Article information
Resumen
Una enfermedad crónica como la enfermedad pulmonar obstructiva crónica (EPOC) debe tener necesariamente marcadores que pueden influir en su evolución o historia natural. El marcador mejor estudiado ha sido el volumen espiratorio forzado en el primer segundo (FEV1), que clásicamente se ha considerado como el mejor indicador pronóstico de la enfermedad. Junto a este parámetro hay otras variables que también han demostrado tener valor pronóstico. Se conoce la existencia de diferentes patrones evolutivos en la enfermedad, pero todavía se ha de reconocer que esta enfermedad es una desconocida desde el punto de vista de la carencia de datos existentes acerca de su historia natural y de la incapacidad de predecir los casos con mayor o menor progresión. Junto al FEV1 hay otros marcadores fisiopatológicos de la enfermedad, como el estado del intercambio de gases, el atrapamiento aéreo o la presencia de una hipertensión pulmonar. En este artículo se revisan las características de éstos, así como las de otros, clasificados en otros 2 grandes grupos. Por un lado, el de los marcadores clínicos, como son el estado nutricional, la capacidad de ejercicio, el índice BODE, que combina 4 parámetros (fisiopatológicos y clínicos) simultáneos y la presencia o no de excerbaciones frecuentes. Por otra parte, el de los marcadores biológicos potencialmente implicados en la EPOC, como la proteína C reactiva, el estrés oxidativo y los mediadores que originan cambios en el músculo esquelético.
La EPOC también predispone a la aparición de otras enfermedades asociadas o comorbilidades, que llegan a presentarse con más frecuencia por el hecho de tener una EPOC y que igualmente condicionan el pronóstico de esta enfermedad.
Palabras clave:
EPOC
Mortalidad
Marcador
Comorbilidad
Abstract
A chronic disease such as chronic obstructive pulmonary disease (COPD) will inevitably have biological markers influencing its natural history or progression. The most extensively studied marker is forced expiratory volume in 1 second (FEV1), classically recognized as the best prognostic indicator of the disease. Other physiopathological variables are also known to have prognostic value. The course of COPD shows several distinct patterns but data are lacking on the natural history of this disease and the ability to predict which patients will show greater or lesser progression. In addition to FEV1, there are other physiological markers of disease progression, such as gas interchange, air trapping, and pulmonary hypertension. The present article reviews the characteristics of all these markers, as well as those of two other categories: clinical markers, such as nutritional status, exercise capacity, the BODE index, which combines four physiopathological and clinical parameters, and the occurrence or absence of frequent exacerbations. Finally, a group of biological markers, potentially implicated in COPD, such as C-reactive protein, oxidative stress and other variables affecting changes in skeletal muscle, are described.
COPD also predisposes affected individuals to the presence of other associated diseases or comorbidities, which can occur more frequently because of the presence of COPD itself and can potentially influence the outcome of this disease.
Key words:
COPD
Mortality
Marker
Comorbidity
Full text is only aviable in PDF
Bibliografía
[1.]
R.A. Pauwels, A.S. Buist, P.M.A. Calverley, C.R. Jenkins, S.S. Hurd.
Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO global iniciative for chronic obstructive lung disease (GOLD) workshop summary.
Am J Respir Crit Care Med, 163 (2001), pp. 1256-1276
[2.]
B.R. Celli, C.G. Cote, J.M. Marin, C. Casanova, M. Montes de Oca, R.A. Mendez, et al.
The body-mass index, airflow obstruction, dyspnea, and exercise capacity index in chronic obstructive pulmonary disease.
N Engl J Med, 350 (2004), pp. 1005-1012
[3.]
C. Fletcher, R. Peto.
The natural history of chronic bronchitis and emphysema.
Oxford University, (1976),
[4.]
N.R. Anthonisen, M.A. Skeans, R.A. Wise, J. Manfreda, R.E. Kanner, J.E. Connett, The Lung Health Study Research Group.
The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial.
Ann Intern Med, 142 (2005), pp. 233-239
[5.]
N.R. Anthonisen, E.C. Wright, J.E. Hodgkin.
Prognosis in chronic obstructive pulmonary disease.
Am Rev Respir Dis, 133 (1986), pp. 14-20
[6.]
P.S. Burge, P.M. Calverley, P.W. Jones, S. Spencer, J.A. Anderson, T.K. Maslen.
Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial.
Br Med J, 320 (2000), pp. 1297-1303
[7.]
R.A. Pauwels, C.G. Löfdahl, L.A. Laitinen, J.P. Schouten, D.S. Postma, N.B. Pride, et al.
Longterm treatment with inhaled budesonide in persons with mild chronic obstructive pulmonary disease who continue smoking. European Respiratory Society Study on Chronic Obstructive Pulmonary Disease.
N Engl J Med, 340 (1999), pp. 1948-1953
[8.]
B.R. Celli, N.E. Thomas, J.A. Anderson, G.T. Ferguson, C.R. Jenkins, P.W. Jones, et al.
Effect of pharmacotherapy on rate of decline of lung function in chronic obstructive pulmonary disease: results from the TORCH study.
Am J Respir Crit Care Med, 178 (2008), pp. 332-338
[9.]
D.P. Tashkin, B. Celli, S. Senn, D. Burkhart, S. Kesten, S. Menjoge, et al.
A 4-year trial of tiotropium in chronic obstructive pulmonary disease.
N Engl J Med, 359 (2008), pp. 1543-1554
[10.]
Nocturnal Oxygen Therapy Trial.
Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease (a clinical trial).
Ann Inter Med, 93 (1980), pp. 391-398
[11.]
Medical Research Council Working Party.
Long term domiciliary oxygen therapy in chronic cor pulmonale complicating chronic bronchitis and emphysema.
Lancet, 1 (1981), pp. 681-685
[12.]
E. Chailleux, J.P. Laaban, D. Veale.
Prognostic value of nutritional depletion in patients with COPD treated by long-term oxygen therapy: data from the ANTADIR observatory.
Chest, 123 (2003), pp. 1460-1466
[13.]
D.E. O’Donnell, S.M. Revill, K.A. Webb.
Dynamic hyperinflation and exercise intolerance in chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 164 (2001), pp. 770-777
[14.]
C. Casanova, C. Cote, J.P. De Torres, A. Aguirre-Jaime, J.M. Marin, V. Pinto-Plata, et al.
Inspiratory-to-total lung capacity ratio predicts mortality in patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 171 (2005), pp. 591-597
[15.]
D.E. O’Donnell, T. Flüge, F. Gerken, A. Hamilton, K. Webb, B. Aguilaniu, et al.
Effects of tiotropium on lung hyperinflation, dyspnoea and exercise tolerance in COPD.
Eur Respir J, 23 (2004), pp. 832-840
[16.]
D.E. O’Donnell, F. Sciurba, B. Celli, D.A. Mahler, K.A. Webb, C.J. Kalberg, et al.
Effect of fluticasone propionate/salmeterol on lung hyperinflation and exercise endurance in COPD.
Chest, 130 (2006), pp. 647-656
[17.]
A. Fishman, F. Martinez, K. Naunheim, S. Piantadosi, R. Wise, A. Ries, et al.
A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema.
N Engl J Med, 348 (2003), pp. 2059-2073
[18.]
R. Cooper, J. Ghali, B.E. Simmons, A. Castaner.
Elevated pulmonary artery pressure.
Chest, 99 (1991), pp. 112-120
[19.]
M. Oswald-Mammosser, E. Weitzenblum, E. Quoix, G. Moser, A. Chaouat, Cl Charpentier.
Prognostic factors in COPD patients receiving long-term oxygen therapy. Importance of pulmonary artery pressure.
Chest, 107 (1995), pp. 1193-1198
[20.]
J.A. Barbera, V.I. Peinado, S. Santos.
Pulmonary hypertension in chronic obstructive pulmonary disease.
Eur Respir J, 21 (2003), pp. 892-905
[21.]
E. Weitzenblum, A. Sautegeau, M. Ehrhart, M. Mammosser, A. Pelletier.
Long-term oxygen therapy can reverse the progression of pulmonary hypertension in patients with chronic obstructive pulmonary disease.
Am Rev Respir Dis, 131 (1985), pp. 493-498
[22.]
S.R. Selinger, T.P. Kennedy, P. Buescher.
Effects of removing oxygen from patients with chronic obstructive pulmonary disease.
Am Rev Respir Dis, 136 (1987), pp. 85-91
[23.]
M.I. Burgess, N. Mogulkoc, R.J. Bright-Thomas, P. Bishop, J.J. Egan, S.G. Ray.
Comparison of echocardiographic markers of right ventricular function in determining prognosis in chronic obstructive pulmonary disease.
J Am Soc Echocardiogr, 15 (2002), pp. 633-639
[24.]
R.A. Incalzi, L. Fuso, M. De Rosa, A. Di Napoli, S. Basso, G. Pagliari, et al.
Electrocardiographic signs of chronic cor pulmonale: a negative prognostic findings in chronic obstructive pulmonary disease.
Circulation, 99 (1999), pp. 1600-1605
[25.]
R.E. Kanner, J.E. Connett, D.E. Williams, A.S. Buist, The Lung Health Study Research Group.
Effects of randomized assignment to a smoking cessation intervention and changes in smoking habits on respiratory symptoms in the Lung Health Study.
Am J Med, 106 (1999), pp. 410-416
[26.]
P.D. Scanlon, J.E. Connett, L.A. Walter, M.D. Altose, W.C. Bailey, A.C. Buist.
Smoking cessation and lung function in mild-to-moderate chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 161 (2000), pp. 381-390
[27.]
T. Oga, K. Nishimura, M. Tsukino, S. Sato, T. Hajiro.
Analysis of the factors related to mortality in chronic obstructive pulmonary disease. Role of exercise capacity and health status.
Am J Respir Crit Care Med, 167 (2003), pp. 544-549
[28.]
N.R. Anthonisen, M.A. Skeans, R.A. Wise, J. Manfreda, R.E. Kanner, J.E. Connett, et al.
The effects of a smoking cessation intervention on 14.5-year mortality: a randomized clinical trial.
Ann Intern Med, 142 (2005), pp. 233-239
[29.]
J. Vestbo, E. Prescott, T. Almdal, M. Dahl, B.G. Nordestgaard, T. Andersen, et al.
Body mass, fat-free body mass, and prognosis in patients with chronic obstructive pulmonary disease from a random population sample: findings from the Copenhagen City Heart Study.
Am J Respir Crit Care Med, 173 (2006), pp. 79-83
[30.]
A.M. Schols, J. Slangen, L. Volovics, E.F. Wouters.
Weight loss is a reversible factor in the prognosis of chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 157 (1998), pp. 1791-1797
[31.]
J.J. Soler, L. Sanchez, P. Roman, M.A. Martinez, M. Perpiñá.
Prevalencia de desnutrición en pacientes con EPOC estable.
Arch Bronconeumol, 40 (2004), pp. 250-258
[32.]
A.G. Agusti, A. Noguera, J. Sauleda, E. Sala, J. Pons, X. Busquets.
Systemic effects of chronic obstructive pulmonary disease.
Eur Respir J, 21 (2003), pp. 347-360
[33.]
L. Nici.
Mechanisms and measures of exercise intolerance in chronic obstructive pulmonary disease.
Clin Chest Med, 21 (2000), pp. 693-704
[34.]
V.M. Pinto-Plata, C. Cote, H. Cabral, J. Taylor, B.R. Celli.
The 6-min walk distance: change over time and value as a predictor of survival in severe COPD.
Eur Respir J, 23 (2004), pp. 28-33
[35.]
T. Oga, K. Nishimura, M. Tsukino, S. Sato, T. Hajiro.
Analysis of the factors related to mortality in chronic obstructive pulmonary disease: role of exercise capacity and health status.
Am J Respir Crit Care Med, 167 (2003), pp. 544-549
[36.]
C.G. Cote, B.R. Celli.
Pulmonary rehabilitation and the BODE index in COPD.
Eur Respir J, 26 (2005), pp. 630-636
[37.]
K. Nishimura, T. Izumi, M. Tsukino, T. Oga.
Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD.
Chest, 121 (2002), pp. 1434-1440
[38.]
A. Domingo-Salvany, R. Lamarca, M. Ferrer, J. Garcia-Aymerich, J. Alonso, M. Félez, et al.
Health-related quality of life and mortality in male patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 166 (2002), pp. 680-685
[39.]
G. Van den Boom, M.P. Rutten-van Molken, P.R. Tirimanna, C.P. van Schayck, H. Folgering, C. van Weel.
Association between health-related quality of life and consultation for respiratory symptoms: results from the DIMCA programme.
Eur Respir J, 11 (1998), pp. 67-72
[40.]
J.B. Orens, M. Estenne, S. Arcasoy, J.V. Conte, P. Corris, J.J. Egan, et al.
International guidelines for the selection of lung transplant candidates: 2006 update-a consensus report from the Pulmonary Scientific Council of the International Society for Heart and Lung Transplantation.
J Heart Lung Transplant, 25 (2006), pp. 745-755
[41.]
J.J. Soler-Cataluña, M.A. Martínez-García, P. Román Sánchez, E. Salcedo, M. Navarro, R. Ochando.
Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease.
Thorax, 60 (2005), pp. 925-931
[42.]
J.J. Soler Cataluña, M.A. Martínez García, L. Sánchez, P. Román.
Valor pronóstico del índice e-BODE (exacerbaciones graves y BODE) en la EPOC.
Arch Bronconeumol, 43 (2007), pp. 63-64
[43.]
R. Rodriguez Roisin.
Toward a consensus definition for COPD exacerbations.
Chest, 117 (2000), pp. 398S-401S
[44.]
N.R. Anthonisen, J. Manfreda, C.P. Warren, E.S. Hershfield, G.K. Harding, N.A. Nelson.
Antibiotic therapy in exacerbations of chronic obstructive pulmonary disease.
Ann Intern Med, 106 (1987), pp. 196-204
[45.]
T.A. Seemungal, G.C. Donaldson, E.A. Paul, J.C. Bestall, D.J. Jeffries, J.A. Wedzicha.
Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 157 (1998), pp. 1418-1422
[46.]
P.S. Burge, P.M. Calverley, P.W. Jones, S. Spencer, J.A. Anderson, T.K. Maslen.
Randomised, double blind, placebo controlled study of fluticasone propionate in patients with moderate to severe chronic obstructive pulmonary disease: the ISOLDE trial.
Br Med J, 320 (2000), pp. 1297-1303
[47.]
G.C. Donaldson, T.A. Seemungal, A. Bhowmik, J.A. Wedzicha.
Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease.
Thorax, 57 (2002), pp. 847-852
[48.]
P.K. MacCallum.
Markers of hemostasis and systemic inflammation in heart disease and atherosclerosis in smokers.
Proc Am Thorac Soc, 2 (2005), pp. 34-43
[49.]
J.P. De Torres, E. Cordoba Lanus, C. López Aguilar, M. Muros de Fuentes, A. Montejo de Garcini, A. Aguirre Jaime, et al.
C-reactive protein levels and clinically important predictive outcomes in stable COPD patients.
Eur Respir J, 27 (2006), pp. 902-907
[50.]
P. Joppa, D. Petrasova, B. Stancak, R. Tkacova.
Systemic inflammation in patients with COPD and pulmonary hypertension.
Chest, 130 (2006), pp. 326-333
[51.]
P.M. Ridker, N. Rifai, L. Rose, J.E. Buring, N.R. Cook.
Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events.
N Engl J Med, 347 (2002), pp. 1557-1565
[52.]
S.F. Man, D.D. Sin.
Effects of corticosteroids on systemic inflammation in chronic obstructive pulmonary disease.
Proc Am Thorac Soc, 2 (2005), pp. 78-82
[53.]
D.D. Sin, P. Lacy, E. York, S.F. Man.
Effects of fluticasone on systemic markers of inflammation in chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 170 (2004), pp. 760-765
[54.]
M. Dahl, J. Vestbo, P. Lange, S.E. Bojesen, A. Tybjaerg-Hansen, B.G. Nordestgaard.
Creactive protein as a predictor of prognosis in chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 175 (2007), pp. 250-255
[55.]
V.M. Keatings, P.D. Collins, D.M. Scott, P.J. Barnes.
Differences in interleukin-8 and tumor necrosis factor-alpha in induced sputum from patients with chronic obstructive pulmonary disease or asthma.
Am J Respir Crit Care Med, 153 (1996), pp. 530-534
[56.]
S.D. Aaron, J.B. Angel, M. Lunau, K. Wright, C. Fex, N. Le Saux, et al.
Granulocyte inflammatory markers and airway infection during acute exacerbation of chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 163 (2001), pp. 349-355
[57.]
I. De Godoy, M. Donahoe, W.J. Calhoun, J. Mancino, R.M. Rogers.
Elevated TNF-alpha production by peripheral blood monocytes of weight-losing COPD patients.
Am J Respir Crit Care Med, 153 (1996), pp. 633-637
[58.]
C. Casanova Macario, J.P. De Torres Tajes, M. Montes de Oca.
Aspectos sistémicos y factores pronósticos.
Arch Broncocneumol, 43 (2007), pp. 25-34
[59.]
H.A. Van Helvoort, Y.F. Heijdra, H.M. Thijs, J. Viña, G.J. Wanten, P.N. Dekhuijzen.
Exercise-induced systemic effects in muscle-wasted patients with COPD.
Med Sci Sports Exerc, 38 (2006), pp. 1543-1552
[60.]
A.M. Schols, W.A. Buurman, A.J. Staal van den Brekel, M.A. Dentener, E.F. Wouters.
Evidence for a relation between metabolic derangements and increased levels of inflammatory mediators in a subgroup of patients with chronic obstructive pulmonary disease.
Thorax, 51 (1996), pp. 819-824
[61.]
E. Antón Díaz, D. Ruíz López, J. Ancochea Bermúdez.
Herencia y ambiente en la EPOC.
Arch Bronconeumol, 43 (2007), pp. 10-17
[62.]
H. Van der Vaart, D.S. Postma, W. Timens, M.N. Hylkema, B.W. Willemse, H.M. Boezen, et al.
Acute effects of cigarette smoking on inflammation in healthy intermittent smokers.
Respir Res, 6 (2005), pp. 22-33
[63.]
K.A. McCrea, J.E. Ensor, K. Nall, E.R. Bleecker, J.D. Hasday.
Altered cytokine regulation in the lungs of cigarette smokers.
Am J Respir Crit Care Med, 150 (1994), pp. 696-703
[64.]
A.M. Wood, R.A. Stockley.
The genetics of chronic obstructive pulmonary disease.
Respir Res, 7 (2006), pp. 130-144
[65.]
P. Jakobsson, L. Jorfeldt, A. Brundin.
Skeletal muscle metabolites and fiber types in patients with advanced chronic obstructive pulmonary disease (COPD), with and without chronic respiratory failure.
Eur Respir J, 3 (1990), pp. 192-196
[66.]
A.G. Agustí, J. Sauleda, C. Miralles, C. Gomez, B. Togores, E. Sala, et al.
Skeletal muscle apoptosis and weight loss in chronic obstructive pulmonary disease.
Am J Respir Crit Care Med, 166 (2002), pp. 485-489
[67.]
P.D. Thompson, D. Buchner, I.L. Piña, G.J. Balady, M.A. Williams, B.H. Macus, et al.
Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease.
Circulation, 107 (2003), pp. 3109-3116
[68.]
M. Montes de Oca, S.H. Torres, Y. González, E. Romero, N. Hernández, C. Tálamo.
Cambios en la tolerancia al ejercicio, calidad de vida relacionada con la salud y características de los músculos periféricos después de 6 semanas de entrenamiento en pacientes con EPOC.
Arch Bronconeumol, 41 (2005), pp. 413-418
[69.]
L. Puente Maestu, T. Tena, C. Trascasa, J. Pérez Parra, R. Godoy, M.J. García, et al.
Training improves muscle oxidative capacity and oxygenation recovery kinetics in patients with chronic obstructive pulmonary disease.
Eur J Appl Physiol, 88 (2003), pp. 580-587
[70.]
J. Gea, E. Barreiro.
Update on the mechanisms of muscle dysfunction in COPD.
Arch Bronconeumol, 44 (2008), pp. 328-337
[71.]
W.M. Chatila, B.M. Thomashow, O.A. Minai, G.J. Criner, B.J. Make.
Comorbidities in chronic obstructive pulmonary disease.
Proc Am Thorac Soc, 5 (2008), pp. 549-555
[72.]
J. De Miguel Díez, M. Méndez Bailón.
Comorbilidad en la EPOC. Implicaciones diagnósticas y terapéuticas.
Rev Patol Respir, 11 (2008), pp. 109-116
[73.]
J.B. Soriano, G.T. Visick, H. Muellerova, N. Payvandi, A.L. Hansell.
Patterns of comorbilities in newly diagnosed COPD and asthma in primary care.
Chest, 128 (2005), pp. 2099-2107
[74.]
P. Almagro.
Factores pronósticos en la EPOC. El papel de la comorbilidad.
Rev Clin Esp, 207 (2007), pp. 8-13
[75.]
J. De Miguel Díez, J.L. Izquierdo Alonso, J. Molina París, J.M. Bellón Cano, J.M. Rodríguez González-Moro, P. De Lucas Ramos.
Factores determinantes de la prescripción farmacológica en los pacientes con EPOC estable. Resultados de un estudio multicéntrico español (IDENTEPOC).
Arch Bronconeumol, 41 (2005), pp. 63-70
Copyright © 2009. Sociedad Española de Neumología y Cirugía Torácica
