array:24 [
  "pii" => "S1579212917300812"
  "issn" => "15792129"
  "doi" => "10.1016/j.arbr.2017.03.004"
  "estado" => "S300"
  "fechaPublicacion" => "2017-07-01"
  "aid" => "1451"
  "copyright" => "SEPAR"
  "copyrightAnyo" => "2016"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "sco"
  "cita" => "Arch Bronconeumol. 2017;53:362-3"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 1444
    "formatos" => array:3 [
      "EPUB" => 149
      "HTML" => 930
      "PDF" => 365
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0300289616302332"
      "issn" => "03002896"
      "doi" => "10.1016/j.arbres.2016.08.005"
      "estado" => "S300"
      "fechaPublicacion" => "2017-07-01"
      "aid" => "1451"
      "copyright" => "SEPAR"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "sco"
      "cita" => "Arch Bronconeumol. 2017;53:362-3"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 2898
        "formatos" => array:3 [
          "EPUB" => 123
          "HTML" => 2098
          "PDF" => 677
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
        "titulo" => "&#191;Es realmente la enfermedad pulmonar obstructiva cr&#243;nica una enfermedad progresiva&#63;"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "362"
            "paginaFinal" => "363"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Is Chronic Obstructive Pulmonary Disease Really a Progressive Disease&#63;"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Juan P&#46; de Torres, Bartolome R&#46; Celli"
            "autores" => array:2 [
              0 => array:2 [
                "nombre" => "Juan P&#46;"
                "apellidos" => "de Torres"
              ]
              1 => array:2 [
                "nombre" => "Bartolome R&#46;"
                "apellidos" => "Celli"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1579212917300812"
          "doi" => "10.1016/j.arbr.2017.03.004"
          "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/S1579212917300812?idApp=UINPBA00003Z"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289616302332?idApp=UINPBA00003Z"
      "url" => "/03002896/0000005300000007/v2_201706291228/S0300289616302332/v2_201706291228/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1579212917300071"
    "issn" => "15792129"
    "doi" => "10.1016/j.arbr.2017.01.003"
    "estado" => "S300"
    "fechaPublicacion" => "2017-07-01"
    "aid" => "1507"
    "copyright" => "SEPAR"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Arch Bronconeumol. 2017;53:364-5"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 1637
      "formatos" => array:3 [
        "EPUB" => 139
        "HTML" => 1051
        "PDF" => 447
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
      "titulo" => "Epigenetics and Susceptibility to Muscle Wasting in COPD"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "364"
          "paginaFinal" => "365"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Epigen&#233;tica y propensi&#243;n a la atrofia muscular en la EPOC"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Paul Kemp, Amanda Natanek"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "Paul"
              "apellidos" => "Kemp"
            ]
            1 => array:2 [
              "nombre" => "Amanda"
              "apellidos" => "Natanek"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0300289616303350"
        "doi" => "10.1016/j.arbres.2016.10.020"
        "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/S0300289616303350?idApp=UINPBA00003Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212917300071?idApp=UINPBA00003Z"
    "url" => "/15792129/0000005300000007/v1_201706290145/S1579212917300071/v1_201706290145/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1579212917300824"
    "issn" => "15792129"
    "doi" => "10.1016/j.arbr.2017.03.005"
    "estado" => "S300"
    "fechaPublicacion" => "2017-07-01"
    "aid" => "1452"
    "copyright" => "SEPAR"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Arch Bronconeumol. 2017;53:360-1"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 2692
      "formatos" => array:3 [
        "EPUB" => 126
        "HTML" => 1287
        "PDF" => 1279
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
      "titulo" => "Test of Adherence to Inhalers"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "360"
          "paginaFinal" => "361"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "El test de adhesi&#243;n a los inhaladores"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Vicente Plaza, Antol&#237;n L&#243;pez-Vi&#241;a, Borja G&#46; Cosio"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Vicente"
              "apellidos" => "Plaza"
            ]
            1 => array:2 [
              "nombre" => "Antol&#237;n"
              "apellidos" => "L&#243;pez-Vi&#241;a"
            ]
            2 => array:2 [
              "nombre" => "Borja G&#46;"
              "apellidos" => "Cosio"
            ]
            3 => array:1 [
              "colaborador" => "in representation of the Comit&#233; Cient&#237;fico del Proyecto TAI"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0300289616302344"
        "doi" => "10.1016/j.arbres.2016.08.006"
        "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/S0300289616302344?idApp=UINPBA00003Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212917300824?idApp=UINPBA00003Z"
    "url" => "/15792129/0000005300000007/v1_201706290145/S1579212917300824/v1_201706290145/en/main.assets"
  ]
  "en" => array:12 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
    "titulo" => "Is Chronic Obstructive Pulmonary Disease Really a Progressive Disease&#63;"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "362"
        "paginaFinal" => "363"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Juan P&#46; de Torres, Bartolome R&#46; Celli"
        "autores" => array:2 [
          0 => array:4 [
            "nombre" => "Juan P&#46;"
            "apellidos" => "de Torres"
            "email" => array:1 [
              0 => "jpdetorres&#64;unav&#46;es"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Bartolome R&#46;"
            "apellidos" => "Celli"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Departamento de Neumolog&#237;a&#44; Cl&#237;nica Universidad de Navarra&#44; Pamplona&#44; Navarra&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Pulmonary Department&#44; Brigham and Women&#39;s Hospital&#44; Boston&#44; MA&#44; United States"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "&#191;Es realmente la enfermedad pulmonar obstructiva cr&#243;nica una enfermedad progresiva&#63;"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The Global Initiative for Chronic Obstructive Lung Disease &#40;GOLD&#41; defines chronic obstructive pulmonary disease &#40;COPD&#41; as a disease characterized by usually progressive&#44; irreversible airflow obstruction&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The degree of bronchial obstruction measured by volume exhaled during the first second of a forced expiratory maneuver &#40;FEV1&#41; is the conventional method of evaluating disease &#8220;progression&#8221;&#46; This implies that&#44; according to the GOLD definition&#44; most COPD patients have a progressive decline of lung function with a fall in FEV1&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Recent studies<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2&#44;3</span></a> indicate that not all patients have the same lung function decline&#46; These publications show 3 different patterns of progress&#58; rapid decliners&#44; slow decliners&#44; and those who even experience an improvement in lung function&#46; These studies also confirm that only a small percentage of patients &#40;20&#37;&#8211;30&#37;&#41; are rapid decliners&#44; and thus meet the definition of clear disease &#8220;progression&#8221;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The idea that lung function declines over time implies that most COPD patients will inexorably &#8220;progress&#8221; after diagnosis to more severe disease stages&#46; This would suggest that patients who are currently in GOLD spirometric stages I&#8211;II will progress to stages II&#8211;IV&#44; if they manage to survive long enough&#46; In contrast&#44; it would also suggest that patients in GOLD spirometric stages III&#8211;IV would have previously progressed through stages of less severity in the natural course of their disease&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">This ingrained concept of the progressive nature of the disease has recently been questioned in a study published by the BODE group in <span class="elsevierStyleItalic">PloSOne</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> This group of investigators determined the proportion of patients with COPD whose GOLD stage changed over a prolonged follow-up period&#46; They looked at a group of 318 patients who they called &#8220;survivors&#8221;&#44; who were regularly monitored over at least 8 years&#44; and another group of &#8220;non-survivors&#8221; who had died during the follow-up period&#44; but who had been monitored for at least 4 years before death&#46; The &#8220;non-survivor&#8221; group was purposely included in order to avoid the modifying effect observed when only healthy subjects who &#8220;survive&#8221; are evaluated&#44; as this latter group would be more resilient&#44; and consequently slower decliners&#46; This design also helped the authors explore what happens to patients in the years before death&#44; so that those with a poorer prognosis&#44; who presumably would be rapid decliners&#44; also contributed to the analysis&#46; All study patients received standard medical treatment according to GOLD guidelines&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">One of the most important findings of the study was that 9&#37; of survivors and 11&#37; of non-survivors improved their GOLD stage during the follow-up period&#44; suggesting that a certain proportion of patients really do show a highly favorable response to treatment&#46; Moreover&#44; among the survivors&#44; the proportion of patients who progress reduces and the proportion who improve increases as the severity of the obstruction increases&#44; while among non-survivors&#44; the proportion of patients who progress appears to fall&#44; but clearly the number who improve falls as the severity of their obstruction increases&#46; This suggests the existence of 2 patient profiles&#58; &#8220;responders&#8221; to standard medical treatment&#44; who are consequently survivors&#44; and &#8220;non-responders&#8221;&#44; who are consequently &#8220;non-survivors&#8221;&#46; GOLD stages also remained unchanged in approximately 70&#37; of patients in both groups&#46; In other words&#44; most patients remained stable throughout the course of their disease&#46; Some other aspects of these findings are of interest&#58; &#40;1&#41; The 8-year follow-up &#40;10&#8211;12 years in many cases&#41; of survivors represents 40&#37;&#8211;50&#37; of the potential survival time of a patient diagnosed with COPD between the ages of 50&#8211;60 years&#44; so it is probably truly representative of what happens in the &#8220;real-life&#8221; course of a COPD patient&#46; &#40;2&#41; The percentage of patients who decline rapidly &#40;and whose GOLD stage therefore worsens&#41; is similar to figures published in other studies&#44; adding external validity to the findings&#46; The authors mention some limitations&#44; the most important being that their population comprises mainly men&#59; that during the follow-up period&#44; new therapies appeared that probably affected the natural course of the disease&#59; and that the yearly exacerbation rate of patients that might have an impact on lung function decline was not consistently collected&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The observation that a large proportion of patients remained in the same GOLD stage for a prolonged time is consistent with a recent report that found that almost half of patients with COPD are diagnosed without having experienced a rapid decline in lung function&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> The authors of this study suggested that in individuals with COPD without rapid FEV1 deterioration&#44; the decline may have already occurred as a result of having started out with functional compromise from an early age&#44; whether as a result of genetic problems or pulmonary insult during childhood caused by factors such as asthma and infections during the early postnatal period of lung growth&#46; Finally&#44; the fact that almost 10&#37; of patients show improved lung function to the extent of dropping one grade on the GOLD scale is very significant&#46; Is it possible that the lungs of these patients are really being repaired&#63; To date&#44; all our attention has been focused on slowing down the process of functional decline&#44; but these findings oblige us to rethink our position and wonder if it is possible to recover lost function&#44; at least partially&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">These studies may have important implications in the interpretation of the course of COPD<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> and the impact of treatment on patient progress&#46; The participants in this observational study were treated according to the guidelines applicable at the time&#44; and probably reflect the real life and progress of patients we see on a daily basis in our clinics&#46; The findings underline that our day-to-day management of our patients has a real impact on their COPD progress&#44; and that most remain at the same stage of spirometric severity&#44; and some even improve&#44; overturning our nihilistic concept of a disease described in the current guidelines as &#8220;usually progressive&#8221;&#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; de Torres JP&#44; Celli BR&#46; &#191;Es realmente la enfermedad pulmonar obstructiva cr&#243;nica una enfermedad progresiva&#63; Arch Bronconeumol&#46; 2017&#59;53&#58;362&#8211;363&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:6 [
            0 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Global strategy for the diagnosis&#44; management&#44; and prevention of chronic obstructive pulmonary disease&#58; GOLD executive summary"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Vestbo"
                            1 => "S&#46;S&#46; Hurd"
                            2 => "A&#46;G&#46; Agust&#237;"
                            3 => "P&#46;W&#46; Jones"
                            4 => "C&#46; Vogelmeier"
                            5 => "A&#46; Anzueto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.201204-0596PP"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2013"
                        "volumen" => "187"
                        "paginaInicial" => "347"
                        "paginaFinal" => "365"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22878278"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The progression of chronic obstructive pulmonary disease is heterogeneous&#58; the experience of the BODE cohort"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Casanova"
                            1 => "J&#46;P&#46; de Torres"
                            2 => "A&#46; Aguirre-Jaime"
                            3 => "V&#46; Pinto-Plata"
                            4 => "J&#46;M&#46; Mar&#237;n"
                            5 => "E&#46; C&#243;rdoba"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.201105-0831OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2011"
                        "volumen" => "184"
                        "paginaInicial" => "1015"
                        "paginaFinal" => "1021"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21836135"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Annual change in pulmonary function and clinical phenotype in chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Nishimura"
                            1 => "H&#46; Makita"
                            2 => "K&#46; Nagai"
                            3 => "S&#46; Konno"
                            4 => "Y&#46; Nasuhara"
                            5 => "M&#46; Hasegawa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.201106-0992OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2012"
                        "volumen" => "185"
                        "paginaInicial" => "44"
                        "paginaFinal" => "52"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22016444"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Is COPD a progressive disease&#63; A long term bode cohort observation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;P&#46; de-Torres"
                            1 => "J&#46;M&#46; Mar&#237;n"
                            2 => "V&#46; Pinto-Plata"
                            3 => "M&#46; Divo"
                            4 => "P&#46; S&#225;nchez-Salcedo"
                            5 => "J&#46; Zagaceta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0151856"
                      "Revista" => array:5 [
                        "tituloSerie" => "PLOS ONE"
                        "fecha" => "2016"
                        "volumen" => "11"
                        "paginaInicial" => "e0151856"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27100872"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lung-function trajectories leading to chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Lange"
                            1 => "B&#46; Celli"
                            2 => "A&#46; Agusti"
                            3 => "G&#46; Boje Jensen"
                            4 => "M&#46; Divo"
                            5 => "R&#46; Faner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1411532"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2015"
                        "volumen" => "373"
                        "paginaInicial" => "111"
                        "paginaFinal" => "122"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26154786"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pathophysiology of airflow limitation in chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;C&#46; Hogg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(04)16900-6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2004"
                        "volumen" => "364"
                        "paginaInicial" => "709"
                        "paginaFinal" => "721"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15325838"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15792129/0000005300000007/v1_201706290145/S1579212917300812/v1_201706290145/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "46447"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Editorial"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005300000007/v1_201706290145/S1579212917300812/v1_201706290145/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212917300812?idApp=UINPBA00003Z"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Editorial
Is Chronic Obstructive Pulmonary Disease Really a Progressive Disease?
¿Es realmente la enfermedad pulmonar obstructiva crónica una enfermedad progresiva?
Juan P. de Torresa,
Corresponding author
jpdetorres@unav.es

Corresponding author.
, Bartolome R. Cellib
a Departamento de Neumología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
b Pulmonary Department, Brigham and Women's Hospital, Boston, MA, United States
Read
6601
Times
was read the article
1729
Total PDF
4872
Total HTML
Share statistics
 array:24 [
  "pii" => "S1579212917300812"
  "issn" => "15792129"
  "doi" => "10.1016/j.arbr.2017.03.004"
  "estado" => "S300"
  "fechaPublicacion" => "2017-07-01"
  "aid" => "1451"
  "copyright" => "SEPAR"
  "copyrightAnyo" => "2016"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "sco"
  "cita" => "Arch Bronconeumol. 2017;53:362-3"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 1444
    "formatos" => array:3 [
      "EPUB" => 149
      "HTML" => 930
      "PDF" => 365
    ]
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0300289616302332"
      "issn" => "03002896"
      "doi" => "10.1016/j.arbres.2016.08.005"
      "estado" => "S300"
      "fechaPublicacion" => "2017-07-01"
      "aid" => "1451"
      "copyright" => "SEPAR"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "sco"
      "cita" => "Arch Bronconeumol. 2017;53:362-3"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 2898
        "formatos" => array:3 [
          "EPUB" => 123
          "HTML" => 2098
          "PDF" => 677
        ]
      ]
      "es" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
        "titulo" => "&#191;Es realmente la enfermedad pulmonar obstructiva cr&#243;nica una enfermedad progresiva&#63;"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "362"
            "paginaFinal" => "363"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Is Chronic Obstructive Pulmonary Disease Really a Progressive Disease&#63;"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Juan P&#46; de Torres, Bartolome R&#46; Celli"
            "autores" => array:2 [
              0 => array:2 [
                "nombre" => "Juan P&#46;"
                "apellidos" => "de Torres"
              ]
              1 => array:2 [
                "nombre" => "Bartolome R&#46;"
                "apellidos" => "Celli"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1579212917300812"
          "doi" => "10.1016/j.arbr.2017.03.004"
          "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/S1579212917300812?idApp=UINPBA00003Z"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289616302332?idApp=UINPBA00003Z"
      "url" => "/03002896/0000005300000007/v2_201706291228/S0300289616302332/v2_201706291228/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1579212917300071"
    "issn" => "15792129"
    "doi" => "10.1016/j.arbr.2017.01.003"
    "estado" => "S300"
    "fechaPublicacion" => "2017-07-01"
    "aid" => "1507"
    "copyright" => "SEPAR"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Arch Bronconeumol. 2017;53:364-5"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 1637
      "formatos" => array:3 [
        "EPUB" => 139
        "HTML" => 1051
        "PDF" => 447
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
      "titulo" => "Epigenetics and Susceptibility to Muscle Wasting in COPD"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "364"
          "paginaFinal" => "365"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Epigen&#233;tica y propensi&#243;n a la atrofia muscular en la EPOC"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Paul Kemp, Amanda Natanek"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "Paul"
              "apellidos" => "Kemp"
            ]
            1 => array:2 [
              "nombre" => "Amanda"
              "apellidos" => "Natanek"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0300289616303350"
        "doi" => "10.1016/j.arbres.2016.10.020"
        "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/S0300289616303350?idApp=UINPBA00003Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212917300071?idApp=UINPBA00003Z"
    "url" => "/15792129/0000005300000007/v1_201706290145/S1579212917300071/v1_201706290145/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1579212917300824"
    "issn" => "15792129"
    "doi" => "10.1016/j.arbr.2017.03.005"
    "estado" => "S300"
    "fechaPublicacion" => "2017-07-01"
    "aid" => "1452"
    "copyright" => "SEPAR"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Arch Bronconeumol. 2017;53:360-1"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 2692
      "formatos" => array:3 [
        "EPUB" => 126
        "HTML" => 1287
        "PDF" => 1279
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
      "titulo" => "Test of Adherence to Inhalers"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "360"
          "paginaFinal" => "361"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "El test de adhesi&#243;n a los inhaladores"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Vicente Plaza, Antol&#237;n L&#243;pez-Vi&#241;a, Borja G&#46; Cosio"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Vicente"
              "apellidos" => "Plaza"
            ]
            1 => array:2 [
              "nombre" => "Antol&#237;n"
              "apellidos" => "L&#243;pez-Vi&#241;a"
            ]
            2 => array:2 [
              "nombre" => "Borja G&#46;"
              "apellidos" => "Cosio"
            ]
            3 => array:1 [
              "colaborador" => "in representation of the Comit&#233; Cient&#237;fico del Proyecto TAI"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0300289616302344"
        "doi" => "10.1016/j.arbres.2016.08.006"
        "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/S0300289616302344?idApp=UINPBA00003Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212917300824?idApp=UINPBA00003Z"
    "url" => "/15792129/0000005300000007/v1_201706290145/S1579212917300824/v1_201706290145/en/main.assets"
  ]
  "en" => array:12 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
    "titulo" => "Is Chronic Obstructive Pulmonary Disease Really a Progressive Disease&#63;"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "362"
        "paginaFinal" => "363"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Juan P&#46; de Torres, Bartolome R&#46; Celli"
        "autores" => array:2 [
          0 => array:4 [
            "nombre" => "Juan P&#46;"
            "apellidos" => "de Torres"
            "email" => array:1 [
              0 => "jpdetorres&#64;unav&#46;es"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Bartolome R&#46;"
            "apellidos" => "Celli"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Departamento de Neumolog&#237;a&#44; Cl&#237;nica Universidad de Navarra&#44; Pamplona&#44; Navarra&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Pulmonary Department&#44; Brigham and Women&#39;s Hospital&#44; Boston&#44; MA&#44; United States"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "&#191;Es realmente la enfermedad pulmonar obstructiva cr&#243;nica una enfermedad progresiva&#63;"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The Global Initiative for Chronic Obstructive Lung Disease &#40;GOLD&#41; defines chronic obstructive pulmonary disease &#40;COPD&#41; as a disease characterized by usually progressive&#44; irreversible airflow obstruction&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The degree of bronchial obstruction measured by volume exhaled during the first second of a forced expiratory maneuver &#40;FEV1&#41; is the conventional method of evaluating disease &#8220;progression&#8221;&#46; This implies that&#44; according to the GOLD definition&#44; most COPD patients have a progressive decline of lung function with a fall in FEV1&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Recent studies<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2&#44;3</span></a> indicate that not all patients have the same lung function decline&#46; These publications show 3 different patterns of progress&#58; rapid decliners&#44; slow decliners&#44; and those who even experience an improvement in lung function&#46; These studies also confirm that only a small percentage of patients &#40;20&#37;&#8211;30&#37;&#41; are rapid decliners&#44; and thus meet the definition of clear disease &#8220;progression&#8221;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The idea that lung function declines over time implies that most COPD patients will inexorably &#8220;progress&#8221; after diagnosis to more severe disease stages&#46; This would suggest that patients who are currently in GOLD spirometric stages I&#8211;II will progress to stages II&#8211;IV&#44; if they manage to survive long enough&#46; In contrast&#44; it would also suggest that patients in GOLD spirometric stages III&#8211;IV would have previously progressed through stages of less severity in the natural course of their disease&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">This ingrained concept of the progressive nature of the disease has recently been questioned in a study published by the BODE group in <span class="elsevierStyleItalic">PloSOne</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> This group of investigators determined the proportion of patients with COPD whose GOLD stage changed over a prolonged follow-up period&#46; They looked at a group of 318 patients who they called &#8220;survivors&#8221;&#44; who were regularly monitored over at least 8 years&#44; and another group of &#8220;non-survivors&#8221; who had died during the follow-up period&#44; but who had been monitored for at least 4 years before death&#46; The &#8220;non-survivor&#8221; group was purposely included in order to avoid the modifying effect observed when only healthy subjects who &#8220;survive&#8221; are evaluated&#44; as this latter group would be more resilient&#44; and consequently slower decliners&#46; This design also helped the authors explore what happens to patients in the years before death&#44; so that those with a poorer prognosis&#44; who presumably would be rapid decliners&#44; also contributed to the analysis&#46; All study patients received standard medical treatment according to GOLD guidelines&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">One of the most important findings of the study was that 9&#37; of survivors and 11&#37; of non-survivors improved their GOLD stage during the follow-up period&#44; suggesting that a certain proportion of patients really do show a highly favorable response to treatment&#46; Moreover&#44; among the survivors&#44; the proportion of patients who progress reduces and the proportion who improve increases as the severity of the obstruction increases&#44; while among non-survivors&#44; the proportion of patients who progress appears to fall&#44; but clearly the number who improve falls as the severity of their obstruction increases&#46; This suggests the existence of 2 patient profiles&#58; &#8220;responders&#8221; to standard medical treatment&#44; who are consequently survivors&#44; and &#8220;non-responders&#8221;&#44; who are consequently &#8220;non-survivors&#8221;&#46; GOLD stages also remained unchanged in approximately 70&#37; of patients in both groups&#46; In other words&#44; most patients remained stable throughout the course of their disease&#46; Some other aspects of these findings are of interest&#58; &#40;1&#41; The 8-year follow-up &#40;10&#8211;12 years in many cases&#41; of survivors represents 40&#37;&#8211;50&#37; of the potential survival time of a patient diagnosed with COPD between the ages of 50&#8211;60 years&#44; so it is probably truly representative of what happens in the &#8220;real-life&#8221; course of a COPD patient&#46; &#40;2&#41; The percentage of patients who decline rapidly &#40;and whose GOLD stage therefore worsens&#41; is similar to figures published in other studies&#44; adding external validity to the findings&#46; The authors mention some limitations&#44; the most important being that their population comprises mainly men&#59; that during the follow-up period&#44; new therapies appeared that probably affected the natural course of the disease&#59; and that the yearly exacerbation rate of patients that might have an impact on lung function decline was not consistently collected&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The observation that a large proportion of patients remained in the same GOLD stage for a prolonged time is consistent with a recent report that found that almost half of patients with COPD are diagnosed without having experienced a rapid decline in lung function&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> The authors of this study suggested that in individuals with COPD without rapid FEV1 deterioration&#44; the decline may have already occurred as a result of having started out with functional compromise from an early age&#44; whether as a result of genetic problems or pulmonary insult during childhood caused by factors such as asthma and infections during the early postnatal period of lung growth&#46; Finally&#44; the fact that almost 10&#37; of patients show improved lung function to the extent of dropping one grade on the GOLD scale is very significant&#46; Is it possible that the lungs of these patients are really being repaired&#63; To date&#44; all our attention has been focused on slowing down the process of functional decline&#44; but these findings oblige us to rethink our position and wonder if it is possible to recover lost function&#44; at least partially&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">These studies may have important implications in the interpretation of the course of COPD<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> and the impact of treatment on patient progress&#46; The participants in this observational study were treated according to the guidelines applicable at the time&#44; and probably reflect the real life and progress of patients we see on a daily basis in our clinics&#46; The findings underline that our day-to-day management of our patients has a real impact on their COPD progress&#44; and that most remain at the same stage of spirometric severity&#44; and some even improve&#44; overturning our nihilistic concept of a disease described in the current guidelines as &#8220;usually progressive&#8221;&#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; de Torres JP&#44; Celli BR&#46; &#191;Es realmente la enfermedad pulmonar obstructiva cr&#243;nica una enfermedad progresiva&#63; Arch Bronconeumol&#46; 2017&#59;53&#58;362&#8211;363&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:6 [
            0 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Global strategy for the diagnosis&#44; management&#44; and prevention of chronic obstructive pulmonary disease&#58; GOLD executive summary"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Vestbo"
                            1 => "S&#46;S&#46; Hurd"
                            2 => "A&#46;G&#46; Agust&#237;"
                            3 => "P&#46;W&#46; Jones"
                            4 => "C&#46; Vogelmeier"
                            5 => "A&#46; Anzueto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.201204-0596PP"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2013"
                        "volumen" => "187"
                        "paginaInicial" => "347"
                        "paginaFinal" => "365"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22878278"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The progression of chronic obstructive pulmonary disease is heterogeneous&#58; the experience of the BODE cohort"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46; Casanova"
                            1 => "J&#46;P&#46; de Torres"
                            2 => "A&#46; Aguirre-Jaime"
                            3 => "V&#46; Pinto-Plata"
                            4 => "J&#46;M&#46; Mar&#237;n"
                            5 => "E&#46; C&#243;rdoba"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.201105-0831OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2011"
                        "volumen" => "184"
                        "paginaInicial" => "1015"
                        "paginaFinal" => "1021"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21836135"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Annual change in pulmonary function and clinical phenotype in chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Nishimura"
                            1 => "H&#46; Makita"
                            2 => "K&#46; Nagai"
                            3 => "S&#46; Konno"
                            4 => "Y&#46; Nasuhara"
                            5 => "M&#46; Hasegawa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.201106-0992OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2012"
                        "volumen" => "185"
                        "paginaInicial" => "44"
                        "paginaFinal" => "52"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22016444"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Is COPD a progressive disease&#63; A long term bode cohort observation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;P&#46; de-Torres"
                            1 => "J&#46;M&#46; Mar&#237;n"
                            2 => "V&#46; Pinto-Plata"
                            3 => "M&#46; Divo"
                            4 => "P&#46; S&#225;nchez-Salcedo"
                            5 => "J&#46; Zagaceta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1371/journal.pone.0151856"
                      "Revista" => array:5 [
                        "tituloSerie" => "PLOS ONE"
                        "fecha" => "2016"
                        "volumen" => "11"
                        "paginaInicial" => "e0151856"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27100872"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lung-function trajectories leading to chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Lange"
                            1 => "B&#46; Celli"
                            2 => "A&#46; Agusti"
                            3 => "G&#46; Boje Jensen"
                            4 => "M&#46; Divo"
                            5 => "R&#46; Faner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1411532"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2015"
                        "volumen" => "373"
                        "paginaInicial" => "111"
                        "paginaFinal" => "122"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26154786"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pathophysiology of airflow limitation in chronic obstructive pulmonary disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46;C&#46; Hogg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(04)16900-6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "2004"
                        "volumen" => "364"
                        "paginaInicial" => "709"
                        "paginaFinal" => "721"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15325838"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15792129/0000005300000007/v1_201706290145/S1579212917300812/v1_201706290145/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "46447"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Editorial"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005300000007/v1_201706290145/S1579212917300812/v1_201706290145/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212917300812?idApp=UINPBA00003Z"
]
Article information
ISSN: 15792129
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 19 4 23
2024 October 131 21 152
2024 September 154 26 180
2024 August 135 38 173
2024 July 125 27 152
2024 June 124 43 167
2024 May 111 35 146
2024 April 86 32 118
2024 March 86 19 105
2024 February 39 18 57
2023 March 18 4 22
2023 February 94 19 113
2023 January 103 31 134
2022 December 76 24 100
2022 November 81 21 102
2022 October 126 47 173
2022 September 93 20 113
2022 August 96 47 143
2022 July 109 39 148
2022 June 81 27 108
2022 May 82 36 118
2022 April 83 37 120
2022 March 78 41 119
2022 February 110 44 154
2022 January 86 39 125
2021 December 59 35 94
2021 November 69 44 113
2021 October 96 49 145
2021 September 78 39 117
2021 August 72 37 109
2021 July 59 29 88
2021 June 78 49 127
2021 May 108 37 145
2021 April 237 100 337
2021 March 146 27 173
2021 February 96 20 116
2021 January 77 14 91
2020 December 69 12 81
2020 November 53 21 74
2020 October 49 22 71
2020 September 41 9 50
2020 August 50 13 63
2020 July 42 20 62
2020 June 29 6 35
2020 May 19 9 28
2020 April 50 18 68
2020 March 28 10 38
2020 February 33 14 47
2020 January 30 20 50
2019 December 44 11 55
2019 November 43 25 68
2019 October 20 10 30
2019 September 20 5 25
2019 August 23 13 36
2019 July 17 20 37
2019 June 21 10 31
2019 May 31 16 47
2019 April 37 25 62
2019 March 27 14 41
2019 February 22 14 36
2019 January 18 16 34
2018 December 19 15 34
2018 November 58 32 90
2018 October 89 24 113
2018 September 30 15 45
2018 May 12 0 12
2018 April 27 7 34
2018 March 42 5 47
2018 February 37 6 43
2018 January 105 9 114
2017 December 78 11 89
2017 November 27 12 39
2017 October 31 18 49
2017 September 0 2 2
2017 April 0 1 1
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?