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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Hemos disfrutado del art&#237;culo de L&#243;pez-Campos et al&#46; que describe la distribuci&#243;n geogr&#225;fica en Espa&#241;a de los factores de riesgo adicionales&#44; distintos del tabaco&#44; para la enfermedad pulmonar obstructiva cr&#243;nica &#40;EPOC&#41;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>&#46; Desear&#237;amos hacer unos comentarios sobre sus resultados&#44; obtenidos a partir del estudio On-Sint<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a>&#46; Los autores hallaron que el sexo masculino se asociaba con la presencia de un factor adicional al tabaco&#44; y que la exposici&#243;n al humo de biomasa era baja &#40;2&#44;6&#37; de los casos con EPOC&#44; de forma global&#41;&#44; e inferior a la exposici&#243;n laboral a otros t&#243;xicos&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Aunque la combusti&#243;n de biomasa es un factor de riesgo de especial relevancia en pa&#237;ses en v&#237;as de desarrollo&#44; la exposici&#243;n a esta noxa podr&#237;a ser significativa tambi&#233;n en pa&#237;ses industrializados<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a>&#46; En un estudio realizado en poblaci&#243;n predominantemente rural en nuestro pa&#237;s&#44; m&#225;s del 20&#37; de los pacientes con EPOC remitidos a una consulta neumol&#243;gica monogr&#225;fica presentaba como &#250;nico factor de riesgo para la enfermedad la combusti&#243;n de biomasa<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>&#46; Algunos aspectos de la metodolog&#237;a de L&#243;pez-Campos et al&#46; sugieren que la relevancia de la biomasa podr&#237;a estar infravalorada&#46; Los autores reconocen que su estudio no pretendi&#243; obtener una muestra con una distribuci&#243;n geogr&#225;fica uniforme<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>&#46; La mayor&#237;a de los pacientes fueron reclutados en centros asistenciales urbanos<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a>&#44; donde la exposici&#243;n a la biomasa ser&#237;a menos prevalente&#46; La asociaci&#243;n entre el sexo masculino y la presencia de un factor de riesgo adicional parece derivarse de la distribuci&#243;n de sexos en los trabajos que acarrean una exposici&#243;n laboral a t&#243;xicos<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>&#46; Por el contrario&#44; la exposici&#243;n a la biomasa&#44; por condicionantes socioculturales&#44; es m&#225;s elevada en las mujeres<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>&#46; Por ello&#44; agradecer&#237;amos un an&#225;lisis adicional por parte de los autores&#44; valorando por separado la exposici&#243;n a la biomasa entre los sujetos reclutados en centros asistenciales rurales y entre las mujeres&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Adem&#225;s&#44; el estudio incluy&#243; exclusivamente pacientes fumadores&#44; y no pretend&#237;a valorar los factores de riesgo en sujetos sin h&#225;bito tab&#225;quico&#44; entre los cuales la combusti&#243;n de biomasa es el factor m&#225;s relevante&#44; a nivel mundial<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a>&#46; Asimismo&#44; la exposici&#243;n a biomasa fue autorreferida&#44; y el interrogatorio comenz&#243; preguntando a los sujetos si hab&#237;an estado expuestos a otro factor de riesgo diferente del tabaco&#44; y solo si la respuesta era positiva se solicit&#243; que identificasen la exposici&#243;n<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>&#46; En nuestra experiencia&#44; muchos pacientes desconocen la relevancia cl&#237;nica que puede tener la quema de biomasa&#44; y podr&#237;an por ello haber contestado negativamente a la pregunta inicial&#44; especialmente si la exposici&#243;n fue remota&#44; y tuvo lugar en la infancia y juventud&#44; etapas en las cuales&#44; de forma plausible&#44; los sujetos ser&#237;an m&#225;s susceptibles a los efectos adversos de los t&#243;xicos inhalados<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">En resumen&#44; aunque el trabajo de L&#243;pez-Campos et al ofrece la mejor informaci&#243;n actual sobre la distribuci&#243;n de factores de riesgo para la EPOC diferentes al tabaco en Espa&#241;a&#44; creemos que deben realizarse estudios espec&#237;ficos que analicen la relevancia real de la biomasa como factor de riesgo para la enfermedad en nuestro pa&#237;s&#44; con el objetivo que plantean los autores<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>&#58; mejorar el diagn&#243;stico precoz y la prevenci&#243;n de la EPOC&#46;</p></span>"
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Carta al Director
Combustión de biomasa como factor de riesgo para enfermedad pulmonar obstructiva crónica en España
Biomass Burning as a Risk Factor for Chronic Obstructive Pulmonary Disease in Spain
Rafael Golpe
Corresponding author
rafagolpe@gmail.com

Autor para correspondencia.
, Irene Martín-Robles, Pilar Sanjuán-López
Servicio de Neumología, Hospital Universitario Lucus Augusti, Lugo, España
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la exposici&#243;n a esta noxa podr&#237;a ser significativa tambi&#233;n en pa&#237;ses industrializados<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a>&#46; En un estudio realizado en poblaci&#243;n predominantemente rural en nuestro pa&#237;s&#44; m&#225;s del 20&#37; de los pacientes con EPOC remitidos a una consulta neumol&#243;gica monogr&#225;fica presentaba como &#250;nico factor de riesgo para la enfermedad la combusti&#243;n de biomasa<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>&#46; Algunos aspectos de la metodolog&#237;a de L&#243;pez-Campos et al&#46; sugieren que la relevancia de la biomasa podr&#237;a estar infravalorada&#46; Los autores reconocen que su estudio no pretendi&#243; obtener una muestra con una distribuci&#243;n geogr&#225;fica uniforme<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>&#46; La mayor&#237;a de los pacientes fueron reclutados en centros asistenciales urbanos<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a>&#44; donde la exposici&#243;n a la biomasa ser&#237;a menos prevalente&#46; La asociaci&#243;n entre el sexo masculino y la presencia de un factor de riesgo adicional parece derivarse de la distribuci&#243;n de sexos en los trabajos que acarrean una exposici&#243;n laboral a t&#243;xicos<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>&#46; Por el contrario&#44; la exposici&#243;n a la biomasa&#44; por condicionantes socioculturales&#44; es m&#225;s elevada en las mujeres<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>&#46; Por ello&#44; agradecer&#237;amos un an&#225;lisis adicional por parte de los autores&#44; valorando por separado la exposici&#243;n a la biomasa entre los sujetos reclutados en centros asistenciales rurales y entre las mujeres&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Adem&#225;s&#44; el estudio incluy&#243; exclusivamente pacientes fumadores&#44; y no pretend&#237;a valorar los factores de riesgo en sujetos sin h&#225;bito tab&#225;quico&#44; entre los cuales la combusti&#243;n de biomasa es el factor m&#225;s relevante&#44; a nivel mundial<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a>&#46; Asimismo&#44; la exposici&#243;n a biomasa fue autorreferida&#44; y el interrogatorio comenz&#243; preguntando a los sujetos si hab&#237;an estado expuestos a otro factor de riesgo diferente del tabaco&#44; y solo si la respuesta era positiva se solicit&#243; que identificasen la exposici&#243;n<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>&#46; En nuestra experiencia&#44; muchos pacientes desconocen la relevancia cl&#237;nica que puede tener la quema de biomasa&#44; y podr&#237;an por ello haber contestado negativamente a la pregunta inicial&#44; especialmente si la exposici&#243;n fue remota&#44; y tuvo lugar en la infancia y juventud&#44; etapas en las cuales&#44; de forma plausible&#44; los sujetos ser&#237;an m&#225;s susceptibles a los efectos adversos de los t&#243;xicos inhalados<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">En resumen&#44; 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Article information
ISSN: 03002896
Original language: Spanish
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