Editorial
The Name of COPD: Semiotics and Precision
El nombre de la EPOC: semiótica y precisión
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"https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916301768?idApp=UINPBA00003Z" "url" => "/15792129/0000005200000010/v2_201609300109/S1579212916301768/v2_201609300109/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "The Name of COPD: Semiotics and Precision" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "503" "paginaFinal" => "504" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Víctor Bustamante, Isabel Urrutia" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Víctor" "apellidos" => "Bustamante" "email" => array:1 [ 0 => "vipobusta@hotmail.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" => "Isabel" "apellidos" => "Urrutia" "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 Basurto (Osakidetza), Departamento de Medicina, Universidad del País Vasco, Bilbao, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neumología, Hospital de Galdakao (Osakidetza), Galdakao, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El nombre de la EPOC: semiótica y precisión" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleDisplayedQuote" id="dsq0005"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Stat rosa prístina nomine, nomina nuda tenemus.</span> And what is left of the rose is only its name.</p></span><span class="elsevierStyleDisplayedQuote" id="dsq0010"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Umberto Eco, in The Name of the Rose.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p></span></p><p id="par0010" class="elsevierStylePara elsevierViewall">Is it asthma or COPD? Solving this commonly encountered dilemma can lead us through a maze no less complex than the labyrinthine medieval library of the famous novel of the late author and semiotician, Umberto Eco. Perhaps Professor Eco could have helped us define what we understand as disease, syndrome, overlap, comorbidity, phenotype or endotype. Our intention here is to review these concepts in an attempt to avoid confusion and indiscriminate use.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Pathos, Nosos and Aegritudo</span><p id="par0015" class="elsevierStylePara elsevierViewall">The concept of disease or “morbid species” emerged from a taxonomic tradition that aimed to classify knowledge in all scientific disciplines. Classifications were based on <span class="elsevierStyleItalic">pathos</span> and <span class="elsevierStyleItalic">nosos</span>, terms referring to the underlying condition of the disease and its manifestation in signs and symptoms,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> and on etiology, although this was rarely determined. Underlying these attempts is not only the need for “getting as genuine and natural a description, or history of all diseases as can be procured”, as Sydenham wrote, but also a “fix’d and complete method of cure thereof”.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> This therapeutic differentiation still leads us in practice to subclassify diseases such as COPD or asthma according to different therapeutic approaches, or to highlight when these diseases overlap, whether with each other or with conditions such as sleep apneas or bronchiectasis, all of which might impact on a patient's clinical management.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The term <span class="elsevierStyleItalic">aegritudo</span> complements <span class="elsevierStyleItalic">pathos</span> and <span class="elsevierStyleItalic">nosos</span>, as a synonym of disease<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> in the sense of the episode as experienced by the patient. The intention of modern medicine, namely, to determine disease from the signs and symptoms observed at the patient's bedside, known as the Oslerian paradigm, appears to give little importance to the impact of personal experience on the disease. Osler said “the good physician treats the disease; the great physician treats the patient who has the disease”, thus acknowledging a concept of disease as independent from the patient. Until very recently, personalized medicine was considered an empirical “art”.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Subcategories of Disease: From Syndrome to Phenotypes and Endotypes</span><p id="par0025" class="elsevierStylePara elsevierViewall">A syndrome is commonly understood as a set of interrelated signs and symptoms. Since the times of Avicenna, Aristotelian inductive logic has been used to build on this method of grouping postulates to arrive at a diagnosis. At times, the relationship is so clear that the syndrome is identified as the disease, as occurs with genetic disorders, such as Down syndrome or Klinefelter syndrome.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Equally related with <span class="elsevierStyleItalic">nosos</span> is the concept of “phenotype”, which describes all observable characteristics in an individual, such as morphology, markers or biochemical or physiological behavior. The conventional use of the term “phenotype” derives from Mendelian genetics, understood as the expression of the genotype. More recently, it has been used to describe a distinctive disease profile in a wider “clinical phenotype” sense that, in the case of COPD, represents “those attributes of the disease alone or in combination that describe the differences between individuals with COPD in relation to parameters that have clinical significance”.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">It is interesting to note that selective therapeutic approaches are more focused on the modification of biological processes (<span class="elsevierStyleItalic">pathos</span>) than on phenotype. This observation is more apparent in the case of asthma, in which phenotypes are complemented by so-called “pathophenotypes” or “endotypes”. A more personalized molecular therapeutic intervention should be possible if the various biological mechanisms that cause a disease are defined.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> To achieve this, these disease pathways or endotypes must be identified and characterized by “biological markers” that can be either pathognomonic, such as alpha-1 antitrypsin deficit in affected patients, or simply orientative, as is the case for polymorphonuclear neutrophils in the sputum of asthma patients.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Of course, these mechanisms are not exclusive for any single disease, but rather generate associations of entities that in patients are called comorbidity. The “comorbidome” is a graphical representation of all the relationships occurring in a disease.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> For a disease to be considered comorbid, the association must occur more often than by pure chance, and we call this coinciding or overlapping. If defining an entity is difficult, it is even harder to define asthma-COPD overlap syndrome (ACOS), a term used both as a syndrome, due to lack of diagnostic definition, and as a catch-all for all phenotype–endotype intersections of both entities.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Only its future use will clarify its meaning.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Personalized, 4P and Precision Medicine</span><p id="par0045" class="elsevierStylePara elsevierViewall">The interaction of genetic, environmental, biological, clinical and even psychological aspects of the pathogenic mechanism affects how diseases present and evolve. Phenotypes and endotypes are simplified terms that allow us to build a concept of personal variability within a disease. The aim of personalized medicine is to convert an empirical approach, understood as an art, into knowledge. The observation that this exhaustive knowledge can be used as a tool for measuring and modifying health risks gave rise to the idea of “4P medicine”: predictive, preventive, personalized and participatory. “Precision medicine” should represent the ultimate definition of disease mechanisms, allowing us to intervene with the confidence of an assured outcome.</p><p id="par0050" class="elsevierStylePara elsevierViewall">It may be that this vision of medical science based on ever larger registries of genetic, epigenetic, molecular, experience-based, or therapeutic data predicts a future in which only specific cases are treated, a future in which the concept of disease becomes outdated. Until then, we must depend on the rational tradition represented by Brother William of Baskerville,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> replica of Conan Doyle's Sherlock Holmes created in turn inspired by his clinical teacher, Joseph Bell. We will continue to use our deductive skills to hunt out the name of the disease as a mainstay for our reasoning and actions. New cohort studies, such as those which expanded the concepts of COPD and asthma, must be undertaken to further investigate the significance of those names. Much research and discussion will be needed if we are to clearly define subtypes worthy of attention, as well as biomarkers and parameters<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> that will be of practical use in opening the door to even more personalized and precise treatments.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Pathos, Nosos and Aegritudo" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Subcategories of Disease: From Syndrome to Phenotypes and Endotypes" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Personalized, 4P and Precision Medicine" ] 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: Bustamante V, Urrutia I. El nombre de la EPOC: semiótica y precisión. Arch Bronconeumol. 2016;52:503–504.</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" => "El nombre de la rosa" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "U. Eco" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "1985" "editorial" => "Lumen" "editorialLocalizacion" => "Barcelona" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Geschichte, Theorie und Ethik der Medizin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "W.U. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 3 | 11 |
| 2024 October | 40 | 25 | 65 |
| 2024 September | 42 | 18 | 60 |
| 2024 August | 76 | 67 | 143 |
| 2024 July | 36 | 25 | 61 |
| 2024 June | 64 | 34 | 98 |
| 2024 May | 80 | 26 | 106 |
| 2024 April | 39 | 29 | 68 |
| 2024 March | 39 | 23 | 62 |
| 2024 February | 31 | 21 | 52 |
| 2023 March | 6 | 4 | 10 |
| 2023 February | 45 | 23 | 68 |
| 2023 January | 29 | 38 | 67 |
| 2022 December | 32 | 37 | 69 |
| 2022 November | 49 | 27 | 76 |
| 2022 October | 43 | 26 | 69 |
| 2022 September | 32 | 28 | 60 |
| 2022 August | 38 | 45 | 83 |
| 2022 July | 19 | 45 | 64 |
| 2022 June | 24 | 22 | 46 |
| 2022 May | 35 | 30 | 65 |
| 2022 April | 27 | 23 | 50 |
| 2022 March | 30 | 40 | 70 |
| 2022 February | 30 | 31 | 61 |
| 2022 January | 23 | 34 | 57 |
| 2021 December | 44 | 37 | 81 |
| 2021 November | 54 | 49 | 103 |
| 2021 October | 66 | 40 | 106 |
| 2021 September | 59 | 50 | 109 |
| 2021 August | 48 | 50 | 98 |
| 2021 July | 26 | 23 | 49 |
| 2021 June | 41 | 39 | 80 |
| 2021 May | 36 | 34 | 70 |
| 2021 April | 67 | 88 | 155 |
| 2021 March | 64 | 31 | 95 |
| 2021 February | 35 | 31 | 66 |
| 2021 January | 23 | 14 | 37 |
| 2020 December | 46 | 24 | 70 |
| 2020 November | 28 | 11 | 39 |
| 2020 October | 17 | 16 | 33 |
| 2020 September | 27 | 14 | 41 |
| 2020 August | 23 | 9 | 32 |
| 2020 July | 23 | 17 | 40 |
| 2020 June | 30 | 8 | 38 |
| 2020 May | 26 | 16 | 42 |
| 2020 April | 38 | 20 | 58 |
| 2020 March | 24 | 16 | 40 |
| 2020 February | 28 | 28 | 56 |
| 2020 January | 23 | 18 | 41 |
| 2019 December | 28 | 11 | 39 |
| 2019 November | 31 | 18 | 49 |
| 2019 October | 22 | 13 | 35 |
| 2019 September | 22 | 16 | 38 |
| 2019 August | 28 | 12 | 40 |
| 2019 July | 21 | 16 | 37 |
| 2019 June | 14 | 10 | 24 |
| 2019 May | 18 | 11 | 29 |
| 2019 April | 24 | 49 | 73 |
| 2019 March | 35 | 30 | 65 |
| 2019 February | 21 | 20 | 41 |
| 2019 January | 25 | 22 | 47 |
| 2018 December | 28 | 12 | 40 |
| 2018 November | 40 | 27 | 67 |
| 2018 October | 34 | 25 | 59 |
| 2018 September | 27 | 13 | 40 |
| 2018 May | 7 | 0 | 7 |
| 2018 April | 26 | 5 | 31 |
| 2018 March | 17 | 5 | 22 |
| 2018 February | 21 | 12 | 33 |
| 2018 January | 26 | 7 | 33 |
| 2017 December | 36 | 13 | 49 |
| 2017 November | 21 | 7 | 28 |
| 2017 October | 17 | 5 | 22 |
| 2017 September | 26 | 9 | 35 |
| 2017 August | 12 | 7 | 19 |
| 2017 July | 19 | 6 | 25 |
| 2017 June | 27 | 13 | 40 |
| 2017 May | 32 | 15 | 47 |
| 2017 April | 34 | 22 | 56 |
| 2017 March | 21 | 13 | 34 |
| 2017 February | 16 | 8 | 24 |
| 2017 January | 12 | 7 | 19 |
| 2016 December | 1 | 0 | 1 |
| 2016 October | 1 | 0 | 1 |
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