Editorial
COPD in Spain at the start of a new decade
La EPOC en España al inicio de una nueva década
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Soriano" "autores" => array:2 [ 0 => array:3 [ "nombre" => "Julio" "apellidos" => "Ancochea" "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" ] ] ] 1 => array:4 [ "nombre" => "Joan B." "apellidos" => "Soriano" "email" => array:1 [ 0 => "jbsoriano2@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Hospital Universitario de la Princesa, Instituto de Investigación Sanitaria Princesa (IP), Universidad Autónoma de Madrid, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La EPOC en España al inicio de una nueva década" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The National COPD Strategy in Spain was first approved in 2009.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> We are now in 2020, and the ten points we present in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> go beyond the clinical guidelines and complexity of the process itself and its current status, and seek to identify issues and possible solutions to the problem of COPD in Spain, focusing on policy and the health authorities.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">COPD is a preventable and treatable disease,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> the main cause of which in Spain is smoking. Recent trends in smoking among women and children, along with the new vaping and “heat-not-burn” devices, are creating new challenges. In Spain, smoking leads to the loss of 1 million life years annually, and 28,766 people die of COPD every year.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> COPD is still highly prevalent, and the EPISCAN II study concludes that 11.8% of Spain's citizens aged 40 or older (14.6% men and 9.4% women) have this disease,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> and that prevalence among younger patients and women is increasing.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Unfortunately, COPD is still underdiagnosed and treated late: despite the efforts and resources devoted to performing spirometry in primary care, underdiagnosis is as high as 74.7%.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> EPISCAN II also confirms the so-called "Spanish paradox", in which underdiagnosis is greater in women.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> COPD is the paradigm of a chronic, progressive, incapacitating disease with frequent extrapulmonary manifestations and comorbidities, and a prevalence that increases with age. A comprehensive, multidisciplinary approach which incorporates a gender perspective is needed.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Use of resources associated with COPD is high, up to 3 bn Euros a year (0.2% of GDP): most expenditure goes on hospitalization, and 15% of patients consume 80% of all resources.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> There is clearly room for improvement in the care of COPD, the main issues being the low number of quality spirometries being performed,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and the urgent need for advanced nursing skills, comprehensive process management, and prioritization using health indicators.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Alternatives to conventional hospitalization such as home care and new technologies should be promoted<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> with collaborative intervention by the public and private sectors and coordination among the different agencies involved.</p><p id="par0020" class="elsevierStylePara elsevierViewall">We believe that the physician-patient-caregiver relationship must become a true "therapeutic alliance". The new key words in COPD are self-care, adherence, appropriate use of resources, and empowerment of patient associations, all underpinned by quality of care. Quality scientific and technical policies must be implemented, and quality standards ensuring personalized treatment must be established in regularly updated guidelines.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Sponsorship of translational research in both prevention and comprehensive care is essential. Finally, all stakeholders must collaborate in disseminating knowledge to both society and professionals. COPD is changing, and there are still a great many unknowns,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> but awareness must increase,<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13,14</span></a> so we propose writing the copd acronym in lower case to emphasize that this is a disease of capital importance.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In short, the copd patient is a VIP - a very important patient - to whom we must offer a longer and better quality of life. This problem and its causes must be tackled more efficiently in the coming decade, and if we all work together perhaps we can put an end to copd.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-01-25" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ancochea J, Soriano JB. La EPOC en España al inicio de una nueva década. Arch Bronconeumol. 2020;57:1–2.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1. It is a preventable disease \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2. It has a high prevalence \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3. It is underdiagnosed and treated late \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4. It is a paradigm of chronicity \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5. Resource consumption is high \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6. There is room for improvement in care \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7. The physician-patient-caregiver relationship must be remodeled \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8. Quality of care is key \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9. More research is required \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10. Awareness in our society needs to be expanded and the training of professionals must be promoted \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2511087.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Decalogue of COPD.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estrategia en epoc del Sistema Nacional de Salud" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Ministerio de Sanidad y Política Social" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2009" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guía española de la enfermedad pulmonar obstructiva crónica (GesEPOC) 2017. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 4 | 12 |
| 2024 October | 39 | 14 | 53 |
| 2024 September | 35 | 24 | 59 |
| 2024 August | 52 | 78 | 130 |
| 2024 July | 36 | 24 | 60 |
| 2024 June | 57 | 24 | 81 |
| 2024 May | 83 | 36 | 119 |
| 2024 April | 53 | 20 | 73 |
| 2024 March | 37 | 13 | 50 |
| 2024 February | 28 | 24 | 52 |
| 2024 January | 27 | 30 | 57 |
| 2023 December | 37 | 27 | 64 |
| 2023 November | 37 | 22 | 59 |
| 2023 October | 42 | 30 | 72 |
| 2023 September | 36 | 31 | 67 |
| 2023 August | 43 | 32 | 75 |
| 2023 July | 44 | 19 | 63 |
| 2023 June | 51 | 24 | 75 |
| 2023 May | 43 | 22 | 65 |
| 2023 April | 48 | 23 | 71 |
| 2023 March | 76 | 30 | 106 |
| 2023 February | 47 | 17 | 64 |
| 2023 January | 37 | 44 | 81 |
| 2022 December | 70 | 37 | 107 |
| 2022 November | 69 | 31 | 100 |
| 2022 October | 65 | 34 | 99 |
| 2022 September | 54 | 34 | 88 |
| 2022 August | 36 | 43 | 79 |
| 2022 July | 37 | 43 | 80 |
| 2022 June | 45 | 25 | 70 |
| 2022 May | 42 | 35 | 77 |
| 2022 April | 43 | 33 | 76 |
| 2022 March | 73 | 41 | 114 |
| 2022 February | 26 | 18 | 44 |
| 2021 December | 2 | 2 | 4 |
| 2021 May | 2 | 2 | 4 |
| 2021 January | 4 | 0 | 4 |
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