Prognostic Factors in Chronic Obstructive Pulmonary Disease

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Soler Cataluña. Unidad de Neumología. Servicio de Medicina Interna. Hospital General de Requena. Paraje Casablanca, s/n.46340 Requena. Valencia. España" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2007-01-01" "fechaAceptado" => "2007-04-10" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec154717" "palabras" => array:3 [ 0 => "COPD" 1 => "Prognostic factors" 2 => "Predictors of mortality" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec154716" "palabras" => array:3 [ 0 => "EPOC" 1 => "Factores pronósticos" 2 => "Predictores de mortalidad" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "Efforts over the last few decades to extend the life expectancy of patients with chronic obstructive pulmonary disease (COPD) have faced difficulties, but our perception of the problems involved is now starting to change. Improvements in our understanding of the pathogenic and etiological mechanisms of the disease, analysis of the causes of death, and, in particular, identification of the relevant prognostic factors have resulted in firm advances that allow us to face the future with greater optimism. The aim of this review is to provide a detailed analysis of the chief prognostic factors described in the literature and to evaluate the therapeutic implications of these findings. The traditional view maintained that the accelerated decline over time in forced expiratory volume in 1 second was one of the best predictors of mortality, and this belief has for decades determined the strategies used to treat COPD. However, we now know COPD to be a multidimensional disease and are aware that some of its other manifestations have important prognostic implications. Lung hyperinflation, exercise tolerance, exacerbations, comorbidity, and systemic manifestations–in particular those related to the cardiovascular system–have all been shown in recent years to be strong predictors of mortality. The inflammatory substrate, whether local or systemic, merits special consideration because it appears to be the cause of many of these manifestations. These newly identified prognostic factors are of great interest in that it may be possible to moderate their influence, a circumstance that highlights the need to change the traditional treatment approach and devise therapeutic interventions oriented towards reversing the effects of these factors." ] "es" => array:1 [ "resumen" => "Prolongar la supervivencia de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) es, y ha sido durante décadas, un objetivo complicado. Sin embargo, poco a poco esta percepción empieza a cambiar. De la mano de un mejor conocimiento etiopatogénico de la enfermedad, del análisis de las causas de muerte y sobre todo de la identificación de diversos factores pronósticos, se van dando pasos firmes que permiten afrontar el futuro con mayor optimismo. La presente revisión pretende analizar de forma pormenorizada los principales determinantes pronósticos que se han descrito en la literatura médica y valorar sus posibles implicaciones terapéuticas. Tradicionalmente se ha aceptado que el volumen espiratorio forzado en el primer segundo y su descenso acelerado a lo largo del tiempo era uno de los mejores predictores de mortalidad. Este hecho condicionó durante décadas el objetivo terapéutico en la EPOC. Sin embargo, hoy sabemos que la EPOC es una enfermedad con múltiples dimensiones, algunas de las cuales tienen importantes consecuencias pronósticas. La hiperinsuflación pulmonar, la tolerancia al esfuerzo, las exacerbaciones, la comorbilidad y las manifestaciones sistémicas, especialmente las resultantes de la esfera cardiovascular, son dimensiones que en los últimos años se han revelado como potentes predictores de muerte. El sustrato inflamatorio, tanto local como sistémico, parece estar detrás de muchas de estas manifestaciones y por ello merece especial consideración. Estos nuevos factores pronósticos tienen la virtud de ser potencialmente modificables, lo que subraya la necesidad de planificar intervenciones terapéuticas orientadas a revertir sus efectos cambiando de alguna forma la estrategia tradicional." ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:140 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prognosis in chronic obstructive pulmonary disease" "autores" => array:1 [ 0 => array:2 [ …2] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1164/arrd.1986.133.1.14" "Revista" => array:6 [ "tituloSerie" => "Am Rev Respir Dis" "fecha" => "1986" "volumen" => "133" "paginaInicial" => "14" "paginaFinal" => "20" "link" => array:1 [ …1] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Analysis of the factors related to mortality in chronic obstructive pulmonary disease. 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Prognostic Factors in Chronic Obstructive Pulmonary Disease

Juan José Soler Cataluña

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jjsoler@telefonica.net

Correspondence: Dr. J.J. Soler Cataluña. Unidad de Neumología. Servicio de Medicina Interna. Hospital General de Requena. Paraje Casablanca, s/n.46340 Requena. Valencia. España

, Miguel Ángel Martínez García

Unidad de Neumología, Servicio de Medicina Interna, Hospital General de Requena, Requena, Valencia, Spain

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        "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">Efforts over the last few decades to extend the life expectancy of patients with chronic obstructive pulmonary disease &#40;COPD&#41; have faced difficulties&#44; but our perception of the problems involved is now starting to change&#46; Improvements in our understanding of the pathogenic and etiological mechanisms of the disease&#44; analysis of the causes of death&#44; and&#44; in particular&#44; identification of the relevant prognostic factors have resulted in firm advances that allow us to face the future with greater optimism&#46; The aim of this review is to provide a detailed analysis of the chief prognostic factors described in the literature and to evaluate the therapeutic implications of these findings&#46; The traditional view maintained that the accelerated decline over time in forced expiratory volume in 1 second was one of the best predictors of mortality&#44; and this belief has for decades determined the strategies used to treat COPD&#46; However&#44; we now know COPD to be a multidimensional disease and are aware that some of its other manifestations have important prognostic implications&#46; Lung hyperinflation&#44; exercise tolerance&#44; exacerbations&#44; comorbidity&#44; and systemic manifestations&#8211;in particular those related to the cardiovascular system&#8211;have all been shown in recent years to be strong predictors of mortality&#46; The inflammatory substrate&#44; whether local or systemic&#44; merits special consideration because it appears to be the cause of many of these manifestations&#46; These newly identified prognostic factors are of great interest in that it may be possible to moderate their influence&#44; a circumstance that highlights the need to change the traditional treatment approach and devise therapeutic interventions oriented towards reversing the effects of these factors&#46;</p>"
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        "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">Prolongar la supervivencia de los pacientes con enfermedad pulmonar obstructiva cr&#243;nica &#40;EPOC&#41; es&#44; y ha sido durante d&#233;cadas&#44; un objetivo complicado&#46; Sin embargo&#44; poco a poco esta percepci&#243;n empieza a cambiar&#46; De la mano de un mejor conocimiento etiopatog&#233;nico de la enfermedad&#44; del an&#225;lisis de las causas de muerte y sobre todo de la identificaci&#243;n de diversos factores pron&#243;sticos&#44; se van dando pasos firmes que permiten afrontar el futuro con mayor optimismo&#46; La presente revisi&#243;n pretende analizar de forma pormenorizada los principales determinantes pron&#243;sticos que se han descrito en la literatura m&#233;dica y valorar sus posibles implicaciones terap&#233;uticas&#46; Tradicionalmente se ha aceptado que el volumen espiratorio forzado en el primer segundo y su descenso acelerado a lo largo del tiempo era uno de los mejores predictores de mortalidad&#46; Este hecho condicion&#243; durante d&#233;cadas el objetivo terap&#233;utico en la EPOC&#46; Sin embargo&#44; hoy sabemos que la EPOC es una enfermedad con m&#250;ltiples dimensiones&#44; algunas de las cuales tienen importantes consecuencias pron&#243;sticas&#46; La hiperinsuflaci&#243;n pulmonar&#44; la tolerancia al esfuerzo&#44; las exacerbaciones&#44; la comorbilidad y las manifestaciones sist&#233;micas&#44; especialmente las resultantes de la esfera cardiovascular&#44; son dimensiones que en los &#250;ltimos a&#241;os se han revelado como potentes predictores de muerte&#46; El sustrato inflamatorio&#44; tanto local como sist&#233;mico&#44; parece estar detr&#225;s de muchas de estas manifestaciones y por ello merece especial consideraci&#243;n&#46; Estos nuevos factores pron&#243;sticos tienen la virtud de ser potencialmente modificables&#44; lo que subraya la necesidad de planificar intervenciones terap&#233;uticas orientadas a revertir sus efectos cambiando de alguna forma la estrategia tradicional&#46;</p>"
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Article information

ISSN: 15792129
Original language: English

DOI:10.1016/S1579-2129(07)60155-4

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Year/Month	Html	Pdf	Total

2024 November	5	4	9
2024 October	32	17	49
2024 September	34	25	59
2024 August	47	39	86
2024 July	28	20	48
2024 June	26	23	49
2024 May	40	26	66
2024 April	16	23	39
2024 March	31	19	50
2024 February	23	18	41
2023 March	2	0	2
2023 February	14	18	32
2023 January	16	27	43
2022 December	16	21	37
2022 November	21	19	40
2022 October	35	46	81
2022 September	19	22	41
2022 August	18	37	55
2022 July	20	41	61
2022 June	31	31	62
2022 May	26	34	60
2022 April	27	26	53
2022 March	60	42	102
2022 February	46	46	92
2022 January	56	42	98
2021 December	41	42	83
2021 November	17	50	67
2021 October	38	47	85
2021 September	22	65	87
2021 August	12	35	47
2021 July	10	23	33
2021 June	9	29	38
2021 May	16	24	40
2021 April	30	62	92
2021 March	19	36	55
2021 February	9	20	29
2021 January	9	16	25
2020 December	10	18	28
2020 November	6	25	31
2020 October	4	15	19
2020 September	5	7	12
2020 August	9	15	24
2020 July	12	12	24
2020 June	8	4	12
2020 May	13	14	27
2020 April	15	10	25
2020 March	8	14	22
2020 February	12	20	32
2020 January	12	17	29
2019 December	4	20	24
2019 November	20	11	31
2019 October	6	17	23
2019 September	10	15	25
2019 August	12	9	21
2019 July	11	24	35
2019 June	7	16	23
2019 May	11	25	36
2019 April	15	33	48
2019 March	11	24	35
2019 February	7	16	23
2019 January	3	16	19
2018 December	9	17	26
2018 November	13	27	40
2018 October	14	18	32
2018 September	10	8	18
2018 May	0	1	1
2018 April	10	24	34
2018 March	3	10	13
2018 February	4	8	12
2018 January	3	10	13
2017 December	3	11	14
2017 November	3	11	14
2017 October	4	15	19
2017 September	3	5	8
2017 August	6	15	21
2017 July	8	5	13
2017 June	8	12	20
2017 May	10	8	18
2017 April	3	6	9
2017 March	3	4	7
2017 February	1	4	5
2017 January	1	3	4
2016 December	7	5	12
2016 November	9	7	16
2016 October	7	5	12
2016 September	6	3	9
2016 August	7	3	10
2016 July	1	6	7
2016 May	1	0	1
2016 March	2	0	2
2015 December	2	0	2
2015 October	185	18	203
2015 September	197	10	207
2015 August	172	12	184
2015 July	195	7	202
2015 June	163	11	174
2015 May	142	10	152
2015 April	138	12	150
2015 March	149	6	155
2015 February	124	5	129
2015 January	131	4	135
2014 December	107	6	113
2014 November	155	9	164
2014 October	186	8	194
2014 September	135	12	147
2014 August	110	8	118
2014 July	119	11	130
2014 June	104	18	122
2014 May	104	6	110
2014 April	72	7	79
2014 March	90	8	98
2014 February	67	9	76
2014 January	53	7	60
2013 December	47	4	51
2013 November	47	4	51
2013 October	63	10	73
2013 September	51	9	60
2013 August	49	9	58
2013 July	58	18	76
2013 June	41	6	47
2013 May	41	8	49
2013 April	24	2	26
2013 March	8	1	9

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