Discussion Letter
Comment on “Multidisciplinary Management of Patients With Chronic Obstructive Pulmonary Disease and Cardiovascular Disease”
a Servicio de Neumología, Hospital Universitario Lucus Augusti, Lugo, Spain
b Servicio de Neumología y Cirugía Torácica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
c University Institute of Tropical Disease and Public Health of the Canary Islands, University of La Laguna, Santa Cruz de Tenerife, Spain
Read
761
Timeswas read the article
155
Total PDF
606
Total HTML
Share statistics
array:24 [ "pii" => "S030028962400067X" "issn" => "03002896" "doi" => "10.1016/j.arbres.2024.03.008" "estado" => "S300" "fechaPublicacion" => "2024-06-01" "aid" => "3507" "copyright" => "SEPAR" "copyrightAnyo" => "2024" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2024;60:391" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S0300289624001248" "issn" => "03002896" "doi" => "10.1016/j.arbres.2024.04.016" "estado" => "S300" "fechaPublicacion" => "2024-06-01" "aid" => "3544" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2024;60:392-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:9 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Discussion Letter</span>" "titulo" => "Multidisciplinary Management of Patients With Chronic Obstructive Pulmonary Disease and Cardiovascular Disease: Response to Additional Considerations" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "392" "paginaFinal" => "393" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Javier de Miguel-Díez, Juan José Gómez Doblas" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Javier" "apellidos" => "de Miguel-Díez" ] 1 => array:2 [ "nombre" => "Juan José" "apellidos" => "Gómez Doblas" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289624001248?idApp=UINPBA00003Z" "url" => "/03002896/0000006000000006/v2_202408290625/S0300289624001248/v2_202408290625/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0300289624000553" "issn" => "03002896" "doi" => "10.1016/j.arbres.2024.02.015" "estado" => "S300" "fechaPublicacion" => "2024-06-01" "aid" => "3495" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2024;60:388-90" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:9 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Effect of Comorbidities and Gender Differences in Survival in Patients With Bronchiectasis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "388" "paginaFinal" => "390" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Blanca Urrutia-Royo, Ignasi Garcia-Olivé, Marina Compte, Carlos Folgado, Antoni Rosell, Jorge Abad Capa" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Blanca" "apellidos" => "Urrutia-Royo" ] 1 => array:2 [ "nombre" => "Ignasi" "apellidos" => "Garcia-Olivé" ] 2 => array:2 [ "nombre" => "Marina" "apellidos" => "Compte" ] 3 => array:2 [ "nombre" => "Carlos" "apellidos" => "Folgado" ] 4 => array:2 [ "nombre" => "Antoni" "apellidos" => "Rosell" ] 5 => array:2 [ "nombre" => "Jorge Abad" "apellidos" => "Capa" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289624000553?idApp=UINPBA00003Z" "url" => "/03002896/0000006000000006/v2_202408290625/S0300289624000553/v2_202408290625/en/main.assets" ] "asociados" => array:1 [ 0 => array:18 [ "pii" => "S0300289624001248" "issn" => "03002896" "doi" => "10.1016/j.arbres.2024.04.016" "estado" => "S300" "fechaPublicacion" => "2024-06-01" "aid" => "3544" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2024;60:392-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:9 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Discussion Letter</span>" "titulo" => "Multidisciplinary Management of Patients With Chronic Obstructive Pulmonary Disease and Cardiovascular Disease: Response to Additional Considerations" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "392" "paginaFinal" => "393" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Javier de Miguel-Díez, Juan José Gómez Doblas" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Javier" "apellidos" => "de Miguel-Díez" ] 1 => array:2 [ "nombre" => "Juan José" "apellidos" => "Gómez Doblas" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289624001248?idApp=UINPBA00003Z" "url" => "/03002896/0000006000000006/v2_202408290625/S0300289624001248/v2_202408290625/en/main.assets" ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Discussion Letter</span>" "titulo" => "Comment on “Multidisciplinary Management of Patients With Chronic Obstructive Pulmonary Disease and Cardiovascular Disease”" "tieneTextoCompleto" => true "saludo" => "To the Director," "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "391" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Rafael Golpe, Juan Marco Figueira-Gonçalves" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Rafael" "apellidos" => "Golpe" "email" => array:2 [ 0 => "rafagolpe@gmail.com" 1 => "rafael.golpe.gomez@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" => "Juan Marco" "apellidos" => "Figueira-Gonçalves" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario Lucus Augusti, Lugo, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neumología y Cirugía Torácica, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "University Institute of Tropical Disease and Public Health of the Canary Islands, University of La Laguna, Santa Cruz de Tenerife, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The special article “Multidisciplinary Management of Patients with Chronic Obstructive Pulmonary Disease and Cardiovascular Disease” represents an interesting and much-needed effort to create a comprehensive guideline on an important yet somewhat neglected topic.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> However, we would like to make some considerations regarding the manuscript.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The authors have discussed the potential risks of pulmonary toxicity associated with commonly used cardiovascular drugs such as amiodarone and beta-blockers, as well as the cardiovascular risks of respiratory medications like bronchodilators. Long-term use of azithromycin is recommended for COPD patients with chronic bronchial infection and frequent exacerbations<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a>; however, there are concerns about serious adverse cardiovascular effects due to its potential proarrhythmic effects, especially in patients with a high baseline risk of cardiovascular disease.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Therefore, it is advisable to use this antibiotic with caution in patients with cardiovascular disease, avoiding its use in those with a prolonged QT interval in their electrocardiogram, and to monitor the QT interval after initiating treatment.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Furthermore, theophylline is recommended as a third-line therapy for COPD patients with uncontrolled dyspnea.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> As theophylline has a narrow therapeutic window and can cause cardiac arrhythmias, it should be avoided or closely monitored in patients with cardiovascular disease, especially those who are taking multiple medications due to potential interactions.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Regarding the recommendation stated in Table 3 of prescribing triple therapy for COPD exacerbators to reduce exacerbations and mortality, we believe that it should be somewhat tempered. We agree with the authors comment that the benefits of triple therapy over double bronchodilation (LABA plus LAMA) in COPD are mostly seen in exacerbator patients with a baseline blood eosinophil count of 100<span class="elsevierStyleHsp" style=""></span>cells/mm<span class="elsevierStyleSup">3</span> or higher.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Taking into account the broad audience of the manuscript beyond the pulmonology field, it may be advisable to explicitly state caution in using triple therapy in patients with low eosinophil counts. These patients are unlikely to benefit from inhaled corticosteroids (ICS), which may have significant adverse effects, particularly in patients with cardiovascular disease. There is controversy surrounding the potential impact of prolonged use of inhaled ICS on worsening diabetes mellitus (DM) control or increasing the incidence of DM.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> DM is both a cardiovascular risk factor and a risk factor for exacerbation and death in COPD.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Therefore, caution should be exercised when considering long-term use of ICS, especially in those patients with poor glycemic control since this could promote respiratory infection or chronic bronchial colonization, including those caused by potentially pathogenic microorganisms (i.e. <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>), which has been associated with an increased risk of cardiovascular events.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Artificial intelligence involvement</span><p id="par0025" class="elsevierStylePara elsevierViewall">No AI tool or software has been used to produce this manuscript.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">This manuscript has received no funding.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">Rafael Golpe declares that he has received speaking or advisory fees, or economic aid to attend congresses from Astra-Zeneca, GSK, Novartis, FAES, Chiesi, Mundipharma, Menarini, TEVA, Grifols, Ferrer, Boehringer-Ingelheim, Rovi, and Gebro.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Juan Marco Figueira-Gonçalves has received speaking or advisory fees, or economic aid to attend congresses from Laboratorio Esteve, Mundipharma, Astra-Zeneca, Boehringer-Ingelheim, Ferrer, Menarini, Rovi, GlaxoSmithKline, Chiesi, Novartis y GebroPharma.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Artificial intelligence involvement" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multidisciplinary management of patients with chronic obstructive pulmonary disease and cardiovascular disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. de Miguel-Díez" 1 => "J. Núñez Villota" 2 => "S. Santos Pérez" 3 => "N. Manito Lorite" 4 => "B. Alcázar Navarrete" 5 => "J.F. Delgado Jiménez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2024.01.013" "Revista" => array:7 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2024" "volumen" => "60" "paginaInicial" => "226" "paginaFinal" => "237" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/38383272" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0749806322002869" "estado" => "S300" "issn" => "07498063" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spanish COPD Guidelines (GesEPOC) 2021: updated pharmacological treatment of stable COPD" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Miravitlles" 1 => "M. Calle" 2 => "J. Molina" 3 => "P. Almagro" 4 => "J.T. Gómez" 5 => "J.A. Trigueros" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2022.02.006" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2022" "volumen" => "58" "paginaInicial" => "69" "paginaFinal" => "81" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/35431085" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Azithromycin and the risk of cardiovascular death" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "W.A. Ray" 1 => "K.T. Murray" 2 => "K. Hall" 3 => "P.G. Arbogast" 4 => "C.M. Stein" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1003833" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2012" "volumen" => "366" "paginaInicial" => "1881" "paginaFinal" => "1890" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22591294" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Impact of inhaled and intranasal corticosteroids on glucose metabolism and diabetes mellitus: a mini review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K.C. See" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4239/wjd.v14.i8.1202" "Revista" => array:6 [ "tituloSerie" => "World J Diabetes" "fecha" => "2023" "volumen" => "14" "paginaInicial" => "1202" "paginaFinal" => "1211" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/37664474" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diabetes as a risk factor for severe exacerbation and death in patients with COPD: a prospective cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.T. Castañ-Abad" 1 => "J. Montserrat-Capdevila" 2 => "P. Godoy" 3 => "J.R. Marsal" 4 => "M. Ortega" 5 => "M. Alsedà" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurpub/ckz219" "Revista" => array:6 [ "tituloSerie" => "Eur J Public Health" "fecha" => "2020" "volumen" => "30" "paginaInicial" => "822" "paginaFinal" => "827" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31951259" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000006000000006/v2_202408290625/S030028962400067X/v2_202408290625/en/main.assets" "Apartado" => array:4 [ "identificador" => "97467" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Discussion Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000006000000006/v2_202408290625/S030028962400067X/v2_202408290625/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S030028962400067X?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 7 | 0 | 7 |
| 2024 September | 18 | 2 | 20 |
| 2024 August | 2 | 2 | 4 |
| 2024 July | 54 | 2 | 56 |
| 2024 June | 105 | 17 | 122 |
| 2024 May | 117 | 25 | 142 |
| 2024 April | 125 | 30 | 155 |
| 2024 March | 178 | 77 | 255 |
