Actualización 2021 de la Guía Española de la EPOC (GesEPOC). Tratamiento farmacológico de la EPOC estable

Miravitlles, Marc; Calle, Myriam; Molina, Jesús; Almagro, Pere; Gómez, José-Tomás; Trigueros, Juan Antonio; Cosío, Borja G.; Casanova, Ciro; Lόpez-Campos, José Luís; Riesco, Juan Antonio; Simonet, Pere; Rigau, David; Soriano, Joan B.; Ancochea, Julio; Soler-Cataluña, Juan José

doi:10.1016/j.arbres.2021.03.005

Cited by 132 publications

(41 citation statements)

References 95 publications

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“…This concept is analogous to that proposed by the Spanish COPD guidelines (GesEPOC), recently updated for 2021. 6 This classification between high and low impact (or high and low risk, according to GesEPOC terminology) is extremely useful, since it identifies subjects who do not need an intensification of treatment and for whom a de-escalation could even be considered, as will be discussed later.…”

Section: Initial Stepping Up From Initial Treatmentmentioning

confidence: 99%

“…5 Others have proposed a phenotype-based approach which has also gained popularity via the Spanish Guidelines for COPD (GesEPOC). 6 Although both initiatives have benefits and drawbacks, 7,8 they provide an opportunity for clinicians to manage COPD more successfully in their daily clinical practice. Nowadays, at the start of this new decade, COPD management has progressed to the stage where specific patient-based recommendations can be provided.…”

Section: Introductionmentioning

confidence: 99%

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Step-Up and Step-Down Treatment Approaches for COPD: A Holistic View of Progressive Therapies

Lόpez-Campos¹,

Hernández²,

Ruiz-Duque³

et al. 2021

COPD

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Recent advances in inhaled drugs and a clearer definition of the disease have made the task of managing COPD more complex. Different proposals have been put forward which combine all the available treatments and the different clinical presentations in an effort to select the best therapeutic options for each clinical context. As COPD is a chronic progressive disease, the escalation of therapy has traditionally been considered the most natural way to tackle it. However, the notion of COPD as a constantly progressing disease has recently been challenged and, in specific areas, this points to the possibility of a deescalation in treatment. In this context, the clinician requires simple, specific recommendations to guide these changes in treatment in their daily clinical practice. To accomplish this, the first step must be a correct evaluation and an accurate initial preliminary diagnosis of the patient's condition. Thereafter, the first escalation in therapy must be introduced with caution as the disease progresses, since clinical trials are not designed with clinical decision-making in mind. During this escalation, three possibilities are open to change the current treatment for a different one within the same family, to increase non-pharmacological interventions or to increase the pharmacological therapies. Beyond that point, a patient with persistent symptoms represents a complex clinical scenario which requires a specialized approach, including the evaluation of different respiratory and non-respiratory comorbidities. Unfortunately, there are few de-escalation studies available, and these are mainly observational in nature. The debate on de-escalation in pharmacological treatment, therefore, involves two main discussion points: the withdrawal of bronchodilators and the withdrawal of inhaled steroids. Altogether, the scheme for modifying treatment must be more personalized than just adding molecules, and the therapeutic response and its conditioning factors should be evaluated at each step before proceeding further.

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Section: Initial Stepping Up From Initial Treatmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Step-Up and Step-Down Treatment Approaches for COPD: A Holistic View of Progressive Therapies

Lόpez-Campos¹,

Hernández²,

Ruiz-Duque³

et al. 2021

COPD

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“…En bastantes ocasiones, estos episodios se observan agrupados y continuados, lo que plantea la duda de si realmente son nuevas exacerbaciones o son resoluciones incompletas del episodio precedente. De hecho, guías como GesEPOC han establecido en su clasificación la existencia del fenotipo exacerbador [12,13] a la hora de pautar un determinado tratamiento, y han introducido los conceptos de fracaso terapéutico, recaída y recurrencia, que analizaremos posteriormente.…”

Section: Frecuencia Y Gravedadunclassified

“…El diagnóstico de la EAEPOC es fundamentalmente clínico, aunque se espera que en un futuro próximo estén disponibles algunos marcadores biológicos que aumenten la precisión diagnóstica [5,6,12,13]. Se recomienda realizar una anamnesis que incluya el diagnóstico de confirmación previo de EPOC mediante espirometría, historia de exacerbaciones anteriores, gravedad de los síntomas respiratorios en función de su situación basal previa, exposición al humo del tabaco u a otros tóxicos ambientales y la presencia de comorbilidad.…”

Section: Diagnósticounclassified

“…La situación postcovid no parece haber modificado esta flora, aunque como ya hemos comentado si se ha puesto de ción en las cuatro semanas previas se considera que no presentan una EAEPOC como tal, puesto que esta situación indica recaída, fracaso terapéutico o recurrencia [12,13]. Para la valoración diagnóstica y de la gravedad, dependiendo de si la consulta se produce en atención primaria u hospitalaria, se recomienda realizar una serie de exploraciones complementarias.…”

Section: Microorganismos Frecuentes En Eaepocunclassified

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Oral antibiotic treatment of exacerbation of COPD. Beyond COVID-19

González-Moro

Alonso²

2021

Rev Esp Quimioter

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COPD (chronic obstructive pulmonary disease) includes patients with chronic bronchitis and / or emphysema who have in common the presence of a chronic and progressive airflow obstruction, with symptoms of dyspnea and whose natural history is modified by acute episodes of exacerbations. Exacerbation (EACOPD) is defined as an acute episode of clinical instability characterized by a sustained worsening of respiratory symptoms. It is necessary to distinguish a new EACOPD from a previous treatment failure or a relapse. EACOPD become more frequent and intense over time, deteriorating lung function and quality of life. The diagnosis of EACOPD consists of 3 essential steps: a) differential diagnosis; b) establish the severity, and c) identify its etiology. The main cause of exacerbations is infection, both bacterial and viral. Antibiotics are especially indicated in severe EACOPD and the presence of purulent sputum. Beta-lactams (amoxicillin-clavulanate and cefditoren) and fluoroquinolones (levofloxacin) are the most widely used antimicrobials. This review updates the problem of acute exacerbation with infectious origin from the perspective of etiology, antimicrobial resistance, microbiological studies, risk stratification, and antimicrobial management. The risk, prognosis and characteristics of COPD patients who develop COVID19 are analyzed.

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