Editorial
Chronic Obstructive Pulmonar Disease Mortality. SEPAR COPD-Smoking Year
Mortalidad en la enfermedad pulmonar obstructiva crónica. Año SEPAR EPOC/Tabaco
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SEPAR COPD-Smoking Year" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "407" "paginaFinal" => "408" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "José Ignacio de Granda-Orive, Segismundo Solano-Reina" "autores" => array:2 [ 0 => array:4 [ "nombre" => "José Ignacio" "apellidos" => "de Granda-Orive" "email" => array:1 [ 0 => "igo01m@gmail.com" ] "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" => "Segismundo" "apellidos" => "Solano-Reina" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario 12 de Octubre, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Mortalidad en la enfermedad pulmonar obstructiva crónica. Año SEPAR EPOC/Tabaco" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The EPI-SCAN study concluded that the prevalence of chronic obstructive pulmonary disease (COPD) in Spanish individuals aged between 40 and 80 years is 10.2%.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> In 2012 in Spain, the rate of deaths due to respiratory diseases rose sharply, to become the third most common cause of death in 2013 (91.4 deaths per 100<span class="elsevierStyleHsp" style=""></span>000 inhabitants; <a id="intr0010" class="elsevierStyleInterRef" href="http://www.ine.es/prensa/np896.pdf">http://www.ine.es/prensa/np896.pdf</a>), and the third cause of hospital discharge (11.2%) in 2014 (<a id="intr0015" class="elsevierStyleInterRef" href="http://www.ine.es/prensa/np942.pdf">http://www.ine.es/prensa/np942.pdf</a>).</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Causes of Death in Chronic Obstructive Pulmonary Disease</span><p id="par0010" class="elsevierStylePara elsevierViewall">In recent years, the prevalence of smoking has fallen in Western countries; healthcare and the economy, together with the therapeutic arsenal and living conditions of patients with COPD, have all improved. These changes have led to a fall in standardized COPD mortality rates in Europe, but the importance of COPD in the 21st century will continue to be a growing problem for different reasons, as reported by López Campos et al.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a> Patients with mild COPD generally die from cardiovascular diseases and lung cancer. In contrast, when the disease is more severe, the main cause of death is progression of the disease itself. Between 50% and 80% of our COPD patients die from lung disease, whether disease exacerbation (30%–50%) or lung cancer (8%–13%) or other respiratory diseases. The main causes of death in patients with severe COPD are respiratory (80.9%), cardiac (5.6%), cerebrovascular accidents (12.4%), and other causes (6.7%).</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Predictors of Mortality in Chronic Obstructive Pulmonary Disease</span><p id="par0015" class="elsevierStylePara elsevierViewall">Predictors of mortality can be grouped as follows:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Signs</span>/<span class="elsevierStyleItalic">symptoms.</span> Dyspnea is the major and most debilitating symptom of COPD, and the most important clinical predictor of mortality.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> Loss of weight has been considered an independent factor for mortality. There is a clear association between a low body mass index (BMI<25<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>) and higher COPD mortality.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Lung function.</span> Both diminished forced expiratory volume in 1<span class="elsevierStyleHsp" style=""></span>s (FEV<span class="elsevierStyleInf">1</span>) and static hyperinflation (inspiratory fraction: inspiratory capacity/total lung capacity and residual volume/total lung capacity ratio: RV/TLC) have been associated with greater mortality. Moreover, hyperinflation predicts exercise capacity<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> and is measured by the 6-minute walk test (6MWT), which has been clearly correlated with mortality in COPD patients. Recently, Rim Shin et al.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a> confirmed that, in addition to advanced age, both raised RV/TLC and a short 6-minute walking distance are independent predictors for all-cause mortality.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0030" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Multidimensional indices.</span> Various independent variables are used to predict mortality in COPD, and these have been incorporated into multidimensional indices which can determine the patient's status.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> Four easily-recorded variables, clearly predictive of the risk of mortality, were identified for the BODE index: BMI, degree of airflow obstruction, dyspnea (measured according to the Medical Research Council [MRC] scale), and exercise capacity (measured by the 6MWT). An increase in the BODE index has been shown to increase the risk of death, to the extent that in the fourth quartile (BODE index 7–10), mortality rises to 80% in 52 months. BODE is a better predictor of mortality than FEV<span class="elsevierStyleInf">1</span>. BODE is even a good predictor of the risk of hospitalization due to COPD exacerbation.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a></p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Other variables predictive of mortality.</span> COPD outcome has been shown to be clearly linked to the presence, frequency, and intensity of exacerbations, and mortality is higher in patients with more yearly exacerbations. Moreover, adding exacerbations to the BODE index improves its predictive capacity.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> This led to the introduction of the multicomponent BODE index (BODEx), in which the exacerbation rate replaces the 6MWT when the latter is not available. Both BODE and BODEx have high prognostic reliability in the evaluation of severity.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a></p></li></ul></p><p id="par0040" class="elsevierStylePara elsevierViewall">Comorbidities are very common in COPD. In a recent study,<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> after adjusting for age and sex, a higher prevalence than expected was found for 10 chronic diseases: heart failure, chronic liver disease, asthma, osteoporosis, ischemic heart disease, anxiety, depression, arrhythmias, and obesity. The Charlson index, which quantifies comorbidities, has demonstrated its utility as an independent predictor of mortality in patients hospitalized for recurrent COPD exacerbations.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Another aspect recently linked to higher mortality is continuity of care in COPD patients: if continuity is low, all-cause mortality rises by 22%.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Anemia has been associated with higher mortality—a linear correlation has been found between hemoglobin levels and mortality—and the associated dyspnea contributes to poorer exercise tolerance.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Factors Related with Improved COPD Survival</span><p id="par0055" class="elsevierStylePara elsevierViewall">Below is a short analysis of factors known to be related with improved survival in COPD patients. It is clear beyond doubt that stopping smoking is the best strategy for avoiding disease progression, and reduces mortality by 50% compared to COPD patients who continue to smoke.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> For many years now, home oxygen therapy has been accepted as a strategy which prolongs survival in patients with advanced COPD and severe hypoxemia (basal oxygen arterial pressure<55<span class="elsevierStyleHsp" style=""></span>mmHg). This scientific evidence comes from the results of 2 large controlled studies which were presented at the beginning of the 1980s: the British Medical Research Council, and the North American Nocturnal Oxygen Therapy Trial (NOTT), as indicated in the revised SEPAR guidelines (2014).<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> In both series, administration of home oxygen therapy for at least 15<span class="elsevierStyleHsp" style=""></span>h a day prolonged survival.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Pulmonary rehabilitation has been related with lower mortality in COPD, since it improves dyspnea and exercise capacity.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> Weight gain (>8<span class="elsevierStyleHsp" style=""></span>kg/8 weeks) is also a significant predictor of survival.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> Volume reduction surgery in selected patients is known to reduce the BODE index,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> and non-invasive ventilation during exacerbations with respiratory failure improves survival.</p><p id="par0065" class="elsevierStylePara elsevierViewall">To conclude, we remind our readers that we are currently in the SEPAR COPD/Smoking Year. To our knowledge, only 17% of the Spanish population is aware of the term COPD,<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> so we face the significant challenge of raising awareness of this respiratory disease, currently the third cause of death, and its undeniable relationship with smoking.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Causes of Death in Chronic Obstructive Pulmonary Disease" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Predictors of Mortality in Chronic Obstructive Pulmonary Disease" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Factors Related with Improved COPD Survival" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: de Granda-Orive JI, Solano-Reina S. Mortalidad en la enfermedad pulmonar obstructiva crónica. Año SEPAR EPOC/Tabaco. Arch Bronconeumol. 2016;52:407–408.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of COPD in Spain: impact of undiagnosed COPD on quality of life and daily life activities" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Miravitlles" 1 => "J.B. Soriano" 2 => "F. García-Río" 3 => "L. Muñoz" 4 => "E. Duran-Tauleria" 5 => "G. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 1 | 0 | 1 |
| 2024 October | 37 | 11 | 48 |
| 2024 September | 43 | 19 | 62 |
| 2024 August | 54 | 39 | 93 |
| 2024 July | 37 | 21 | 58 |
| 2024 June | 59 | 37 | 96 |
| 2024 May | 60 | 29 | 89 |
| 2024 April | 41 | 31 | 72 |
| 2024 March | 45 | 25 | 70 |
| 2024 February | 23 | 20 | 43 |
| 2023 March | 20 | 7 | 27 |
| 2023 February | 75 | 25 | 100 |
| 2023 January | 54 | 32 | 86 |
| 2022 December | 71 | 35 | 106 |
| 2022 November | 73 | 46 | 119 |
| 2022 October | 81 | 70 | 151 |
| 2022 September | 55 | 46 | 101 |
| 2022 August | 59 | 71 | 130 |
| 2022 July | 60 | 83 | 143 |
| 2022 June | 61 | 52 | 113 |
| 2022 May | 81 | 78 | 159 |
| 2022 April | 86 | 78 | 164 |
| 2022 March | 123 | 61 | 184 |
| 2022 February | 91 | 71 | 162 |
| 2022 January | 80 | 60 | 140 |
| 2021 December | 63 | 50 | 113 |
| 2021 November | 72 | 53 | 125 |
| 2021 October | 44 | 60 | 104 |
| 2021 September | 32 | 83 | 115 |
| 2021 August | 38 | 74 | 112 |
| 2021 July | 26 | 46 | 72 |
| 2021 June | 43 | 42 | 85 |
| 2021 May | 43 | 45 | 88 |
| 2021 April | 94 | 135 | 229 |
| 2021 March | 68 | 26 | 94 |
| 2021 February | 32 | 25 | 57 |
| 2021 January | 28 | 24 | 52 |
| 2020 December | 33 | 21 | 54 |
| 2020 November | 31 | 15 | 46 |
| 2020 October | 38 | 28 | 66 |
| 2020 September | 29 | 9 | 38 |
| 2020 August | 32 | 15 | 47 |
| 2020 July | 25 | 25 | 50 |
| 2020 June | 29 | 5 | 34 |
| 2020 May | 41 | 22 | 63 |
| 2020 April | 42 | 25 | 67 |
| 2020 March | 39 | 14 | 53 |
| 2020 February | 34 | 29 | 63 |
| 2020 January | 49 | 22 | 71 |
| 2019 December | 47 | 19 | 66 |
| 2019 November | 41 | 22 | 63 |
| 2019 October | 23 | 8 | 31 |
| 2019 September | 32 | 22 | 54 |
| 2019 August | 34 | 17 | 51 |
| 2019 July | 28 | 28 | 56 |
| 2019 June | 20 | 20 | 40 |
| 2019 May | 44 | 18 | 62 |
| 2019 April | 47 | 36 | 83 |
| 2019 March | 43 | 27 | 70 |
| 2019 February | 38 | 21 | 59 |
| 2019 January | 36 | 24 | 60 |
| 2018 December | 37 | 20 | 57 |
| 2018 November | 44 | 25 | 69 |
| 2018 October | 74 | 13 | 87 |
| 2018 September | 42 | 20 | 62 |
| 2018 May | 40 | 0 | 40 |
| 2018 April | 25 | 6 | 31 |
| 2018 March | 22 | 10 | 32 |
| 2018 February | 23 | 12 | 35 |
| 2018 January | 27 | 13 | 40 |
| 2017 December | 29 | 6 | 35 |
| 2017 November | 23 | 11 | 34 |
| 2017 October | 16 | 10 | 26 |
| 2017 September | 25 | 20 | 45 |
| 2017 August | 20 | 16 | 36 |
| 2017 July | 24 | 34 | 58 |
| 2017 June | 30 | 12 | 42 |
| 2017 May | 40 | 15 | 55 |
| 2017 April | 47 | 18 | 65 |
| 2017 March | 19 | 11 | 30 |
| 2017 February | 17 | 17 | 34 |
| 2017 January | 14 | 7 | 21 |
| 2016 December | 29 | 21 | 50 |
| 2016 November | 50 | 36 | 86 |
| 2016 October | 5 | 2 | 7 |
| 2016 August | 1 | 1 | 2 |
| 2016 July | 1 | 0 | 1 |
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