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Soriano" "autores" => array:8 [ 0 => array:2 [ "nombre" => "Julio" "apellidos" => "Ancochea" ] 1 => array:2 [ "nombre" => "Marc" "apellidos" => "Miravitlles" ] 2 => array:2 [ "nombre" => "Francisco" "apellidos" => "García-Río" ] 3 => array:2 [ "nombre" => "Luis" "apellidos" => "Muñoz" ] 4 => array:2 [ "nombre" => "Guadalupe" "apellidos" => "Sánchez" ] 5 => array:2 [ "nombre" => "Víctor" "apellidos" => "Sobradillo" ] 6 => array:2 [ "nombre" => "Enric" "apellidos" => "Duran-Tauleria" ] 7 => array:2 [ "nombre" => "Joan B." "apellidos" => "Soriano" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289612003328" "doi" => "10.1016/j.arbres.2012.11.010" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289612003328?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212913000712?idApp=UINPBA00003Z" "url" => "/15792129/0000004900000006/v1_201306280033/S1579212913000712/v1_201306280033/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "The Underdiagnosis of Chronic Obstructive Pulmonary Disease in Women. Another Pending Task?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "221" "paginaFinal" => "222" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Aurelio Arnedillo Muñoz" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Aurelio" "apellidos" => "Arnedillo Muñoz" "email" => array:2 [ 0 => "aure152@separ.es" 1 => "arnedillo@comcadiz.com" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "U.G.C. de Neumología y Alergia, Hospital Universitario Puerta del Mar, Cádiz, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El infradiagnóstico de la enfermedad pulmonar obstructiva crónica en mujeres. ¿Otra tarea pendiente?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The prevalence of Chronic Obstructive Pulmonary disease (COPD) in various epidemiological studies conducted in Europe is between 5% and 11%, with a higher prevalence in men than in women. This can be explained by the higher prevalence of smoking in males, which is the principal risk factor associated with COPD, at least in industrialised countries.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">However, in recent years we have witnessed an increase in the prevalence of COPD in women, due to their incorporation to smoking in the 1960–1970s in developed countries,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> (incorporation which has been somewhat later in Spain) and the exposure to other risk factors such as the combustion of biomass products, especially in developing countries.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> In fact, in the year 2000 in the United States, mortality due to COPD in women exceeded that in men for the first time.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">From a symptomatic point of view, women with COPD have more dyspnoea, a higher prevalence of anxiety and depression and lower quality of life with respect to men for the same lung function and intensity of smoking, and more often have a chronic bronchitis-like phenotype, while males are more likely to have an emphysema phenotype. Furthermore, the loss of lung function that they experience may be greater than in men, and they have more difficulty in quitting smoking.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Despite the increase in the prevalence of COPD in women, underdiagnosis in females is usually greater than in men. A clear example of this underdiagnosis was shown by Chapman et al.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In their study, they showed that when hypothetical cases of smokers with dyspnoea and cough were presented to Primary Care physicians, in which the only parameters that varied were sex and age, the probability of diagnosing COPD in men was greater than in women (58% vs 42%, <span class="elsevierStyleItalic">P</span><.05).<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In the study published in this edition of <span class="elsevierStyleItalic">Archivos de Bronconeumología</span>, Ancochea et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> present results on the underdiagnosis of COPD in women in Spain, its regional distribution and determinants, extracted from the EPI-SCAN epidemiological study. In this study, the rate of underdiagnosis in patients with COPD was very high, 73% in the population aged between 40 and 80 years, although somewhat lower than the 78.2% described 10 years earlier in the IBERPOC study. The distribution of this underdiagnosis varied according to sex, and was greater in women than in men (86% vs 67.6%, <span class="elsevierStyleItalic">P</span><.05).</p><p id="par0030" class="elsevierStylePara elsevierViewall">These women were younger, smoked less and had better lung function on the spirometry than men. By geographical areas, the underdiagnosis of COPD in women was widespread, although it was particularly significant in the areas of Córdoba and Vic, the latter area having a 100% rate of underdiagnosis in women.</p><p id="par0035" class="elsevierStylePara elsevierViewall">It should be highlighted that in this underdiagnosed group of women with COPD, more than half did not smoke (55.3%). Similar data have been published in the PLATINO study, conducted in Latin America, in which 48.1% of the women diagnosed with COPD had never smoked either.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> This leads us to think that other risk factors in addition to direct smoking could be contributing to the development of COPD, such as passive smoking and exposure to environmental and occupational pollutants, which could play a greater role than initially thought.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Orozco-Levi et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> studied a group of women discharged after admission for exacerbation of COPD in Barcelona, and observed that 70% had never smoked; however, 85% of these women had been exposed to coal and/or wood combustion smoke, and there was an association between this exposure and COPD. The association between the exposure time and the development of COPD would also suggest a dose-response curve.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The findings of this study are consistent with the data obtained by Ancochea et al.,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> and show that there is a significant percentage of women with COPD who are not smokers and who may be exposed to other aetiological factors. This characteristic is an important aspect to bear in mind in the diagnostic approach to these patients.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Another factor to take into account is the age of the women diagnosed with COPD. Age within the group of non-smokers with COPD is often higher than the age of the group of smokers, which may lead to overdiagnosis of COPD, especially when the degree of impairment is mild using GOLD criteria, as happened in this study in most patients.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The population recruited in the EPI-SCAN study was aged between 40 and 80 years, and there are publications that have demonstrated this tendency to overdiagnosis in the population aged over 65 years when a ratio between the forced expiratory volume in the first second (FEV<span class="elsevierStyleInf">1</span>) and the forced vital capacity (FVC) that is less than 0.7 is used to define obstruction.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9,10</span></a> This occurs even in the healthy non-smoking population. Considering the increase in life expectancy (which furthermore is longer in women than in men), this may lead to bias in the interpretation of results that may be more pronounced in women.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In short, the study by Ancochea et al.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> reveals the significant underdiagnosis that exists in Spain in women with COPD, and leads us to reflect on how to improve its diagnosis in this patient group. It is therefore important that we doctors change our perception of COPD in women, and that we are aware of its different characteristics compared to men with this disease. Perhaps in this way we can help to increase its diagnosis and resolve this task we have pending with our female patients with COPD.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Arnedillo Muñoz A. El infradiagnóstico de la enfermedad pulmonar obstructiva crónica en mujeres. ¿Otra tarea pendiente? Arch Bronconeumol. 2013;49:221–2.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Differences between males and females in the natural history of asthma and COPD" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "L. 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2022 April | 38 | 27 | 65 |
2022 March | 40 | 36 | 76 |
2022 February | 32 | 31 | 63 |
2022 January | 26 | 36 | 62 |
2021 December | 39 | 33 | 72 |
2021 November | 43 | 42 | 85 |
2021 October | 38 | 33 | 71 |
2021 September | 26 | 48 | 74 |
2021 August | 24 | 40 | 64 |
2021 July | 36 | 26 | 62 |
2021 June | 28 | 20 | 48 |
2021 May | 47 | 34 | 81 |
2021 April | 75 | 42 | 117 |
2021 March | 41 | 15 | 56 |
2021 February | 24 | 19 | 43 |
2021 January | 26 | 11 | 37 |
2020 December | 23 | 15 | 38 |
2020 November | 15 | 12 | 27 |
2020 October | 16 | 8 | 24 |
2020 September | 13 | 6 | 19 |
2020 August | 21 | 12 | 33 |
2020 July | 20 | 18 | 38 |
2020 June | 19 | 1 | 20 |
2020 May | 16 | 13 | 29 |
2020 April | 38 | 21 | 59 |
2020 March | 27 | 10 | 37 |
2020 February | 30 | 31 | 61 |
2020 January | 37 | 14 | 51 |
2019 December | 34 | 14 | 48 |
2019 November | 36 | 16 | 52 |
2019 October | 13 | 8 | 21 |
2019 September | 12 | 7 | 19 |
2019 August | 22 | 12 | 34 |
2019 July | 23 | 8 | 31 |
2019 June | 20 | 12 | 32 |
2019 May | 30 | 8 | 38 |
2019 April | 52 | 31 | 83 |
2019 March | 43 | 21 | 64 |
2019 February | 28 | 13 | 41 |
2019 January | 25 | 10 | 35 |
2018 December | 23 | 17 | 40 |
2018 November | 55 | 14 | 69 |
2018 October | 79 | 17 | 96 |
2018 September | 32 | 13 | 45 |
2018 May | 15 | 0 | 15 |
2018 April | 36 | 7 | 43 |
2018 March | 44 | 2 | 46 |
2018 February | 18 | 2 | 20 |
2018 January | 23 | 9 | 32 |
2017 December | 38 | 3 | 41 |
2017 November | 27 | 3 | 30 |
2017 October | 21 | 8 | 29 |
2017 September | 36 | 3 | 39 |
2017 August | 46 | 10 | 56 |
2017 July | 39 | 6 | 45 |
2017 June | 51 | 10 | 61 |
2017 May | 49 | 10 | 59 |
2017 April | 35 | 5 | 40 |
2017 March | 35 | 19 | 54 |
2017 February | 22 | 3 | 25 |
2017 January | 16 | 6 | 22 |
2016 December | 35 | 9 | 44 |
2016 November | 39 | 12 | 51 |
2016 October | 59 | 15 | 74 |
2016 September | 45 | 18 | 63 |
2016 August | 64 | 13 | 77 |
2016 July | 30 | 9 | 39 |
2016 March | 2 | 0 | 2 |
2016 February | 1 | 0 | 1 |
2015 December | 3 | 0 | 3 |
2015 October | 42 | 3 | 45 |
2015 September | 36 | 10 | 46 |
2015 August | 43 | 12 | 55 |
2015 July | 32 | 4 | 36 |
2015 June | 36 | 2 | 38 |
2015 May | 51 | 11 | 62 |
2015 April | 42 | 7 | 49 |
2015 March | 41 | 8 | 49 |
2015 February | 32 | 5 | 37 |
2015 January | 37 | 7 | 44 |
2014 December | 42 | 7 | 49 |
2014 November | 31 | 7 | 38 |
2014 October | 42 | 15 | 57 |
2014 September | 34 | 11 | 45 |
2014 August | 30 | 14 | 44 |
2014 July | 35 | 12 | 47 |
2014 June | 42 | 13 | 55 |
2014 May | 55 | 17 | 72 |
2014 April | 44 | 14 | 58 |
2014 March | 65 | 16 | 81 |
2014 February | 43 | 17 | 60 |
2014 January | 40 | 13 | 53 |
2013 December | 50 | 13 | 63 |
2013 November | 38 | 9 | 47 |
2013 October | 38 | 14 | 52 |
2013 September | 43 | 14 | 57 |
2013 July | 0 | 1 | 1 |
2013 June | 1 | 2 | 3 |
2013 May | 2 | 7 | 9 |