Article information
Resumen
La enfermedad pulmonar obstructiva crónica (EPOC) es una enfermedad muy prevalente, pero, en contraste, carece de una adecuada definición y existe una gran confusión en cuanto a su tratamiento. Los conocimientos de los que disponemos nos deberían permitir establecer unas normativas de tratamiento más específicas, según las características clínicas de cada paciente. En el presente trabajo se presenta una propuesta de tratamiento dirigido por la clínica. Los broncodilatadores de larga duración, solos o en diversas combinaciones, serán la base del tratamiento, y los corticoides inhalados (CI) se deberán utilizar en un subgrupo de pacientes con características bien definidas. Los últimos estudios indican que los beneficios de los CI son limitados en la EPOC y los riesgos no son despreciables, por lo que su uso debe quedar limitado a pacientes “respondedores” y administrarse siempre asociados a un broncodilatador β2 de larga duración. Se debe conocer más a fondo la patogenia de la enfermedad y clasificar adecuadamente a los pacientes según su gravedad, su frecuencia de agudizaciones, su reversibilidad, comorbilidad y medicación concomitante, para escoger el mejor tratamiento posible.
Palabras clave:
Enfermedad pulmonar obstructiva crónica
Tratamiento
Normativas
Abstract
Chronic obstructive pulmonary disease (COPD) is a highly prevalent but poorly defined disease and there is wide confusion regarding its treatment. The available knowledge should allow guidelines for specific treatment to be established according to each patient's clinical features. The present article describes a proposal for individually-tailored treatment. Long-acting bronchodilators, alone or in various combinations, would be the basis of treatment and inhaled corticosteroids (IC) should be used in a subgroup with well-defined characteristics. The latest studies indicate that the benefits of IC are limited in COPD and that the risks are not inconsiderable. Consequently, these drugs should be limited to “responders” and should always be administered in association with a long-acting β2 bronchodilator. The pathogenesis of this disease should be studied in greater depth and patients should be classified according to their severity, the frequency of acute exacerbations, their reversibility, comorbidity and concomitant medication in order to choose the most appropriate treatment.
Keywords:
Chronic obstructive pulmonary disease
Treatment
Guidelines
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