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array:23 [ "pii" => "S0300289623003666" "issn" => "03002896" "doi" => "10.1016/j.arbres.2023.10.011" "estado" => "S300" "fechaPublicacion" => "2024-01-01" "aid" => "3429" "copyright" => "SEPAR" "copyrightAnyo" => "2023" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2024;60:65-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S0300289623003800" "issn" => "03002896" "doi" => "10.1016/j.arbres.2023.11.012" "estado" => "S300" "fechaPublicacion" => "2024-01-01" "aid" => "3441" "copyright" => "SEPAR" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2024;60:67-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:9 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Director</span>" "titulo" => "Reply to Figueroa-Gonçalves and de Miguel-Díez" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "67" "paginaFinal" => "68" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Marc Miravitlles, Konstantinos Kostikas, Nikoletta Bizymi, Nikolaos Tzanakis" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Marc" "apellidos" => "Miravitlles" ] 1 => array:2 [ "nombre" => "Konstantinos" "apellidos" => "Kostikas" ] 2 => array:2 [ "nombre" => "Nikoletta" "apellidos" => "Bizymi" ] 3 => array:2 [ "nombre" => "Nikolaos" "apellidos" => "Tzanakis" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623003800?idApp=UINPBA00003Z" "url" => "/03002896/0000006000000001/v3_202406051404/S0300289623003800/v3_202406051404/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0300289623003654" "issn" => "03002896" "doi" => "10.1016/j.arbres.2023.11.003" "estado" => "S300" "fechaPublicacion" => "2024-01-01" "aid" => "3428" "copyright" => "The Author(s)" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Arch Bronconeumol. 2024;60:62-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Persistent Pulmonary Fibrotic Sequelae in Patients With Telomere Shortening One Year After Severe COVID-19" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "62" "paginaFinal" => "64" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 902 "Ancho" => 2341 "Tamanyo" => 120516 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evolution of telomere shortening over one year after severe COVID-19. (A) Representation of relative telomere length (RTL) of patients admitted for bilateral COVID-19 pneumonia at admission and 1 year after discharge compared to controls. (B) RTL changes in patients without fibrosis. (C) RTL changes in patients with fibrosis.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Alba Mulet, Pilar González-Cabo, Federico V. Pallardó, Jaime Signes-Costa" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Alba" "apellidos" => "Mulet" ] 1 => array:2 [ "nombre" => "Pilar" "apellidos" => "González-Cabo" ] 2 => array:2 [ "nombre" => "Federico V." "apellidos" => "Pallardó" ] 3 => array:2 [ "nombre" => "Jaime" "apellidos" => "Signes-Costa" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623003654?idApp=UINPBA00003Z" "url" => "/03002896/0000006000000001/v3_202406051404/S0300289623003654/v3_202406051404/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Director</span>" "titulo" => "Initial Treatment in COPD Patients. Do We Take into Account the Severity of the Exacerbation?" "tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">To the Director,</span>" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "65" "paginaFinal" => "66" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Juan Marco Figueira-Gonçalves, Javier de Miguel-Díez" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Juan Marco" "apellidos" => "Figueira-Gonçalves" "email" => array:1 [ 0 => "juanmarcofigueira@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" ] ] ] 1 => array:3 [ "nombre" => "Javier" "apellidos" => "de Miguel-Díez" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Pneumology and Thoracic Surgery Service, Unit for Patients with Highly Complex COPD, University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "University Institute of Tropical Disease and Public Health of the Canary Islands, University of La Laguna, Santa Cruz de Tenerife, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Respiratory Department, Gregorio Marañón General University Hospital, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Faculty of Medicine, Complutense University of Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1537 "Ancho" => 2508 "Tamanyo" => 184741 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Proposal for initial pharmacological treatment. Low risk: Patients who present mild or moderate airflow obstruction, low degree of dyspnea (mMRC of 0–1) and ≤<span class="elsevierStyleHsp" style=""></span>1 exacerbation that has not required admission (all criteria must be met). High risk: Patients who present severe or very severe airflow obstruction, a high degree of dyspnea (mMRC<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>2) and/or at least ≥<span class="elsevierStyleHsp" style=""></span>2 moderate exacerbations in the previous year or at least 1 that required hospital admission (at least 1 criterion must be met). <span class="elsevierStyleItalic">Abbreviations</span>: LAMA: long-acting muscarinic antagonist; LABA: long-acting β2-agonist; ICS: inhaled corticosteroid; Eo: eosinophils.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read with special interest the article by Miravitlles et al. in which a simple algorithm is proposed for the initial treatment of chronic obstructive pulmonary disease (COPD) based on the GOLD ABE proposal.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Following the GOLD 2023 scheme, the indication for triple therapy with LAMA-LABA-ICS (LAMA: long-acting muscarinic antagonist; LABA: long-acting β2-agonist; ICS: inhaled corticosteroid) as initial therapy in the exacerbator patient (patients with ≥<span class="elsevierStyleHsp" style=""></span>2 moderate exacerbations or ≥<span class="elsevierStyleHsp" style=""></span>1 exacerbation leading to hospitalization) will depend on the degree of peripheral eosinophilia (greater than 300<span class="elsevierStyleHsp" style=""></span>cells per μL) without taking into account the exacerbation severity. Both scenarios (COPD exacerbation requiring hospital admission and frequent exacerbations with outpatient management) have shown to have short, medium and long-term clinical implications including accelerated loss of lung function, poor long-term survival, high impact on health status, development of cardiovascular events and increase in healthcare costs. However, these aspects are especially critical in those exacerbations that require hospital management.</p><p id="par0010" class="elsevierStylePara elsevierViewall">According to data extracted from the AUDIPOC study, up to 35% of COPD patients admitted for an exacerbation are readmitted after 90 days,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> which reflects the difficulty in controlling these events and the need to optimize treatment upon discharge. On the other hand, start maintenance inhaled therapy for the first time after a severe exacerbation is not an uncommon situation. In a study carried out by Balcells et al.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> in which characteristics of patients with COPD who were admitted for the first time due to an exacerbation were analyzed, it was described that around 40% of them did not receive prior inhaled treatment. In this context, the treatment prescribed at discharge would be considered as “initial therapy” according to the GOLD 2023 guideline. To date, multiple studies support the role of inhaled corticosteroids in preventing exacerbations. A post hoc analysis of the IMPACT study demonstrates that the initiation of LAMA-LABA-ICS triple therapy after a severe COPD exacerbation provides a greater benefit in terms of the development of future exacerbations than LAMA-LABA therapy in those patients with a level of eosinophils in peripheral blood<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>100<span class="elsevierStyleHsp" style=""></span>cells per μL.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> Added to these results are those presented in the PRIMUS study, which describes that early initiation of triple therapy after a severe exacerbation is associated with lower morbidity and economic burden. Based on all this, the recent publication of the document “Referral criteria in COPD. Continuity of care”,<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> proposes anticipating the prescription of LAMA-LABA-ICS as initial therapy in subjects with a severe exacerbation of COPD who present an eosinophil count in peripheral blood greater than 100<span class="elsevierStyleHsp" style=""></span>cells per μL (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> This approach is intended to maximize treatment and thus avoid future adverse events.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Authors’ contribution</span><p id="par0015" class="elsevierStylePara elsevierViewall">All authors have made substantial contributions to the intellectual content and manuscript design and drafting.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors’ approval</span><p id="par0020" class="elsevierStylePara elsevierViewall">All authors gave their approval to the final version of the manuscript and declare to have met the requirements for authorship.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">All authors declare that there is no funding in this manuscript.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of interest</span><p id="par0025" class="elsevierStylePara elsevierViewall">Javier de Miguel-Díez has received honoraria and funding from Laboratories AstraZeneca, Bial, Boehringer, Chiesi, Esteve, FAES, Ferrer, Gebro Pharma, GlaxoSmithKline, Janssen, Menarini, MundiPharma, Novartis, Roche, Rovi, Teva y Pfizer. Juan Marco Figueira-Gonçalves has received honoraria for speaking engagements and funding for conference attendance from Laboratories Esteve, MundiPharma, AstraZeneca, Boehringer Ingelheim, Ferrer, Menarini, Rovi, GlaxoSmithKline, Chiesi, Novartis, and Gebro Pharma.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Authors’ contribution" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors’ approval" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Funding" ] 3 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1537 "Ancho" => 2508 "Tamanyo" => 184741 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Proposal for initial pharmacological treatment. Low risk: Patients who present mild or moderate airflow obstruction, low degree of dyspnea (mMRC of 0–1) and ≤<span class="elsevierStyleHsp" style=""></span>1 exacerbation that has not required admission (all criteria must be met). High risk: Patients who present severe or very severe airflow obstruction, a high degree of dyspnea (mMRC<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>2) and/or at least ≥<span class="elsevierStyleHsp" style=""></span>2 moderate exacerbations in the previous year or at least 1 that required hospital admission (at least 1 criterion must be met). <span class="elsevierStyleItalic">Abbreviations</span>: LAMA: long-acting muscarinic antagonist; LABA: long-acting β2-agonist; ICS: inhaled corticosteroid; Eo: eosinophils.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A novel figure and algorithm for the gold ABE classification" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Miravitlles" 1 => "K. Kostikas" 2 => "N. Bizymi" 3 => "N. Tzanakis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2023" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Risk of death and readmission of hospital-admitted COPD exacerbations: European COPD audit" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Hartl" 1 => "J.L. Lopez-Campos" 2 => "F. Pozo-Rodriguez" 3 => "A. Castro-Acosta" 4 => "M. Studnicka" 5 => "B. Kaiser" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/13993003.01391-2014" "Revista" => array:6 [ "tituloSerie" => "Eur Respir J" "fecha" => "2016" "volumen" => "47" "paginaInicial" => "113" "paginaFinal" => "121" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26493806" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characteristics of patients admitted for the first time for COPD exacerbation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Balcells" 1 => "J.M. Antó" 2 => "J. Gea" 3 => "F.P. Gómez" 4 => "E. Rodríguez" 5 => "A. Marin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Respir Med" "fecha" => "2009" "volumen" => "103" "paginaInicial" => "1293" "paginaFinal" => "1302" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of exacerbation history on outcomes in the IMPACT trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.M.G. Halpin" 1 => "M.T. Dransfield" 2 => "M.K. Han" 3 => "C.E. Jones" 4 => "S. Kilbride" 5 => "P. Lange" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1183/13993003.01921-2019" "Revista" => array:5 [ "tituloSerie" => "Eur Respir J" "fecha" => "2020" "volumen" => "55" "paginaInicial" => "1901921" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32299860" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "SEMERGEN, SEPAR, semFYC, SEMG, SEFAC, GRAP. Criterios de derivación en EPOC. Continuidad asistencial. IMC 2023, Madrid. ISBN: 978-84-19457-41-7. Depósito legal: M-18163-2023." ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000006000000001/v3_202406051404/S0300289623003666/v3_202406051404/en/main.assets" "Apartado" => array:4 [ "identificador" => "94562" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the Director" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000006000000001/v3_202406051404/S0300289623003666/v3_202406051404/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289623003666?idApp=UINPBA00003Z" ]
