Letter to the Editor
2014 GesEPOC and Systemic Steroids in Chronic Obstructive Pulmonary Disease (COPD) Exacerbation: An Update
Actualización de GesEPOC 2014 y corticoides sistémicos en la agudización de enfermedad pulmonar obstructiva crónica (EPOC)
a Servicio de Neumología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña(CHUAC), SERGAS, A Coruña, Spain
b Imperial College London Academic Unit of Respiratory Medicine at Royal Brompton Hospital, London, United Kingdom
c Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Virgen del Rocío, Sevilla, Spain
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Marcos, Arturo Huerta, Eduardo Márquez-Martín" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Pedro J." "apellidos" => "Marcos" "email" => array:1 [ 0 => "pedro.jorge.marcos.rodriguez@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" => "Arturo" "apellidos" => "Huerta" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Eduardo" "apellidos" => "Márquez-Martín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña(CHUAC), SERGAS, A Coruña, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Imperial College London Academic Unit of Respiratory Medicine at Royal Brompton Hospital, London, United Kingdom" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Virgen del Rocío, Sevilla, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Actualización de GesEPOC 2014 y corticoides sistémicos en la agudización de enfermedad pulmonar obstructiva crónica (EPOC)" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read the latest version of the Spanish guidelines on COPD (GesEPOC), published recently (January 2014) in Archivos de Bronconeumología.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> When the AUDIEPOC study was published in July 2012, we observed that there was little homogeneity in the management of COPD exacerbation at the national level.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> A more rigorous review of the published data revealed that this variability also exists in the use of systemic corticosteroids during exacerbations. In the 2014 update, GesEPOC clinical guidelines propose a change in systemic corticosteroid treatment during exacerbations. Thus, the original version recommended a short course of 7–10 days,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> while in the 2014 update, the guidelines <span class="elsevierStyleItalic">support</span> the use of “<span class="elsevierStyleItalic">short 5-day courses for</span> […] <span class="elsevierStyleItalic">exacerbations that do not require hospitalization</span>”.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We believe that this change is based essentially on data from the REDUCE clinical trial,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> which compared treatment with a short 5-day course of 40<span class="elsevierStyleHsp" style=""></span>mg of prednisone versus a 14-day course during exacerbations. The trial showed a similar reexacerbation rate, with the advantage of lower exposure to corticosteroids and very similar findings as regards outcomes (hospital stay and deaths).</p><p id="par0015" class="elsevierStylePara elsevierViewall">We agree that exacerbations can be managed with lower doses and shorter treatment times than those used in routine clinical practice. At the same time, we consider that this conclusion, currently limited by the guidelines to outpatients, could also be extended to some patients with more severe exacerbations who require hospital admission. In the REDUCE clinical trial, of the 314 patients who attended the Emergency Department (311 evaluated) and were randomized to receive a short or long corticosteroid regimen, 289 (92%) patients were admitted to hospital. The groups were adequately balanced with respect to COPD severity (GOLD 2, 3 and 4 in both groups) and clinical presentation (vital signs, oxygenation on admission, leukocytosis).</p><p id="par0020" class="elsevierStylePara elsevierViewall">The meta-analysis published by Cheng et al.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> also reinforces the hypothesis that lower doses of corticosteroids (30–80<span class="elsevierStyleHsp" style=""></span>mg of prednisolone for 5 days) can be safely used in inpatients with COPD exacerbation.</p><p id="par0025" class="elsevierStylePara elsevierViewall">This meta-analysis and the REDUCE clinical trial are perhaps the only studies to support short in-hospital regimens, and further research will probably be required to confirm this in special populations (e.g. patients with persistent bronchospasm). However, we consider that GesEPOC guidelines should include this patient population, and indicate that this treatment regimen is not limited to outpatients treated for COPD exacerbation.</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: Marcos PJ, Huerta A, Márquez-Martín E. Actualización de GesEPOC 2014 y corticoides sistémicos en la agudización de enfermedad pulmonar obstructiva crónica (EPOC). Arch Bronconeumol. 2015;51:360.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guía Española de la EPOC (GesEPOC). Actualización" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Miravitlles" 1 => "J.J. Soler-Cataluña" 2 => "M.D. Calle" 3 => "J. Molina" 4 => "P. Almagro" 5 => "J.A. Quintano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0300-2896(14)70070-5" "Revista" => array:7 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2014" "volumen" => "50" "numero" => "Suppl. 1" "paginaInicial" => "1" "paginaFinal" => "16" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24507959" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical audit of COPD patients requiring hospital admissions in Spain: AUDIPOC study" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "AUDIPOC Study Group" "etal" => true "autores" => array:6 [ 0 => "F. Pozo-Rodríguez" 1 => "J.L. 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Leuppi" 1 => "P. Schuetz" 2 => "R. Bingisser" 3 => "M. Bodmer" 4 => "M. Briel" 5 => "T. Drescher" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jama.2013.5023" "Revista" => array:7 [ "tituloSerie" => "JAMA" "fecha" => "2013" "volumen" => "309" "paginaInicial" => "2223" "paginaFinal" => "2231" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23695200" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0022534707028698" "estado" => "S300" "issn" => "00225347" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systemic corticosteroid for COPD exacerbations, whether the higher dose is better? A meta-analysis of randomized controlled trials" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Cheng" 1 => "Y. Gong" 2 => "Y. Guo" 3 => "Q. Cheng" 4 => "M. Zhou" 5 => "G. Shi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/crj.12008" "Revista" => array:7 [ "tituloSerie" => "Clin Respir J" "fecha" => "2013" "volumen" => "7" "paginaInicial" => "305" "paginaFinal" => "318" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23072733" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0022534713051355" "estado" => "S300" "issn" => "00225347" ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005100000007/v1_201506250123/S1579212915001202/v1_201506250123/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005100000007/v1_201506250123/S1579212915001202/v1_201506250123/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212915001202?idApp=UINPBA00003Z" ]
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| 2017 November | 17 | 3 | 20 |
| 2017 October | 18 | 7 | 25 |
| 2017 September | 16 | 5 | 21 |
| 2017 August | 17 | 9 | 26 |
| 2017 July | 10 | 4 | 14 |
| 2017 June | 29 | 26 | 55 |
| 2017 May | 26 | 6 | 32 |
| 2017 April | 18 | 10 | 28 |
| 2017 March | 16 | 13 | 29 |
| 2017 February | 8 | 8 | 16 |
| 2017 January | 16 | 6 | 22 |
| 2016 December | 21 | 7 | 28 |
| 2016 November | 21 | 15 | 36 |
| 2016 October | 33 | 17 | 50 |
| 2016 September | 33 | 11 | 44 |
| 2016 August | 46 | 17 | 63 |
| 2016 July | 29 | 11 | 40 |
| 2016 March | 3 | 0 | 3 |
| 2015 December | 4 | 0 | 4 |
| 2015 November | 1 | 16 | 17 |
| 2015 October | 30 | 4 | 34 |
| 2015 September | 1 | 1 | 2 |
| 2015 August | 0 | 1 | 1 |
| 2015 July | 0 | 1 | 1 |
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