Carta al Director
Eosinófilos y corticoides inhalados en la enfermedad pulmonar obstructiva crónica
Eosinophils and Inhaled Corticosteroids in Chronic Obstructive Pulmonary Disease
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"es" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>" "titulo" => "Eosinófilos y corticoides inhalados en la enfermedad pulmonar obstructiva crónica" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Sr. Director:</span>" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "541" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Adolfo Baloira Villar, Abel Pallarés Sanmartín, Marta Núñez Fernández" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Adolfo" "apellidos" => "Baloira Villar" "email" => array:1 [ 0 => "adolfo.baloira.villar@sergas.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Abel" "apellidos" => "Pallarés Sanmartín" "referencia" => array:1 [ 0 => 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"<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Agradecemos los comentarios recibidos, con los que en esencia estamos de acuerdo<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a>. Existen todavía importantes puntos por aclarar respecto al papel que la eosinofilia sanguínea juega en el manejo de la enfermedad pulmonar obstructiva crónica (EPOC), quizá el más importante el número absoluto o relativo de eosinófilos que tiene un valor diferencial, ya sea pronóstico, terapéutico o incluso para definir lo que podría ser un fenotipo propio. Como señalan los autores, los estudios realizados son en su mayor parte análisis <span class="elsevierStyleItalic">post hoc</span>, pero también es cierto que en todos ellos los resultados son coincidentes: la respuesta a los corticoides inhalados es solo significativa a partir de un valor determinado de eosinófilos sanguíneos: Desde que escribimos nuestra carta, hace algo más de un año, se han publicado nuevos estudios que añaden más evidencia a esta conclusión. Un reanálisis de ISOLDE mostró una reducción de la pérdida de FEV1 de unos 34<span class="elsevierStyleHsp" style=""></span>ml/año en los pacientes con más del 2% de eosinófilos en el momento de inicio del estudio, mientras que por debajo de este valor no hubo diferencias<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a>. Otra forma de enfocar esta cuestión se ha realizado con un nuevo análisis del estudio WISDOM, donde tras la retirada de fluticasona se observó un incremento de agudizaciones, únicamente cuando el porcentaje de eosinófilos era igual o superior al 2%, con un riesgo relativo (RR) de 1,22, aumentando a medida que lo hacía la eosinofilia (≥<span class="elsevierStyleHsp" style=""></span>4%, RR: 1,63; ≥<span class="elsevierStyleHsp" style=""></span>5%, RR: 1,82)<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a>.</p><p id="par0010" class="elsevierStylePara elsevierViewall">En resumen, aun coincidiendo con los autores en la mayor parte de sus aseveraciones, creemos que las evidencias disponibles hacen de los eosinófilos sanguíneos un excelente biomarcador de respuesta a corticoides inhalados en la EPOC, e incluso podrían conformar un fenotipo específico<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a>.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Corticoides inhalados, eosinófilos y exacerbaciones de enfermedad pulmonar obstructiva crónica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Golpe" 1 => "I. Martín-Robles" 2 => "P. Sanjuán-López" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2015.06.004" "Revista" => array:5 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2016" "volumen" => "52" "paginaInicial" => "229" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26216714" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Blood eosinophils as a marker of response to inhaled corticosteroids in COPD" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N.C. Barnes" 1 => "R. Sharma" 2 => "S. Lettis" 3 => "P.M. Calverley" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/13993003.01370-2015" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2016" "volumen" => "47" "paginaInicial" => "1374" "paginaFinal" => "1382" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26917606" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Blood eosinophil count and exacerbations in severe chronic obstructive pulmonary disease after withdrawal of inhaled corticosteroids: A post-hoc analysis of the WISDOM trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Watz" 1 => "K. Tetzlaff" 2 => "E.F. Wouters" 3 => "A. Kirsten" 4 => "H. Magnussen" 5 => "R. Rodríguez-Roisin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S2213-2600(13)70187-5" "Revista" => array:4 [ "tituloSerie" => "Lancet Respir Med" "fecha" => "2016" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24429275" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673601057750" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Enfermedad pulmonar obstructiva crónica con eosinofilia, ¿un fenotipo emergente?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Baloira Villar" 1 => "A. Pallarés Sanmartín" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2015.11.015" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2016" "volumen" => "52" "paginaInicial" => "177" "paginaFinal" => "178" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26852358" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/03002896/0000005200000010/v3_201609300128/S0300289616301764/v3_201609300128/es/main.assets" "Apartado" => array:4 [ "identificador" => "9222" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the Director / Cartas al Director" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005200000010/v3_201609300128/S0300289616301764/v3_201609300128/es/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289616301764?idApp=UINPBA00003Z" ]
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