array:23 [
  "pii" => "S1579212916000379"
  "issn" => "15792129"
  "doi" => "10.1016/j.arbr.2016.02.012"
  "estado" => "S300"
  "fechaPublicacion" => "2016-04-01"
  "aid" => "1301"
  "copyright" => "SEPAR"
  "copyrightAnyo" => "2016"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "sco"
  "cita" => "Arch Bronconeumol. 2016;52:177-8"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 2442
    "formatos" => array:3 [
      "EPUB" => 148
      "HTML" => 1649
      "PDF" => 645
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0300289616000119"
      "issn" => "03002896"
      "doi" => "10.1016/j.arbres.2015.11.015"
      "estado" => "S300"
      "fechaPublicacion" => "2016-04-01"
      "aid" => "1301"
      "copyright" => "SEPAR"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "sco"
      "cita" => "Arch Bronconeumol. 2016;52:177-8"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 8137
        "formatos" => array:3 [
          "EPUB" => 132
          "HTML" => 6798
          "PDF" => 1207
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
        "titulo" => "Enfermedad pulmonar obstructiva cr&#243;nica con eosinofilia&#44; &#191;un fenotipo emergente&#63;"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "177"
            "paginaFinal" => "178"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Chronic obstructive pulmonary disease with Eosinophilia&#44; an Emerging Phenotype&#63;"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Adolfo Baloira Villar, Abel Pallar&#233;s Sanmart&#237;n"
            "autores" => array:2 [
              0 => array:2 [
                "nombre" => "Adolfo"
                "apellidos" => "Baloira Villar"
              ]
              1 => array:2 [
                "nombre" => "Abel"
                "apellidos" => "Pallar&#233;s Sanmart&#237;n"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1579212916000379"
          "doi" => "10.1016/j.arbr.2016.02.012"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916000379?idApp=UINPBA00003Z"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289616000119?idApp=UINPBA00003Z"
      "url" => "/03002896/0000005200000004/v1_201603270531/S0300289616000119/v1_201603270531/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1579212916000628"
    "issn" => "15792129"
    "doi" => "10.1016/j.arbr.2016.01.020"
    "estado" => "S300"
    "fechaPublicacion" => "2016-04-01"
    "aid" => "1323"
    "copyright" => "Grupo BODE"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Arch Bronconeumol. 2016;52:179-80"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 3383
      "formatos" => array:3 [
        "EPUB" => 152
        "HTML" => 2395
        "PDF" => 836
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
      "titulo" => "Simplifying the Guidelines&#58; The 10 COPD Commandments"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "179"
          "paginaFinal" => "180"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Simplificando las gu&#237;as&#58; los 10 mandamientos de la epoc"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Jos&#233; Mar&#237;a Marin, Claudia Cote, Ciro Casanova, Victor Pinto-Plata, Mar&#237;a Montes de Oca, Miguel J Divo, Juan P de Torres, Javier Zulueta, Carlos Cabrera, Santiago Carrizo, Francesca Polverino, Bartolom&#233; R Celli"
          "autores" => array:13 [
            0 => array:2 [
              "nombre" => "Jos&#233; Mar&#237;a"
              "apellidos" => "Marin"
            ]
            1 => array:2 [
              "nombre" => "Claudia"
              "apellidos" => "Cote"
            ]
            2 => array:2 [
              "nombre" => "Ciro"
              "apellidos" => "Casanova"
            ]
            3 => array:2 [
              "nombre" => "Victor"
              "apellidos" => "Pinto-Plata"
            ]
            4 => array:2 [
              "nombre" => "Mar&#237;a"
              "apellidos" => "Montes de Oca"
            ]
            5 => array:2 [
              "nombre" => "Miguel J"
              "apellidos" => "Divo"
            ]
            6 => array:2 [
              "nombre" => "Juan P"
              "apellidos" => "de Torres"
            ]
            7 => array:2 [
              "nombre" => "Javier"
              "apellidos" => "Zulueta"
            ]
            8 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "Cabrera"
            ]
            9 => array:2 [
              "nombre" => "Santiago"
              "apellidos" => "Carrizo"
            ]
            10 => array:2 [
              "nombre" => "Francesca"
              "apellidos" => "Polverino"
            ]
            11 => array:2 [
              "nombre" => "Bartolom&#233; R"
              "apellidos" => "Celli"
            ]
            12 => array:1 [
              "colaborador" => "en representaci&#243;n del grupo BODE"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0300289616000338"
        "doi" => "10.1016/j.arbres.2016.01.012"
        "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/S0300289616000338?idApp=UINPBA00003Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916000628?idApp=UINPBA00003Z"
    "url" => "/15792129/0000005200000004/v2_201604010234/S1579212916000628/v2_201604010234/en/main.assets"
  ]
  "en" => array:12 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
    "titulo" => "Chronic Obstructive Pulmonary Disease With Eosinophilia&#44; an Emerging Phenotype&#63;"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "177"
        "paginaFinal" => "178"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Adolfo Baloira Villar, Abel Pallar&#233;s Sanmart&#237;n"
        "autores" => array:2 [
          0 => array:4 [
            "nombre" => "Adolfo"
            "apellidos" => "Baloira Villar"
            "email" => array:1 [
              0 => "adolfo&#46;baloira&#46;villar&#64;sergas&#46;es"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "Abel"
            "apellidos" => "Pallar&#233;s Sanmart&#237;n"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servicio de Neumolog&#237;a&#44; Complejo Hospitalario Universitario de Pontevedra&#44; Pontevedra&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Enfermedad pulmonar obstructiva cr&#243;nica con eosinofilia&#44; &#191;un fenotipo emergente&#63;"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic obstructive pulmonary disease &#40;COPD&#41; is diagnosed on the basis of a spirometry test&#44; which provides indirect data on the degree of resistance offered by the airways to the passage of gas within&#46; Currently&#44; no histological pattern&#44; biomarker&#44; or even clinical criteria can give a more accurate picture of what it means to have COPD&#46; Since it was first described&#44; over 60 years ago&#44; attempts have been made to differentiate COPD patients on the basis of clinical characteristics&#46; In recent years&#44; knowledge of the disease has increased significantly&#44; and specific disease types which have become to be known as COPD phenotypes have been characterized&#46; A phenotype is a description of the features presented by an individual&#44; caused by the interaction of their genetic makeup with the environment in which they live&#46; In all chronic diseases&#44; the damage generated by a noxious agent is modulated by the patient&#39;s response to that molecule&#46; The GesEPOC guideline<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> described 4 phenotypes &#40;exacerbator&#44; emphysema&#44; chronic bronchitis&#44; and overlap syndrome&#41;&#44; with characteristics more or less defined within the COPD spectrum&#46; It seems that this classification is set to change substantially in the next update of the guideline&#44; since after the first edition was published&#44; several studies have challenged some of the previously established concepts&#46; In our opinion&#44; 2 key points may need in-depth revision&#58; the &#8220;exacerbator&#8221; concept and the &#8220;COPD&#47;asthma overlap&#8221; phenotype&#46; According to the ECLIPSE study&#44; a patient with at least 2 exacerbations in the first year &#40;the definition of an exacerbator phenotype&#41; has about a 40&#37; chance of having 1 exacerbation or none in the second year&#44; while a patient who has been an exacerbator for the first 2 years&#44; has a 30&#37; chance of converting to a non-exacerbator phenotype in the third year&#46; Furthermore&#44; a patient who has not had any exacerbation during the first year&#44; has about a 35&#37; chance of having 2 in the second year&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> This &#8220;phenotype&#8221; seems rather variable over time&#44; to say the least&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">When COPD presents with asthma&#44; other problems emerge&#46; The definition of the overlap syndrome is imprecise&#44; no clear biomarkers have been defined&#44; and diagnosis is based on a series of consensus criteria with a modest grade of evidence&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;4</span></a> Many experts are firmly convinced that it is just 2 common diseases occurring together&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In recent years&#44; the importance of the role of eosinophils in a generally small group of COPD patients has emerged&#46; Eosinophilia is difficult to define&#46; Eosinophils are cells that tend to occur in small proportions in peripheral blood&#44; varying widely over time&#46; In the ECLIPSE cohort&#44; approximately 37&#37; of subjects had persistent eosinophil levels &#62;2&#37; in blood samples&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> a percentage similar to that described in healthy subjects&#46; However&#44; these patients were older&#44; predominantly male&#44; and fewer were active smokers&#46; They also had higher FEV1&#44; less dyspnea&#44; higher BODE index scores&#44; and generally appeared to have a more benign form of the disease&#46; Moreover&#44; their serum levels of CXCL8&#44; a chemokine involved in neutrophil recruitment&#44; was significantly lower&#44; possibly indicating some genetic modulation of the disease&#46; If a cutoff point of 150 cells &#40;absolute value&#41; is applied to the analysis&#44; the results are similar&#46; This would suggest that clinical and biochemical characteristics differ from those of patients whose eosinophil levels in blood are less than 2&#37;&#46; The significant correlation with eosinophilia in sputum in COPD should also be taken into consideration&#44; although the difficulty of using this test in routine clinical practice should be emphasized&#58; even in a series as sophisticated as the ECLIPSE&#44; only 138 of the 1438 patients evaluated were able to produce at least 3 valid sputum samples&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Why are blood eosinophils levels higher in some COPD patients&#63; The basis is apparently genetic&#44; as was shown in a study in 2 groups of patients in whom asthma was carefully ruled out&#46; Some of these patients revealed a &#8220;genetic signature&#8221;&#44; Th2&#44; characterized by a greater concentration of eosinophils&#44; both in the airways and in blood&#44; and some specific clinical features&#44; such as rapid loss of lung function and greater post-bronchodilator reversibility&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> For a proposed phenotype to have clinical importance&#44; it must be associated with a specific treatment&#44; and this seems to be the case for COPD patients with persistent eosinophilia&#46; In a subanalysis of the 2 studies designed to determine the efficacy of fluticasone furoate and vilaterol&#44; the addition of inhaled corticosteroids reduced exacerbations only in patients with blood eosinophils &#62;2&#37;&#46; Moreover&#44; the effect was greater in patients with higher percentages of eosinophils&#44; and at its height when eosinophil levels exceeded 6&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> Very similar findings were obtained from the FORWARD study&#44; designed to examine the effect of adding beclomethasone dipropionate to formoterol in patients with severe COPD&#46; When the 1184 FORWARD participants were divided into quartiles on the basis of their blood eosinophil level&#44; significant differences in the reduction of exacerbations were observed in the top 2 quartiles only&#44; with a cutoff point of 279 eosinophils&#47;microliter&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> In contrast&#44; a recent study with losmapimod&#44; a potent inhibitor of p38 MAPK&#44; in patients with moderate-severe COPD showed a 55&#37; reduction of exacerbations in patients with &#60;2&#37; eosinophils&#44; and no effect&#44; or even a trend toward more frequent exacerbations in patients with more than 2&#37; eosinophils&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> The protein kinase p38 MAPK is expressed in epithelial cells and macrophages activated by tobacco smoke&#44; leading to proliferation and activation of the macrophages and neutrophils themselves&#44; and alpha-tumor necrosis factor stimulation&#46; Inhibiting this pathway fundamentally affects the function of both these cell types&#46; This observation also appears to support the fact that some underlying cell pathways in COPD patients differ&#44; depending on the presence or absence of blood eosinophilia&#44; with the corresponding therapeutic implications&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">To date&#44; no specifically designed study has been conducted to determine the significance of blood eosinophilia in COPD&#44; limiting the strength of the data presented&#46; Only 1 small study has shown that treatment to reduce eosinophil levels in sputum as far as possible has a favorable impact on the reduction of exacerbations&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">To conclude&#44; evidence is emerging for what might be a specific COPD phenotype&#44; with differentiable clinical characteristics and specific treatment&#44; at least in part&#46; Obviously&#44; many aspects still need clarification&#44; the most important being perhaps the cutoff point for defining eosinophilia&#44; or if an absolute value or percentage of total leukocytes would be a better measure&#46; Nevertheless&#44; it seems likely that we are witnessing the birth of a new COPD phenotype&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Baloira Villar A&#44; Pallar&#233;s Sanmart&#237;n A&#46; Enfermedad pulmonar obstructiva cr&#243;nica con eosinofilia&#44; &#191;un fenotipo emergente&#63; Arch Bronconeumol&#46; 2016&#59;52&#58;177&#8211;178&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gu&#237;a de Pr&#225;ctica Cl&#237;nica para el Diagn&#243;stico y Tratamiento de Pacientes con Enfermedad Pulmonar Obstructiva Cr&#243;nica &#40;EPOC&#41; &#8211; Gu&#237;a Espa&#241;ola de la EPOC &#40;GesEPOC&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Grupo de Trabajo de GesEPOC"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0300-2896(12)70044-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2012"
                        "volumen" => "48"
                        "paginaInicial" => "2"
                        "paginaFinal" => "58"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23116901"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Susceptibility to exacerbation in chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;R&#46; Hurst"
                            1 => "J&#46; Vestbo"
                            2 => "A&#46; Anzueto"
                            3 => "N&#46; Locantore"
                            4 => "H&#46; M&#252;llerova"
                            5 => "R&#46; Tal-Singer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa0909883"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2010"
                        "volumen" => "363"
                        "paginaInicial" => "1128"
                        "paginaFinal" => "1138"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20843247"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The asthma-COPD overlap syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;S&#46; Postma"
                            1 => "K&#46;F&#46; Rabe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMra1411863"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2015"
                        "volumen" => "373"
                        "paginaInicial" => "1241"
                        "paginaFinal" => "1249"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26398072"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Consensus document on the overlap phenotype COPD-asthma in COPD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;J&#46; Soler-Catalu&#241;a"
                            1 => "B&#46; Cos&#237;o"
                            2 => "J&#46;L&#46; Izquierdo"
                            3 => "J&#46;L&#46; L&#243;pez-Campos"
                            4 => "J&#46;M&#46; Mar&#237;n"
                            5 => "R&#46; Ag&#252;ero"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arbres.2011.12.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2012"
                        "volumen" => "48"
                        "paginaInicial" => "331"
                        "paginaFinal" => "337"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22341911"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Eosinophilic inflammation in COPD&#58; prevalence and clinical characteristics"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46; Singh"
                            1 => "U&#46; Kolsum"
                            2 => "C&#46;E&#46; Brightling"
                            3 => "N&#46; Locantore"
                            4 => "A&#46; Agust&#237;"
                            5 => "R&#46; Tal-Singer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00162414"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2014"
                        "volumen" => "44"
                        "paginaInicial" => "1697"
                        "paginaFinal" => "1700"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25323230"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Asthma-COPD overlap&#46; Clinical relevance of genomic signatures of type 2 inflammation in chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;A&#46; Christenson"
                            1 => "K&#46; Steiling"
                            2 => "M&#46; van den Berge"
                            3 => "K&#46; Hijazi"
                            4 => "P&#46;S&#46; Hiemstra"
                            5 => "D&#46;S&#46; Postma"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.201408-1458OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2015"
                        "volumen" => "191"
                        "paginaInicial" => "758"
                        "paginaFinal" => "766"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25611785"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Blood eosinophil counts&#44; exacerbations&#44; and response to the addition of inhaled fluticasone furoate to vilanterol in patients with chronic obstructive pulmonary disease&#58; a secondary analysis of date from two parallel randomised controlled trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46; Pascoe"
                            1 => "N&#46; Locantore"
                            2 => "M&#46;T&#46; Dransfield"
                            3 => "N&#46;C&#46; Barnes"
                            4 => "I&#46;D&#46; Pavord"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S2213-2600(15)00106-X"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet Respir Med"
                        "fecha" => "2015"
                        "volumen" => "3"
                        "paginaInicial" => "435"
                        "paginaFinal" => "442"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25878028"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Blood eosinophils&#58; A biomarker of response to extrafine beclomethasone&#47;formoterol in chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;H&#46; Siddiqui"
                            1 => "A&#46; Guasconi"
                            2 => "J&#46; Vestbo"
                            3 => "P&#46; Jones"
                            4 => "A&#46; Agusti"
                            5 => "P&#46; Paggiaro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.201502-0235LE"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2015"
                        "volumen" => "192"
                        "paginaInicial" => "523"
                        "paginaFinal" => "525"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26051430"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A post-hoc subgroup analysis of data from a six month clinical trial comparing the efficacy and safety of losmapimod in moderate-severe COPD patients with &#8804;2&#37; and &#62;2&#37; blood eosinophils"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Marks-Konczalik"
                            1 => "M&#46; Costa"
                            2 => "J&#46; Robertson"
                            3 => "E&#46; McKie"
                            4 => "S&#46; Yang"
                            5 => "S&#46; Pascoe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rmed.2015.05.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Med"
                        "fecha" => "2015"
                        "volumen" => "109"
                        "paginaInicial" => "860"
                        "paginaFinal" => "869"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26033641"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Eosinophilic airway inflammation and exacerbations of COPD&#58; a randomised controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Siva"
                            1 => "R&#46;H&#46; Green"
                            2 => "C&#46;E&#46; Brightling"
                            3 => "M&#46; Shelley"
                            4 => "B&#46; Hargadon"
                            5 => "S&#46; McKenna"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00146306"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2007"
                        "volumen" => "29"
                        "paginaInicial" => "906"
                        "paginaFinal" => "913"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17301099"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15792129/0000005200000004/v2_201604010234/S1579212916000379/v2_201604010234/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "45360"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Editorials"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005200000004/v2_201604010234/S1579212916000379/v2_201604010234/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916000379?idApp=UINPBA00003Z"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Editorial
Chronic Obstructive Pulmonary Disease With Eosinophilia, an Emerging Phenotype?
Enfermedad pulmonar obstructiva crónica con eosinofilia, ¿un fenotipo emergente?
Adolfo Baloira Villar
Corresponding author
adolfo.baloira.villar@sergas.es

Corresponding author.
, Abel Pallarés Sanmartín
Servicio de Neumología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, Spain
Read
5573
Times
was read the article
2051
Total PDF
3522
Total HTML
Share statistics
 array:23 [
  "pii" => "S1579212916000379"
  "issn" => "15792129"
  "doi" => "10.1016/j.arbr.2016.02.012"
  "estado" => "S300"
  "fechaPublicacion" => "2016-04-01"
  "aid" => "1301"
  "copyright" => "SEPAR"
  "copyrightAnyo" => "2016"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "sco"
  "cita" => "Arch Bronconeumol. 2016;52:177-8"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 2442
    "formatos" => array:3 [
      "EPUB" => 148
      "HTML" => 1649
      "PDF" => 645
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0300289616000119"
      "issn" => "03002896"
      "doi" => "10.1016/j.arbres.2015.11.015"
      "estado" => "S300"
      "fechaPublicacion" => "2016-04-01"
      "aid" => "1301"
      "copyright" => "SEPAR"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "sco"
      "cita" => "Arch Bronconeumol. 2016;52:177-8"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 8137
        "formatos" => array:3 [
          "EPUB" => 132
          "HTML" => 6798
          "PDF" => 1207
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
        "titulo" => "Enfermedad pulmonar obstructiva cr&#243;nica con eosinofilia&#44; &#191;un fenotipo emergente&#63;"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "177"
            "paginaFinal" => "178"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Chronic obstructive pulmonary disease with Eosinophilia&#44; an Emerging Phenotype&#63;"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Adolfo Baloira Villar, Abel Pallar&#233;s Sanmart&#237;n"
            "autores" => array:2 [
              0 => array:2 [
                "nombre" => "Adolfo"
                "apellidos" => "Baloira Villar"
              ]
              1 => array:2 [
                "nombre" => "Abel"
                "apellidos" => "Pallar&#233;s Sanmart&#237;n"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1579212916000379"
          "doi" => "10.1016/j.arbr.2016.02.012"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916000379?idApp=UINPBA00003Z"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289616000119?idApp=UINPBA00003Z"
      "url" => "/03002896/0000005200000004/v1_201603270531/S0300289616000119/v1_201603270531/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1579212916000628"
    "issn" => "15792129"
    "doi" => "10.1016/j.arbr.2016.01.020"
    "estado" => "S300"
    "fechaPublicacion" => "2016-04-01"
    "aid" => "1323"
    "copyright" => "Grupo BODE"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Arch Bronconeumol. 2016;52:179-80"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 3383
      "formatos" => array:3 [
        "EPUB" => 152
        "HTML" => 2395
        "PDF" => 836
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
      "titulo" => "Simplifying the Guidelines&#58; The 10 COPD Commandments"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "179"
          "paginaFinal" => "180"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Simplificando las gu&#237;as&#58; los 10 mandamientos de la epoc"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Jos&#233; Mar&#237;a Marin, Claudia Cote, Ciro Casanova, Victor Pinto-Plata, Mar&#237;a Montes de Oca, Miguel J Divo, Juan P de Torres, Javier Zulueta, Carlos Cabrera, Santiago Carrizo, Francesca Polverino, Bartolom&#233; R Celli"
          "autores" => array:13 [
            0 => array:2 [
              "nombre" => "Jos&#233; Mar&#237;a"
              "apellidos" => "Marin"
            ]
            1 => array:2 [
              "nombre" => "Claudia"
              "apellidos" => "Cote"
            ]
            2 => array:2 [
              "nombre" => "Ciro"
              "apellidos" => "Casanova"
            ]
            3 => array:2 [
              "nombre" => "Victor"
              "apellidos" => "Pinto-Plata"
            ]
            4 => array:2 [
              "nombre" => "Mar&#237;a"
              "apellidos" => "Montes de Oca"
            ]
            5 => array:2 [
              "nombre" => "Miguel J"
              "apellidos" => "Divo"
            ]
            6 => array:2 [
              "nombre" => "Juan P"
              "apellidos" => "de Torres"
            ]
            7 => array:2 [
              "nombre" => "Javier"
              "apellidos" => "Zulueta"
            ]
            8 => array:2 [
              "nombre" => "Carlos"
              "apellidos" => "Cabrera"
            ]
            9 => array:2 [
              "nombre" => "Santiago"
              "apellidos" => "Carrizo"
            ]
            10 => array:2 [
              "nombre" => "Francesca"
              "apellidos" => "Polverino"
            ]
            11 => array:2 [
              "nombre" => "Bartolom&#233; R"
              "apellidos" => "Celli"
            ]
            12 => array:1 [
              "colaborador" => "en representaci&#243;n del grupo BODE"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0300289616000338"
        "doi" => "10.1016/j.arbres.2016.01.012"
        "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/S0300289616000338?idApp=UINPBA00003Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916000628?idApp=UINPBA00003Z"
    "url" => "/15792129/0000005200000004/v2_201604010234/S1579212916000628/v2_201604010234/en/main.assets"
  ]
  "en" => array:12 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
    "titulo" => "Chronic Obstructive Pulmonary Disease With Eosinophilia&#44; an Emerging Phenotype&#63;"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "177"
        "paginaFinal" => "178"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Adolfo Baloira Villar, Abel Pallar&#233;s Sanmart&#237;n"
        "autores" => array:2 [
          0 => array:4 [
            "nombre" => "Adolfo"
            "apellidos" => "Baloira Villar"
            "email" => array:1 [
              0 => "adolfo&#46;baloira&#46;villar&#64;sergas&#46;es"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "Abel"
            "apellidos" => "Pallar&#233;s Sanmart&#237;n"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servicio de Neumolog&#237;a&#44; Complejo Hospitalario Universitario de Pontevedra&#44; Pontevedra&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Enfermedad pulmonar obstructiva cr&#243;nica con eosinofilia&#44; &#191;un fenotipo emergente&#63;"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Chronic obstructive pulmonary disease &#40;COPD&#41; is diagnosed on the basis of a spirometry test&#44; which provides indirect data on the degree of resistance offered by the airways to the passage of gas within&#46; Currently&#44; no histological pattern&#44; biomarker&#44; or even clinical criteria can give a more accurate picture of what it means to have COPD&#46; Since it was first described&#44; over 60 years ago&#44; attempts have been made to differentiate COPD patients on the basis of clinical characteristics&#46; In recent years&#44; knowledge of the disease has increased significantly&#44; and specific disease types which have become to be known as COPD phenotypes have been characterized&#46; A phenotype is a description of the features presented by an individual&#44; caused by the interaction of their genetic makeup with the environment in which they live&#46; In all chronic diseases&#44; the damage generated by a noxious agent is modulated by the patient&#39;s response to that molecule&#46; The GesEPOC guideline<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> described 4 phenotypes &#40;exacerbator&#44; emphysema&#44; chronic bronchitis&#44; and overlap syndrome&#41;&#44; with characteristics more or less defined within the COPD spectrum&#46; It seems that this classification is set to change substantially in the next update of the guideline&#44; since after the first edition was published&#44; several studies have challenged some of the previously established concepts&#46; In our opinion&#44; 2 key points may need in-depth revision&#58; the &#8220;exacerbator&#8221; concept and the &#8220;COPD&#47;asthma overlap&#8221; phenotype&#46; According to the ECLIPSE study&#44; a patient with at least 2 exacerbations in the first year &#40;the definition of an exacerbator phenotype&#41; has about a 40&#37; chance of having 1 exacerbation or none in the second year&#44; while a patient who has been an exacerbator for the first 2 years&#44; has a 30&#37; chance of converting to a non-exacerbator phenotype in the third year&#46; Furthermore&#44; a patient who has not had any exacerbation during the first year&#44; has about a 35&#37; chance of having 2 in the second year&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> This &#8220;phenotype&#8221; seems rather variable over time&#44; to say the least&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">When COPD presents with asthma&#44; other problems emerge&#46; The definition of the overlap syndrome is imprecise&#44; no clear biomarkers have been defined&#44; and diagnosis is based on a series of consensus criteria with a modest grade of evidence&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3&#44;4</span></a> Many experts are firmly convinced that it is just 2 common diseases occurring together&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In recent years&#44; the importance of the role of eosinophils in a generally small group of COPD patients has emerged&#46; Eosinophilia is difficult to define&#46; Eosinophils are cells that tend to occur in small proportions in peripheral blood&#44; varying widely over time&#46; In the ECLIPSE cohort&#44; approximately 37&#37; of subjects had persistent eosinophil levels &#62;2&#37; in blood samples&#44;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> a percentage similar to that described in healthy subjects&#46; However&#44; these patients were older&#44; predominantly male&#44; and fewer were active smokers&#46; They also had higher FEV1&#44; less dyspnea&#44; higher BODE index scores&#44; and generally appeared to have a more benign form of the disease&#46; Moreover&#44; their serum levels of CXCL8&#44; a chemokine involved in neutrophil recruitment&#44; was significantly lower&#44; possibly indicating some genetic modulation of the disease&#46; If a cutoff point of 150 cells &#40;absolute value&#41; is applied to the analysis&#44; the results are similar&#46; This would suggest that clinical and biochemical characteristics differ from those of patients whose eosinophil levels in blood are less than 2&#37;&#46; The significant correlation with eosinophilia in sputum in COPD should also be taken into consideration&#44; although the difficulty of using this test in routine clinical practice should be emphasized&#58; even in a series as sophisticated as the ECLIPSE&#44; only 138 of the 1438 patients evaluated were able to produce at least 3 valid sputum samples&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Why are blood eosinophils levels higher in some COPD patients&#63; The basis is apparently genetic&#44; as was shown in a study in 2 groups of patients in whom asthma was carefully ruled out&#46; Some of these patients revealed a &#8220;genetic signature&#8221;&#44; Th2&#44; characterized by a greater concentration of eosinophils&#44; both in the airways and in blood&#44; and some specific clinical features&#44; such as rapid loss of lung function and greater post-bronchodilator reversibility&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> For a proposed phenotype to have clinical importance&#44; it must be associated with a specific treatment&#44; and this seems to be the case for COPD patients with persistent eosinophilia&#46; In a subanalysis of the 2 studies designed to determine the efficacy of fluticasone furoate and vilaterol&#44; the addition of inhaled corticosteroids reduced exacerbations only in patients with blood eosinophils &#62;2&#37;&#46; Moreover&#44; the effect was greater in patients with higher percentages of eosinophils&#44; and at its height when eosinophil levels exceeded 6&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> Very similar findings were obtained from the FORWARD study&#44; designed to examine the effect of adding beclomethasone dipropionate to formoterol in patients with severe COPD&#46; When the 1184 FORWARD participants were divided into quartiles on the basis of their blood eosinophil level&#44; significant differences in the reduction of exacerbations were observed in the top 2 quartiles only&#44; with a cutoff point of 279 eosinophils&#47;microliter&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> In contrast&#44; a recent study with losmapimod&#44; a potent inhibitor of p38 MAPK&#44; in patients with moderate-severe COPD showed a 55&#37; reduction of exacerbations in patients with &#60;2&#37; eosinophils&#44; and no effect&#44; or even a trend toward more frequent exacerbations in patients with more than 2&#37; eosinophils&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> The protein kinase p38 MAPK is expressed in epithelial cells and macrophages activated by tobacco smoke&#44; leading to proliferation and activation of the macrophages and neutrophils themselves&#44; and alpha-tumor necrosis factor stimulation&#46; Inhibiting this pathway fundamentally affects the function of both these cell types&#46; This observation also appears to support the fact that some underlying cell pathways in COPD patients differ&#44; depending on the presence or absence of blood eosinophilia&#44; with the corresponding therapeutic implications&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">To date&#44; no specifically designed study has been conducted to determine the significance of blood eosinophilia in COPD&#44; limiting the strength of the data presented&#46; Only 1 small study has shown that treatment to reduce eosinophil levels in sputum as far as possible has a favorable impact on the reduction of exacerbations&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">To conclude&#44; evidence is emerging for what might be a specific COPD phenotype&#44; with differentiable clinical characteristics and specific treatment&#44; at least in part&#46; Obviously&#44; many aspects still need clarification&#44; the most important being perhaps the cutoff point for defining eosinophilia&#44; or if an absolute value or percentage of total leukocytes would be a better measure&#46; Nevertheless&#44; it seems likely that we are witnessing the birth of a new COPD phenotype&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Baloira Villar A&#44; Pallar&#233;s Sanmart&#237;n A&#46; Enfermedad pulmonar obstructiva cr&#243;nica con eosinofilia&#44; &#191;un fenotipo emergente&#63; Arch Bronconeumol&#46; 2016&#59;52&#58;177&#8211;178&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gu&#237;a de Pr&#225;ctica Cl&#237;nica para el Diagn&#243;stico y Tratamiento de Pacientes con Enfermedad Pulmonar Obstructiva Cr&#243;nica &#40;EPOC&#41; &#8211; Gu&#237;a Espa&#241;ola de la EPOC &#40;GesEPOC&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "Grupo de Trabajo de GesEPOC"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0300-2896(12)70044-3"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2012"
                        "volumen" => "48"
                        "paginaInicial" => "2"
                        "paginaFinal" => "58"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23116901"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Susceptibility to exacerbation in chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;R&#46; Hurst"
                            1 => "J&#46; Vestbo"
                            2 => "A&#46; Anzueto"
                            3 => "N&#46; Locantore"
                            4 => "H&#46; M&#252;llerova"
                            5 => "R&#46; Tal-Singer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa0909883"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2010"
                        "volumen" => "363"
                        "paginaInicial" => "1128"
                        "paginaFinal" => "1138"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20843247"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The asthma-COPD overlap syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "D&#46;S&#46; Postma"
                            1 => "K&#46;F&#46; Rabe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMra1411863"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2015"
                        "volumen" => "373"
                        "paginaInicial" => "1241"
                        "paginaFinal" => "1249"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26398072"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Consensus document on the overlap phenotype COPD-asthma in COPD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;J&#46; Soler-Catalu&#241;a"
                            1 => "B&#46; Cos&#237;o"
                            2 => "J&#46;L&#46; Izquierdo"
                            3 => "J&#46;L&#46; L&#243;pez-Campos"
                            4 => "J&#46;M&#46; Mar&#237;n"
                            5 => "R&#46; Ag&#252;ero"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arbres.2011.12.009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2012"
                        "volumen" => "48"
                        "paginaInicial" => "331"
                        "paginaFinal" => "337"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22341911"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Eosinophilic inflammation in COPD&#58; prevalence and clinical characteristics"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46; Singh"
                            1 => "U&#46; Kolsum"
                            2 => "C&#46;E&#46; Brightling"
                            3 => "N&#46; Locantore"
                            4 => "A&#46; Agust&#237;"
                            5 => "R&#46; Tal-Singer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00162414"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2014"
                        "volumen" => "44"
                        "paginaInicial" => "1697"
                        "paginaFinal" => "1700"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25323230"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Asthma-COPD overlap&#46; Clinical relevance of genomic signatures of type 2 inflammation in chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;A&#46; Christenson"
                            1 => "K&#46; Steiling"
                            2 => "M&#46; van den Berge"
                            3 => "K&#46; Hijazi"
                            4 => "P&#46;S&#46; Hiemstra"
                            5 => "D&#46;S&#46; Postma"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.201408-1458OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2015"
                        "volumen" => "191"
                        "paginaInicial" => "758"
                        "paginaFinal" => "766"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25611785"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Blood eosinophil counts&#44; exacerbations&#44; and response to the addition of inhaled fluticasone furoate to vilanterol in patients with chronic obstructive pulmonary disease&#58; a secondary analysis of date from two parallel randomised controlled trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46; Pascoe"
                            1 => "N&#46; Locantore"
                            2 => "M&#46;T&#46; Dransfield"
                            3 => "N&#46;C&#46; Barnes"
                            4 => "I&#46;D&#46; Pavord"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S2213-2600(15)00106-X"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet Respir Med"
                        "fecha" => "2015"
                        "volumen" => "3"
                        "paginaInicial" => "435"
                        "paginaFinal" => "442"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25878028"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Blood eosinophils&#58; A biomarker of response to extrafine beclomethasone&#47;formoterol in chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;H&#46; Siddiqui"
                            1 => "A&#46; Guasconi"
                            2 => "J&#46; Vestbo"
                            3 => "P&#46; Jones"
                            4 => "A&#46; Agusti"
                            5 => "P&#46; Paggiaro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.201502-0235LE"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2015"
                        "volumen" => "192"
                        "paginaInicial" => "523"
                        "paginaFinal" => "525"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26051430"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A post-hoc subgroup analysis of data from a six month clinical trial comparing the efficacy and safety of losmapimod in moderate-severe COPD patients with &#8804;2&#37; and &#62;2&#37; blood eosinophils"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Marks-Konczalik"
                            1 => "M&#46; Costa"
                            2 => "J&#46; Robertson"
                            3 => "E&#46; McKie"
                            4 => "S&#46; Yang"
                            5 => "S&#46; Pascoe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rmed.2015.05.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Respir Med"
                        "fecha" => "2015"
                        "volumen" => "109"
                        "paginaInicial" => "860"
                        "paginaFinal" => "869"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26033641"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Eosinophilic airway inflammation and exacerbations of COPD&#58; a randomised controlled trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Siva"
                            1 => "R&#46;H&#46; Green"
                            2 => "C&#46;E&#46; Brightling"
                            3 => "M&#46; Shelley"
                            4 => "B&#46; Hargadon"
                            5 => "S&#46; McKenna"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.00146306"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2007"
                        "volumen" => "29"
                        "paginaInicial" => "906"
                        "paginaFinal" => "913"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17301099"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15792129/0000005200000004/v2_201604010234/S1579212916000379/v2_201604010234/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "45360"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Editorials"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005200000004/v2_201604010234/S1579212916000379/v2_201604010234/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916000379?idApp=UINPBA00003Z"
]
Article information
ISSN: 15792129
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 10 2 12
2024 October 51 23 74
2024 September 53 17 70
2024 August 58 47 105
2024 July 41 16 57
2024 June 69 26 95
2024 May 91 28 119
2024 April 46 32 78
2024 March 49 16 65
2024 February 28 26 54
2023 March 4 5 9
2023 February 33 24 57
2023 January 22 60 82
2022 December 50 42 92
2022 November 39 27 66
2022 October 30 27 57
2022 September 37 32 69
2022 August 40 40 80
2022 July 30 46 76
2022 June 31 28 59
2022 May 39 30 69
2022 April 29 25 54
2022 March 42 43 85
2022 February 38 38 76
2022 January 26 34 60
2021 December 33 41 74
2021 November 31 38 69
2021 October 62 46 108
2021 September 36 52 88
2021 August 28 33 61
2021 July 25 26 51
2021 June 37 36 73
2021 May 40 49 89
2021 April 107 76 183
2021 March 77 39 116
2021 February 31 30 61
2021 January 37 20 57
2020 December 53 26 79
2020 November 27 21 48
2020 October 33 11 44
2020 September 18 12 30
2020 August 35 12 47
2020 July 34 23 57
2020 June 29 12 41
2020 May 45 21 66
2020 April 31 22 53
2020 March 24 20 44
2020 February 39 18 57
2020 January 33 17 50
2019 December 42 25 67
2019 November 27 18 45
2019 October 30 13 43
2019 September 41 15 56
2019 August 31 22 53
2019 July 40 26 66
2019 June 37 14 51
2019 May 57 19 76
2019 April 67 31 98
2019 March 61 27 88
2019 February 72 22 94
2019 January 48 22 70
2018 December 40 24 64
2018 November 69 23 92
2018 October 71 24 95
2018 September 29 10 39
2018 May 28 0 28
2018 April 39 3 42
2018 March 53 12 65
2018 February 43 9 52
2018 January 54 8 62
2017 December 38 6 44
2017 November 26 5 31
2017 October 28 11 39
2017 September 37 12 49
2017 August 26 12 38
2017 July 31 22 53
2017 June 40 15 55
2017 May 42 26 68
2017 April 52 18 70
2017 March 25 12 37
2017 February 22 7 29
2017 January 56 10 66
2016 December 20 11 31
2016 November 37 26 63
2016 October 38 26 64
2016 September 20 6 26
2016 August 45 13 58
2016 July 29 11 40
Show all

Follow this link to access the full text of the article

Archivos de Bronconeumología

Are you a health professional able to prescribe or dispense drugs?