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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">I would like to congratulate all the professionals involved in developing the GesEPOC guidelines &#91;Spanish COPD guidelines&#93; for their excellent review and recommendations&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However&#44; I sadly have difficulties in extrapolating their conclusions to the type of patient I usually see in Geriatric Departments&#44; even though one of the most common diagnoses encountered there is chronic obstructive pulmonary disease &#40;COPD&#41; or its respective exacerbations&#46; In fact&#44; it is surprising that patients over the age of 80 were excluded from one of the largest studies on the prevalence of COPD in Spain&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> when all studies indicate that it is one of the most significant and common diseases in the elderly&#44; and equally surprising is that elderly patients are hardly mentioned in the guidelines&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Since interpretation in multimorbid patients is a highly complex task&#44; elderly populations are routinely excluded from trials in numerous disciplines&#44; and the evidence obtained from young populations in a generally better state of health is taken as valid for older populations&#46; However&#44; in the case of COPD&#44; extrapolating the evidence from the younger population has a series of important limitations&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">From a diagnostic point of view&#44; for example&#44; some patients may present deafness&#44; impaired vision or sarcopenia &#40;among other limitations&#41;&#44; causing difficulties in the correct performance and&#44; as a result&#44; the correct interpretation of spirometry tests&#46; Functional or cognitive deficits can make complex tests&#44; or even something as simple as the 6-min-walk test&#44; difficult to perform and interpret&#46; Most clinical guidelines have numerous limitations&#44; since they do not evaluate the elderly patient&#39;s wide range of needs&#44; and the evidence obtained from these guidelines habitually underestimates the prevalence of side effects&#44; multimorbidity and polypharmacy&#44; as well as the functional&#44; cognitive and social aspects&#44; and does not reflect the clinical reality&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a> From a treatment point of view&#44; special consideration must be given to the iatrogenic effects that can occur in already polymedicated patients&#44; since many of the drugs regularly used in COPD can have significant side effects in the elderly&#46; In addition&#44; the incorrect administration of inhaled therapies can lead not only to possible poor treatment compliance but also to poorer results from conventional treatments&#46; Given the wide heterogeneity of this population&#44; specific guidelines adapted and stratified according to grades of frailty&#44; such as those already beginning to appear for some diseases like diabetes&#44; are required&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Although the new clinical practice guidelines in the treatment of patients with COPD &#40;GesEPOC&#41; are very useful&#44; for these reasons I feel that they are limited in their use in elderly patients and could be substantially improved in this sector of the population&#46; Despite the obvious difficulties in dealing with all aspects of COPD universally&#44; assigning a section exclusively to the elderly patient would provide significant benefits for their clinical management&#46; For future editions&#44; I would urge the authors to call on professional geriatric societies to contribute with their complementary point of view&#46;</p></span>"
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Letter to the Editor
GesEPOC Guidelines and Elderly Patients
Guía GesEPOC y pacientes ancianos
Nicolás Martínez Velilla
Servicio de Geriatría, Complejo Hospitalario de Navarra, Pamplona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">I would like to congratulate all the professionals involved in developing the GesEPOC guidelines &#91;Spanish COPD guidelines&#93; for their excellent review and recommendations&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However&#44; I sadly have difficulties in extrapolating their conclusions to the type of patient I usually see in Geriatric Departments&#44; even though one of the most common diagnoses encountered there is chronic obstructive pulmonary disease &#40;COPD&#41; or its respective exacerbations&#46; In fact&#44; it is surprising that patients over the age of 80 were excluded from one of the largest studies on the prevalence of COPD in Spain&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> when all studies indicate that it is one of the most significant and common diseases in the elderly&#44; and equally surprising is that elderly patients are hardly mentioned in the guidelines&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Since interpretation in multimorbid patients is a highly complex task&#44; elderly populations are routinely excluded from trials in numerous disciplines&#44; and the evidence obtained from young populations in a generally better state of health is taken as valid for older populations&#46; However&#44; in the case of COPD&#44; extrapolating the evidence from the younger population has a series of important limitations&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">From a diagnostic point of view&#44; for example&#44; some patients may present deafness&#44; impaired vision or sarcopenia &#40;among other limitations&#41;&#44; causing difficulties in the correct performance and&#44; as a result&#44; the correct interpretation of spirometry tests&#46; Functional or cognitive deficits can make complex tests&#44; or even something as simple as the 6-min-walk test&#44; difficult to perform and interpret&#46; Most clinical guidelines have numerous limitations&#44; since they do not evaluate the elderly patient&#39;s wide range of needs&#44; and the evidence obtained from these guidelines habitually underestimates the prevalence of side effects&#44; multimorbidity and polypharmacy&#44; as well as the functional&#44; cognitive and social aspects&#44; and does not reflect the clinical reality&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a> From a treatment point of view&#44; special consideration must be given to the iatrogenic effects that can occur in already polymedicated patients&#44; since many of the drugs regularly used in COPD can have significant side effects in the elderly&#46; In addition&#44; the incorrect administration of inhaled therapies can lead not only to possible poor treatment compliance but also to poorer results from conventional treatments&#46; Given the wide heterogeneity of this population&#44; specific guidelines adapted and stratified according to grades of frailty&#44; such as those already beginning to appear for some diseases like diabetes&#44; are required&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Although the new clinical practice guidelines in the treatment of patients with COPD &#40;GesEPOC&#41; are very useful&#44; for these reasons I feel that they are limited in their use in elderly patients and could be substantially improved in this sector of the population&#46; Despite the obvious difficulties in dealing with all aspects of COPD universally&#44; assigning a section exclusively to the elderly patient would provide significant benefits for their clinical management&#46; For future editions&#44; I would urge the authors to call on professional geriatric societies to contribute with their complementary point of view&#46;</p></span>"
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