Scientific Letter
Dogmas and Medical Beliefs in COPD
Dogmas y Creencias Médicas Acerca de la EPOC
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(B) Chest high-resolution computed tomography after corticosteroid treatment, showing resolution of the pulmonary lesions.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Horacio Matías Castro, Esteban Javier Wainstein, Joaquin Maritano Furcada" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Horacio Matías" "apellidos" => "Castro" ] 1 => array:2 [ "nombre" => "Esteban Javier" "apellidos" => "Wainstein" ] 2 => array:2 [ "nombre" => "Joaquin" "apellidos" => "Maritano Furcada" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289616302289" "doi" => "10.1016/j.arbres.2016.08.002" "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/S0300289616302289?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212917300599?idApp=UINPBA00003Z" "url" => "/15792129/0000005300000004/v1_201704070039/S1579212917300599/v1_201704070039/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Dogmas and Medical Beliefs in COPD" "tieneTextoCompleto" => true "saludo" => "To the Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "217" "paginaFinal" => "218" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "António Duarte Araújo" "autores" => array:1 [ 0 => array:4 [ "nombre" => "António Duarte" "apellidos" => "Araújo" "email" => array:1 [ 0 => "duartearaujodr@sapo.pt" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Respiratory Department, Hospital Senhora da Oliveira, Guimarães, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Life and Health Sciences Research Institute (ICVS), University of Minho, Portugal" "etiqueta" => "b" "identificador" => "aff0010" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dogmas y Creencias Médicas Acerca de la EPOC" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Physicians who spend their lives treating patients have always lived with the social representations of health, disease, and medication. These social representations are construct images of a natural reality and are as old as the disease itself. Based on affective and cognitive predispositions, and often inhabited by fears, beliefs, and magical and supernatural elements, the function of social representations is to make something unusual and unknown familiar to the patient.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Chronic obstructive pulmonary disease (COPD) and inhaled medications do not escape these social representation systems. The theory of social representations was first formulated by social psychologist Serge Moscovici in a paper published in France in 1961.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> I wonder, however, if COPD is not itself also represented in doctors who usually treat this complex disease in hospitals or in primary health care, and if their representation is haunted by dogmas and medical beliefs.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In COPD, as in many other chronic diseases, non-adherence to medication is a critical issue.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> Non-adherence to inhaled therapy in COPD has been called a high magnitude problem and a major factor of therapeutic failure, but only a limited number of studies have specifically examined adherence in patients with COPD therapy, and most research was conducted before the widespread availability of inhaled medications taken once or twice daily. In some original articles, many patient characteristics, such as the degree of bronchial obstruction or symptoms like dyspnea, are missing. However, it is well known that dyspnea, fear of dyspnea, and feelings of vulnerability contribute to better adherence to medication. Poor adherence to therapy, therefore, does not seem to make much sense from a clinical point of view, especially in these very symptomatic patients with COPD Gold stage B or D. Poor medication adherence in COPD has become a dogma that may well not correspond to reality, at least in patients with greater severity, and as such remains an open issue that merits further investigation.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Another persistent dogma is the belief that once-daily medication is the best alternative for all COPD patients,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a> because it is easier to use and improves compliance. As effort dyspnea is the main symptom of COPD, the most commonly recommended schedule for bronchodilator therapy administration is early morning. Many patients, however, experience an evening aggravation or at least a fear of a nocturnal aggravation of dyspnea. Patients use inhalers because they feel relief from their dyspnea. As therapy in COPD is to some extent driven by symptoms, a twice-daily bronchodilator regimen may be more suitable in certain patient groups, such as those with exacerbating phenotypes or asthma-COPD overlap syndrome (ACOS).</p><p id="par0025" class="elsevierStylePara elsevierViewall">The introduction of inhaled corticosteroids (ICs) to COPD therapy has been widely debated in medical and scientific communities. Weaning from ICs in COPD, and 4 other important randomized trials that evaluated the effect of IC discontinuity (COPE, COSMIC, INSTEAD, and WISDOM), have also created considerable controversy.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> However, ICs in association bronchodilators have long been a mainstay of treatment for COPD. It was only the recent introduction of new long-acting bronchodilators, specifically developed for the treatment of COPD, and new fixed combinations of LABA-LAMA that led to the current debate in the medical community.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> There is now enough clinical evidence to challenge the widespread use of IC in COPD in patients who do not suffer from exacerbations and who have not shown any benefit with ICs.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The science of medicine is characterized by its evidence-based approach and its revisibility. As a human activity, it is necessarily subject to dogmas and beliefs. Whether it was the medical representation of COPD as an inflammatory disease or the medical belief of a real benefit to the patient that led to the widespread use of ICs in COPD is still unclear. However, the medical community must wonder how real-life patients in real-life situations are represented in large randomized studies (often double-blind, placebo-controlled trials) supporting evidence-based medicine.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of Interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of Interest" ] 1 => 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: Araújo AD. Dogmas y creencias médicas acerca de la EPOC. Arch Bronconeumol. 2017;53:217–218.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "G. Sevalho" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:5 [ "fecha" => "1993" "paginaInicial" => "49" "paginaFinal" => "363" "editorial" => "Escola Nacional de Saúde Pública" "editorialLocalizacion" => "Río de Janeiro" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0045" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The assessment of new drugs for asthma and COPD: a Delphi study examining the perspectives of Italian payers and clinicians" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Sommariva" 1 => "A. Finch" 2 => "C. 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Rossi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/13993003.00282-2015" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2015" "volumen" => "46" "paginaInicial" => "1232" "paginaFinal" => "1235" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26521271" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0065" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inhaled steroids in COPD: reasons for a debate" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Agusti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rppnen.2015.04.005" "Revista" => array:6 [ "tituloSerie" => "Rev Port Pneumol" "fecha" => "2015" "volumen" => "21" "paginaInicial" => "175" "paginaFinal" => "177" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26008770" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0070" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Towards a patient-oriented treatment of COPD" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Miravitlles" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rppnen.2016.02.002" "Revista" => array:6 [ "tituloSerie" => "Rev Port Pneumol" "fecha" => "2016" "volumen" => "22" "paginaInicial" => "73" "paginaFinal" => "74" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26928088" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005300000004/v1_201704070039/S1579212916302129/v1_201704070039/en/main.assets" "Apartado" => array:4 [ "identificador" => "49861" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005300000004/v1_201704070039/S1579212916302129/v1_201704070039/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212916302129?idApp=UINPBA00003Z" ]
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| 2019 January | 25 | 18 | 43 |
| 2018 December | 31 | 15 | 46 |
| 2018 November | 69 | 18 | 87 |
| 2018 October | 104 | 22 | 126 |
| 2018 September | 31 | 11 | 42 |
| 2018 May | 16 | 1 | 17 |
| 2018 April | 39 | 9 | 48 |
| 2018 March | 43 | 5 | 48 |
| 2018 February | 48 | 9 | 57 |
| 2018 January | 137 | 10 | 147 |
| 2017 December | 110 | 6 | 116 |
| 2017 November | 29 | 6 | 35 |
| 2017 October | 22 | 7 | 29 |
| 2017 September | 27 | 13 | 40 |
| 2017 August | 27 | 17 | 44 |
| 2017 July | 26 | 14 | 40 |
| 2017 April | 1 | 1 | 2 |
| 2017 March | 0 | 1 | 1 |
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