2. 2
ÍNDICE
Deberes hechos:
1. Derrota del nihilismo terapéutico
2. Conocimiento de la historia natural
3. Refinamiento de los fenotipos
4. Tecnificación de la imagen
Asignaturas pendientes:
1. Definición/Nosología
2. Erradicación
3. “Peso” de la genética
3. Deberes hechos
Derrota del nihilismo terapéutico
3
Matera MG, Cazzola M
Treatment of COPD: no longer nihilism, but there is still an
urgent need for new therapies.
Curr Opin Pharmacol.. 2012 Jun;12(3):225-8
11. Deberes hechos
Derrota del nihilismo terapéutico
11
Dual bronchodilation with QVA149 reduces patient-reported
dyspnoea in COPD: the BLAZE study.
Mahler DA. Eur Respir J. 2014 Jun;43(6):1599-609: 2013
12. Deberes hechos
Derrota del nihilismo terapéutico
EPOC: Evaluación de la función
pulmonar durante 24 horas
wmFEV1 de 24-h de Relvar® 92/22 mcg (n=33) vs. placebo (n=51) en los días 28–29 1
Adaptado de Boscia JA, et al. Clin Ther 2012;34:1655–66e5
1- Boscia JA, Pudi KK, Zvarich MT, Sanford L, Siederer SK, and Crim C. Effect of once-daily fluticasone furoate/vilanterol on 24-hour pulmonary function in patients with COPD:
a randomized, three-way, incomplete block, crossover study. Clin Ther 2012;34:1655–66e5
16. Deberes hechos
Derrota del nihilismo terapéutico
Unless there is a medical contraindication, low-dose
Aspirin (80–100 mg/day) appears to be a reasonable
therapeutic choice for most patients with COPD in view
of their increased risk of cardiovascular disease and
colorectal cancer.
16
17. 17
Deberes hechos
Derrota del nihilismo terapéutico
Am J Respir Crit Care Med. 2012 Jan 15;185(2):152-9
21. Deberes hechos
Derrota del nihilismo terapéutico
López-García A, Souto-Camba S
Eur J Phys Rehabil Med. 2014 Sep 5. [Epub ahead of print]
Effects of a muscular training program on Chronic Obstructive Pulmonary
Disease patients with moderate or severe exacerbation antecedents.
21
RESULTS:
All subjects improved significantly (p<.001) their HRQoL in the SGRQ, the CRDQ
and the AQ20, and this was demonstrated in each one of the evaluated dimensions.
A positive response in relation to exercise tolerance and illness prognosis was
observed. Following the program subjects walked an average of 56 meters more
(p<.001) and the BODE index was a mean of 1.5 less regarding the initial value
(p<.001).
CONCLUSIONS:
A 20 session muscular training program contributes to an improvement in HRQoL,
exercise tolerance and illness prognosis in COPD subjects with moderate or severe
exacerbations.
44. Deberes hechos:
Refinamiento de los fenotipos
Inspirado en: Dornhorst AC. Lancet. 1955 Jun 11;268(6876):1185-7. 44
45. Deberes hechos:
Refinamiento de los fenotipos
45
John R. Hurst, Evaluation of COPD Longitudinally to Identify Predictive
Surrogate Endpoints (ECLIPSE)
Susceptibility to Exacerbation in Chronic Obstructive Pulmonary Disease
New engl j med 363;12 september 16, 2010
46. Deberes hechos:
Refinamiento de los fenotipos
P.G. Gibson, J.L. Simpson.Thorax 2009;64:728-735
The overlap syndrome of asthma and COPD: what are its features and how important
is it?
46
47. Deberes hechos:
Refinamiento de los fenotipos
Guerra S, et al.Combined effects of parental and active smoking on early lung function
deficits: a prospective study from birth to age 26 years.
Thorax. 2013 Nov;68(11):1021-8.
47
48. Deberes hechos:
Refinamiento de los fenotipos
Miguel-Angel Martínez-García, et al.Prognostic Value of Bronchiectasis in
Patients with Moderate-to-Severe Chronic Obstructive Pulmonary Disease
American Journal of Respiratory and Critical Care Medicine 2013 187: 823-831
48
49. Deberes hechos:
Refinamiento de los fenotipos
Jose M. Marin, et al. "Outcomes in Patients with Chronic Obstructive Pulmonary
Disease and Obstructive Sleep Apnea", American Journal of Respiratory and
Critical Care Medicine, Vol. 182, No. 3 (2010), pp. 325-331.
49
50. Deberes hechos:
Refinamiento de los fenotipos
Almagro P, et al.
Comorbidities in patients hospitalized due to chronic
obstructive pulmonary disease. A comparative analysis of the
ECCO and ESMI.
Rev Clin Esp. 2012 Jun;212(6):281-6
50
Morera Prat J, Martinez –Ortiz ML
Chronic obstructive pulmonary disease in the elderly: next
phenotype
Med Clin (Barc)2012 Apr 28;138(11):478-9.
57. Deberes hechos:
Tecnificación de la imagen
57
Estépar RS, et al. Computed tomographic measures of pulmonary vascular
morphology in smokers and their clinical implications.
Am J Respir Crit Care Med. 2013 Jul 15;188(2):231-9
58. Deberes hechos:
Tecnificación de la imagen
Han MK, et al.
Chronic Obstructive Pulmonary Disease Exacerbations in the COPDGene Study:
Associated Phenotypes. Radiology. 2011 Oct;261(1):274-82
58
59. 4 Causa - Etiología
Desorden Funcional
Basat en J. G. Scadding.
3 Característico
Lesión Anatómica
2 Característica
Principles of definition in medicione. Lancet, 1959; 1: 323-325 .
Meaning of diagnostic terms in bronchopulmonary disease. BMJ, 1963; 2: 1425-1430.
The semantics of medical diagnosis. Niomed. Comput, 1972; 3: 83-90.
Helath and disease: what can medicine do for philosophy?. J. Med. Ethics, 1988; 14: 118-124.
Definition on asthma. In: Weiss EB, Stein M. Editors. Bronchial asthma, mechanisms and therapeutics, 3erd ed. Boston: Litle Brown;
1993. p.1-13.
1 Descripción Clínica
SÍNDROME
ENFERMEDAD
59
Asignaturas pendientes
Definición/Nosología
60. • Host Factors
– Genes
– Airway Hyperresponsiveness
– Lung Growth
• Exposures
– Tobacco Smoke
– Occupational Dust and Chemicals
– Outdoor and Indoor Air Pollution
– Infections
– Socioeconomic Status
1) No menciona que el efecto del tabaco es dosis/efecto. !!!!!
2) No menciona la palabra “Smoke” hasta después de 688 palabras y 2 tablas, y
688 palabras hasta repetirla. !!!!!
Am J Respir Crit Care Med Vol 163. pp 1256–1276, 2001
60
Asignaturas pendientes
Definición/Nosología
62. 1. Miravitlles M, Morera J. It's time for an aetiology-based definition of
chronic obstructive pulmonary disease. Respirology. 2007
May;12(3):317-9.
2. Morera J, Miravitlles M. [Chronic obstructive pulmonary disease: disease
or Zugzwang's syndrome?] Med Clin (Barc). 2008 May 10;130(17):655-6.
3. Snider GL. Nosology for our day: its application to chronic obstructive
pulmonary disease. Am J Respir Crit Care Med. 2003 Mar 1;167(5):678-
83.
62
Asignaturas pendientes
Definición/Nosología
67. Asignaturas pendientes:
Erradicación
67
PLoS Med. 2006 Nov;3(11):e442.
Projections of global mortality and burden of disease from 2002 to 2030.
Mathers CD, Loncar D.
68. Asignaturas pendientes:
Erradicación
PLoS Med. 2006 Nov;3(11):e442. 68
Projections of global mortality and burden of disease from 2002 to 2030 Mathers CD, Loncar D.
69. Asignaturas pendientes:
Erradicación
69
Noncommunicable Diseases David J. Hunter, M.B., B.S., M.P.H., Sc.D., and K. Srinath Reddy, M.D., D.M.N
New Engl J Med 2013; 369:1336-1343 October 3, 2013
70. Asignaturas pendientes:
Erradicación
70
Eriksen M. Judith Mackay Hana Ross EL ATLAS
DEL TABACO cuarta edición.
http://www.tobaccoatlas.org/uploads/Images/PDFs/TA4Spanish.pdf
71. Asignaturas pendientes:
Erradicación
71
2011
Manila (Filipinas) 31 octubre 2011
Nace Danica May Manila Camacho
Es la ciudadana número 7mil millones del planeta
77. Asignaturas pendientes:
Erradicación
Even more effective tobacco legislation, including prevention of passive smoking
exposure for children in cars and at home. Legislation works17dor, if it does not,
let us prorogue parliament at once!
Recognition that airborne pollution is a human rights issuedif you live in a
Western city you cannot avoid air pollution.
The roots of much disease are in povertydand yet it is not only low and middle
income countries that are affected. All major Western countries still have
substantial poverty affecting children.
Finally, invest in research to understand early lung development, and devise
interventions to operate before the lungs are shot to pieces.
77
Thorax. 2011 Aug;66(8):645-6
83. 83
CONCLUSIONES
1.- Se ha superado el nihilismo terapéutico
2.- Ha aumentado el conocimiento de la historia natural
3.- El concepto de fenotipos ha sido un progreso
4.- Las técnicas de imagen “persiguen” la fisiología
5.- La nosología es una asignatura pendiente
6.- La demografía, los intereses económicos y la agnotología
frenan la erradicación de la EPOC
7.- El coste del estudio genético de la EPOC no ha sido rentable
(A) Kaplan-Meier curve of time to first COPD admission during follow up according to level of regular physical activity. (B) Kaplan-Meier curve of time to death (all-cause mortality) according to level of regular physical activity.