (2005), pp. 65-74
[26.]
B. Arnalich Jiménez, I. Cano Pumarega, A. Mola Ausiro, J.L. Izquierdo Alonso.
Novedades en la enfermedad pulmonar obstructiva crónica.
Arch Bronconeumol, 45 (2009), pp. 9-13
[27.]
J.L. López-Campos.
Estrategias de tratamiento en la enfermedad pulmonar obstructiva crónica: una propuesta de sistematización.
Arch Bronconeumol, (2010),
[28.]
A. Alsaeedi, D.D. Sin, F.A. McAlister.
The effect of inhaled corticosteroids in chronic obstructive pulmonary disease: a systematic review of randomized placebo-controlled trials.
Am J Med, 113 (2002), pp. 59-65
[29.]
D. Price, A. Chisholm, D. Ryan, A. Crockett, R. Jones.
The use of roflumilast in COPD: a primary care perspective.
Prim Care Respir J, (2010),
[30.]
B. Schonhofer, M. Wenzel, M. Geibel, D. Kholer.
Blood transfusion and lung function in chronically anemic patients with severe chronic obstructive pulmonary disease.
Crit Care Med, 26 (1998), pp. 1824-1828
[31.]
B. Schonhofer, H. Bohrer, D. Kohler.
Blood transfusion facilitating difficult weaning from ventilatior.
Anaesthesia, 53 (1998), pp. 181-184
[32.]
X. Pena, E. Van Den Eynde, E. Mena, J. Recio.
EPOC y enfermedad cardiovascular.
Rev Clin Esp, 207 (2007), pp. 14-21
[33.]
P.J. Poole, P.N. Black.
Oral mucolytic drugs for exacerbations of chronic obstructive pulmonary disease: a systematic review.
BMJ, 322 (2001), pp. 1271-1274
[34.]
L.J. Palmer, J.C. Celedon, H.A. Chapman, F.E. Speizer, S.T. Weiss, E.K. Silverman.
Genome-wide linkage analysis of bronchodilatos responsiveness and post-bronchodilator spirometric phenotypes in chronic obstructive pulmonary disease.
Hum Molec Genet, 12 (2003), pp. 1199-1210
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