Impacto de las exacerbaciones en la enfermedad pulmonar obstructiva crónica Exacerbaciones en la EPOC
Barra lateral del artículo
Contenido principal del artículo
Resumen
La enfermedad pulmonar obstructiva crónica (EPOC) es la tercera causa de muerte en todo el mundo. Sin embargo, ante la falta de herramientas diagnósticas precisas en el primer nivel de atención médica, como la espirometría, es difícil determinar la prevalencia real de la EPOC.
Por otro lado, la falta de una definición clara y precisa de las exacerbaciones de la EPOC hace que se subestime su impacto en la salud pública; habitualmente, los pacientes con EPOC que cursan una exacerbación retrasan la busqueda de atención médica inmediata porque se acostumbran al deterioro asociado a la enfermedad o lo confunden con cambios por la edad avanzada. Esto puede provocar un aumento de la morbilidad y la mortalidad, asimismo, mayor utilización de los recursos sanitarios y mayor carga económica.
Por lo tanto, es importante sensibilizar sobre la importancia del diagnóstico temprano y el tratamiento adecuado de las exacerbaciones de la EPOC, del mismo modo que el mayor conocimiento público de los síntomas, las causas y los factores de riesgo de la EPOC. Con ello, se podrán aplicar estrategias de prevención, diagnóstico y tratamiento más eficaces que mejoren la calidad de vida de los pacientes y disminuyan la carga de la enfermedad para la sociedad.
Esta revisión ofrece un análisis crítico de la definición más reciente y esboza las implicaciones del comportamiento de las exacerbaciones, su impacto en los distintos ámbitos del sistema sanitario, así como en las diferentes esferas de la vida de los pacientes con EPOC.
Descargas
Detalles del artículo
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
Citas
Kim V, Aaron SD. What is a COPD exacerbation? Current definitions, pitfalls, challenges and opportunities for improvement. Eur Respir J 2018;52:1801261. DOI: 10.1183/13993003.01261-2018
Mathioudakis AG, Janssens W, Sivapalan P et al. Acute exacerbations of chronic obstructive pulmonary disease: in search of diagnostic biomarkers and treatable traits. Thorax 2020;75:520-527.
DOI: 10.1136/thoraxjnl-2019-214484
Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. 2022 Report. [Internet]. [Consultado 1 mar 2022] Disponible en: https://goldcopd.org/2022-gold-reports-2/
Celli BR, Fabbri LM, Aaron SD et al. An Updated Definition and Severity Classification of Chronic Obstructive Pulmonary Disease Exacerbations: The Rome Proposal. Am J Respir Crit Care Med 2021;204:1251-1258. DOI: 10.1164/rccm.202108-1819PP
Wedzicha JA Ers Co-Chair, Miravitlles M, Hurst JR et al. Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline. Eur Respir J 2017;49:1600791. DOI: 10.1183/13993003.00791-2016
Alobaidi NY, Stockley JA, Stockley RA et al. An overview of exacerbations of chronic obstructive pulmonary disease: Can tests of small airways' function guide diagnosis and management? Ann Thorac Med 2020;15:54-63. DOI: 10.4103/atm.ATM_323_19
Padua P, Ramirez-Venegas A, Hernandez-Zenteno RJ et al. High prevalence of grammnegative enteric bacilli and pseudomonas in mild exacerbation of early stages COPD (Gold I-II). Eur Respir J 2008;32 (Suppl. 52):2300.
Waeijen-Smit K, Houben-Wilke S, DiGiandomenico A et al. Unmet needs in the management of exacerbations of chronic obstructive pulmonary disease. Intern Emerg Med 2021;16:559-569. DOI: 10.1007/s11739-020-02612-9
Lee CT, Wang PH. Handgrip strength during admission for COPD exacerbation: impact on further exacerbation risk. BMC Pulm Med 2021;21:245. DOI: 10.1186/s12890-021-01610-7
Wallace AE, Kaila S, Bayer V et al. Health Care Resource Utilization and Exacerbation Rates in Patients with COPD Stratified by Disease Severity in a Commercially Insured Population. J Manag Care Spec Pharm 2019;25:205-217. DOI: 10.18553/jmcp.2019.25.2.205
Zhou A, Zhou Z, Zhao Y et al. The recent advances of phenotypes in acute exacerbations of COPD. Int J Chron Obstruct Pulmon Dis 2017;12:1009-1018. DOI: 10.2147/COPD.S128604
Corlateanu A, Mendez Y, Wang Y et al. Chronic obstructive pulmonary disease and phenotypes: a state-of-the-art. Pulmonology 2020;26:95-100. DOI: 10.1016/j.pulmoe.2019.10.006
Lazic Z, Stankovic I, Milenkovic B et al. Characteristics of COPD Phenotypes in Serbia. Int J Chron Obstruct Pulmon Dis 2021;16:643-654. DOI: 10.2147/COPD.S300693
Hurst JR, Vestbo J, Anzueto A et al. Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med 2010;363:1128-1138. DOI: 10.1056/NEJMoa0909883
Agusti A, Hurd S, Jones P et al. FAQs about the GOLD 2011 assessment proposal of COPD: a comparative analysis of four different cohorts. Eur Respir J 2013;42:1391-1401. DOI: 10.1183/09031936.00036513
Donaldson GC, Seemungal TA, Bhowmik A et al. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax 2002;57:847-852. DOI: 10.1136/thorax.57.10.847
Dransfield MT, Kunisaki KM, Strand MJ et al. Acute exacerbations and lung function loss in smokers with and without chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2017;195:324-330. DOI: 10.1164/rccm.201605-1014OC
Halpin DMG, Decramer M, Celli BR et al. Effect of a single exacerbation on decline in lung function in COPD. Respir Med 2017;128:85-91. DOI: 10.1016/j.rmed.2017.04.013
Alqahtani JS, Njoku CM, Bereznicki B et al. Risk factors for all-cause hospital readmission following exacerbation of COPD: a systematic review and meta-analysis. Eur Respir Rev 2020;29:190166. DOI: 10.1183/16000617.0166-2019
Soler-Cataluña JJ, Martinez-Gracía MA, Roman Sánchez P et al. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax 2005;60:925-931. DOI: 10.1136/thx.2005.040527
Cao Y, Xing Z, Long H et al. Predictors of mortality in COPD exacerbation cases presenting to the respiratory intensive care unit. Respir Res 2021;22:77. DOI: 10.1186/s12931-021-01657-4
Chai CS, Mos SB, Ng DL et al. Clinical phenotypes and health-related quality of life of COPD patients in a rural setting in Malaysia - a cross-sectional study. BMC Pulm Med 2020;20:254. DOI: 10.1186/s12890-020-01295-4
Martin AL, Marvel J, Fahrbach K et al. The association of lung function and St. George's respiratory questionnaire with exacerbations in COPD: a systematic literature review and regression analysis. Respir Res 2016;17:40. DOI: 10.1186/s12931-016-0356-1
Parekh TM, Bhatia S, Cherrington A et al. Factors influencing decline in quality of life in smokers without airflow obstruction: The COPDGene study. Respir Med 2020;161:105820. DOI: 10.1016/j.rmed.2019.105820
Gayaf M, Karadeniz G, Güldaval F et al. Which one is superior in predicting 30 and 90 days mortality after COPD exacerbation: DECAF, CURB-65, PSI, DOSE, BAP-65. Eur Respir J 2020;56:1048. DOI: 10.1080/17476348.2021.1901584
Larsson K, Janson C, Lisspers K et al. The impact of exacerbation frequency on clinical and economic outcomes in Swedish COPD patients: The ARCTIC study. Int J Chron Obstruct Pulmon Dis 2021;16:701-713. DOI: 10.2147/COPD.S297943
Oussedik F, Khelafi R, Skander F. Impact des exacerbations aiguës de BPCO sur la mortalité [The impact of acute exacerbations of COPD on mortality]. Rev Mal Respir 2019;36:7-14. DOI: 10.1016/j.rmr.2017.12.005
Halpin DM, Miravitlles M, Metzdorf N et al. Impact and prevention of severe exacerbations of COPD: a review of the evidence. Int J Chron Obstruct Pulmon Dis 2017;12:2891-2908. DOI: 10.2147/COPD.S139470
Fernández-Plata R, Martínez-Briseño D, García-Sancho Figueroa C et al. Métodos para la estimación de costos en salud de la EPOC: resultados basales. Neumol Cir Torax 2016;75:4-11.
Vázquez‑García JC, Hernández‑Zenteno RJ, Pérez‑Padilla JR et al. Guía de Práctica Clínica Mexicana para el diagnóstico y tratamiento de la Enfermedad Pulmonar Obstructiva Crónica. Neumol Cir Torax 2019;78(Supl. 1):s1-s76.
Au DH, Bryson CL, Chien JW et al. The effects of smoking cessation on the risk of chronic obstructive pulmonary disease exacerbations. J Gen Intern Med 2009;24(4):457-463. DOI: 10.1007/s11606-009-0907-y
Axson EL, Bottle A, Cowie MR et al. Relationship between heart failure and the risk of acute exacerbation of COPD. Thorax 2021;76:807-814. DOI: 10.1136/thoraxjnl-2020-216390
Ryrsø CK, Godtfredsen NS, Kofod LM et al. Lower mortality after early supervised pulmonary rehabilitation following COPD-exacerbations: a systematic review and meta-analysis. BMC Pulm Med 2018;18:154. DOI: 10.1186/s12890-018-0718-1
Menezes AM, Perez-Padilla R, Jardim JR et al. Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study. Lancet 2005;366(9500):1875-1881. DOI: 10.1016/S0140-6736(05)67632-5
Montes de Oca M, Tálamo C, Halbert RJ et al. Frequency of self-reported COPD exacerbation and airflow obstruction in five Latin American cities: the Proyecto Latinoamericano de Investigacion en Obstruccion Pulmonar (PLATINO) study. Chest 2009;136:71-78.
Naranjo L, Torres-Duque CA, Colodenco D et al. Highlights of an Expert Advisory Board on Acute Exacerbations of Chronic Obstructive Pulmonary Disease (AE-COPD) in Latin America. Int J Chron Obstruct Pulmon Dis 2020;15:1919-1929. DOI: 10.2147/COPD.S261258
Brat K, Svoboda M, Zatloukal J et al. The relationship between clinical phenotypes, GOLD Groups/Stages and Mortality in COPD Patients- A Prospective Multicenter Study. International Journal of COPD 2021;16 :1117-1182. DOI: 10.2147/COPD.S297087
Zenteno R, Lemus Rangel R, Martínez Pacheco V et al. EE25. Evaluation of the cost in patients with Chronic Obstructive Pulmonary Disease (COPD) within the public health perspective in Mexico. Value in Health 2022;25(7):S340. DOI: https://doi.org/10.1016/j.jval.2022.04.278
Soto-Rodríguez S, Mahecha-Matsudo S, Sepúlveda C. Enfermedad pulmonar obstructiva crónica y comportamiento sedentario: revisión sistemática. Rev Chil Enferm Respir 2021; 37: 222-229.
Thyregod M, Løkke A, Skou ST, Larsen J, Bodtger U. Changes in systemic inflammation after pulmonary rehabilitation in patients with COPD and severe physical inactivity - an exploratory study. Chron Respir Dis 2022;19. DOI: 10.1177/14799731221112439.
Thyregod M, Løkke A, Bodtger U. The impact of pulmonary rehabilitation on severe physical inactivity in patients with chronic obstructive pulmonary disease: a pilot study. Int J Chron Obstruct Pulmon Dis 2018;13:3359-3365. DOI: 10.2147/COPD.S174710.
Gulart AA, Munari AB, Santos Silva IJC, Alexandre HF, Karloh M, Mayer AF. Baseline characteristics associated to improvement of patients with COPD in physical activity in daily life level after pulmonary rehabilitation. Respir Med 2019;151:142-147. DOI: 10.1016/j.rmed.2019.04.006.
Lasso Apráez JI. Interpretación de los gases arteriales en Bogotá (2.640 msnm) basada en el nomograma de Siggaard-Andersen. Una propuesta para facilitar y unificar la lectura. Revista Colombiana de Neumología 2014;26(1):25-36.
Lorente-Aznara T, Perez-Aguilar G, García-Espot A et al. Estimación de la Saturación Arterial de Oxígeno en función de la Altitud. Medicina Clínica 2016;147(10):435-440. DOI: 10.1016/j.medcli.2016.07.025.
Pasquale MK, Sun SX, Song F, Hartnett HJ, Stemkowski SA. Impact of exacerbations on health care cost and resource utilization in chronic obstructive pulmonary disease patients with chronic bronchitis from a predominantly Medicare population. Int J Chron Obstruct Pulmon Dis 2012;7:757-64. DOI: 10.2147/COPD.S36997.
Foo J, Landis SH, Maskell J et al. Continuing to Confront COPD International Patient Survey: economic impact of COPD in 12 countries. PLoS One 2016;11(4):e0152618. DOI:10.1371/journal. pone.0152618
Larsson K, Janson C, Lisspers K et al. The Impact of Exacerbation Frequency on Clinical and Economic Outcomes in Swedish COPD Patients: The ARCTIC Study. Int J Chron Obstruct Pulmon Dis 2021;16:701-713. DOI: 10.2147/COPD.S297943.
Abudagga A, Sun SX, Tan H, Solem CT. Exacerbations among chronic bronchitis patients treated with maintenance medications from a US managed care population: an administrative claims data analysis. Int J Chron Obstruct Pulmon Dis 2013;8:175-85. DOI: 10.2147/COPD.S40437.
Dalal AA, Patel J, D’Souza A, Farrelly E, Nagar S, Shah M. Impact of COPD exacerbation frequency on costs for a managed care population. J Manag Care Spec Pharm 2015;21(7):575–583. DOI:10.18553/jmcp.2015.21.7.575
Blasi F, Cesana G, Conti S et al. The clinical and economic impact of exacerbations of chronic obstructive pulmonary disease: a cohort of hospitalized patients. PLoS One 2014;9(6):e101228. DOI:10.1371/ journal.pone.0101228
Mittmann N, Kuramoto L, Seung SJ, Haddon JM, Bradley-Kennedy C, Fitzgerald JM. The cost of moderate and severe COPD exacerbations to the Canadian healthcare system. Respir Med 2008;102 (3):413–421. DOI:10.1016/j.rmed.2007.10.010
Silver H, Blanchette CM, Roberts M, Petersen H, StCharles ME. Prevalence of comorbidities in patients hospitalized for COPD exacerbations and impact on impatient mortality and hospital expenditures. Am J Respir Crit Care Med 2010;181:A5943. DOI:10.1164/rccm.200904-0493OC
Roberts MH, Borrego M, Petersen H, Kharat A, Blanchette C. Estimating the burden and course of severe COPD exacerbations in the U.S. Hispanic population. Am J Respir Crit CareMed 2011;183:A1496. DOI:10.1164/ajrccm conference.2011.183.1_MeetingAbstracts.A1496
Xu X, Knight T, Baik R, Tu X, Parker JM. Patient characteristics, health resource utilization (HRU) and treatment costs of chronic obstructive pulmonary disease (COPD) patients treated in hospital facilities for exacerbations. Am J Respir Crit Care Med 2012;185:A3047.
Reynales-Shigematsu LM, Juarez-Marquez SA, Valdes-Salgado R. Costs of medical care attributable to tobacco consumption at the Mexican Institute of Social Security (IMSS), Morelos. Salud Publica de Mexico 2005; 47(6):451–457.
Ciapponi A, Lee A, Mazzoni A, Glujovsky D, Cesaroni S, Sobrino E. The epidemiology and burden of COPD in Latin America and the Caribbean: systematic review and meta-analysis. COPD. 2014;11(3):339-50. DOI: 10.3109/15412555.2013.836479
Punekar YS, Shukla A, Müllerova H. COPD management costs according to the frequency of COPD exacerbations in UK primary care. Int J Chron Obstruct Pulmon Dis 2014;9:65–73. DOI:10.2147/ COPD.
Iheanacho I, Zhang S, King D, Rizzo M, Ismaila AS. Economic Burden of Chronic Obstructive Pulmonary Disease (COPD): A Systematic Literature Review. Int J Chron Obstruct Pulmon Dis 2020;15:439-460. DOI: 10.2147/COPD.S234942.
Stanford RH, Shen Y, McLaughlin T. Cost of chronic obstructive pulmonary disease in the emergency department and hospital: an analysis of administrative data from 218 US hospitals. Treat Respir Med 2006;5(5):343–349. DOI:10.2165/00151829-2006050 50-00005