Juan José Soler-Cataluña

University Hospital Vall d'Hebron, Barcino, Catalonia, Spain

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Publications (63)119.77 Total impact

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    ABSTRACT: ABSTRACT RATIONALE: The Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT) was proposed for assessing health status in COPD, but little is known about its longitudinal changes. OBJECTIVE: To evaluate one-year CAT variability in stable COPD patients and relate its variations to changes in other disease markers. METHODS: We evaluated the following variables in smokers with and without COPD at baseline and after one year: CAT score, age, gender, smoking status, pack-years history, BMI, modified Medical Research Council (MMRC) scale, 6MWD, lung function, BODE index, hospital admissions, Hospital and Depression Questionnaire, and the Charlson comorbidity score. In COPD patients we explored the association of CAT scores and its one-year changes with the studied parameters. RESULTS: 824 smokers with COPD and 126 without were evaluated at baseline, and 441 smokers with COPD and 66 without one year later. At 1 year, CAT scores for COPD patients were similar (±4 points) in 56%, higher in 27%, and lower in 17%. Interestingly, MMRC scores were similar (± 1 point) in 46% of patients, worse in 36% and better in 18% at 1 year. One-year CAT changes were best predicted by changes in MMRC scores (β coefficient 0.47, p<0.001). A similar behavior was found for CAT and MMRC in smokers without COPD. CONCLUSIONS: One-year longitudinal data shows variability in CAT scores among stable COPD patients, similar to what happened to MMRC that was the best predictor of one-year CAT changes. Further longitudinal studies should confirm the long-term CAT variability and it clinical applicability.
    Chest 02/2014; · 5.85 Impact Factor
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    ABSTRACT: FEV1 is universally used as a measure of severity in COPD. Current thresholds are based on expert opinion and not on evidence. We aimed to identify the best FEV1 (% predicted) and dyspnea (mMRC) thresholds to predict 5-yr survival in COPD patients. We conducted a patient-based pooled analysis of eleven COPD Spanish cohorts (COCOMICS). Survival analysis, ROC curves, and C-statistics were used to identify and compare the best FEV1 (%) and mMRC scale thresholds that predict 5-yr survival. A total of 3,633 patients (93% men), totaling 15,878 person-yrs. were included, with a mean age 66.4±9.7, and predicted FEV1 of 53.8% (±19.4%). Overall 975 (28.1%) patients died at 5 years. The best thresholds that spirometrically split the COPD population were: mild ≥70%, moderate 56-69%, severe 36-55%, and very severe ≤35%. Survival at 5 years was 0.89 for patients with FEV1≥70 vs. 0.46 in patients with FEV1 ≤35% (H.R: 6; 95% C.I.: 4.69-7.74). The new classification predicts mortality significantly better than dyspnea (mMRC) or FEV1 GOLD and BODE cutoffs (all p<0.001). Prognostic reliability is maintained at 1, 3, 5, and 10 years. In younger patients, survival was similar for FEV1 (%) values between 70% and 100%, whereas in the elderly the relationship between FEV1 (%) and mortality was inversely linear. The best thresholds for 5-yr survival were obtained stratifying FEV1 (%) by ≥70%, 56-69%, 36-55%, and ≤35%. These cutoffs significantly better predict mortality than mMRC or FEV1 (%) GOLD and BODE cutoffs.
    PLoS ONE 01/2014; 9(2):e89866. · 3.73 Impact Factor
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    Archivos de Bronconeumología 01/2014; 50 Suppl 1:1-16. · 2.17 Impact Factor
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    ABSTRACT: After the development of the COPD Strategy of the National Health Service in Spain, all scientific societies, patient organisations, and central and regional governments formed a partnership to enhance care and research in COPD. At the same time, the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) took the initiative to convene the various scientific societies involved in the National COPD Strategy and invited them to participate in the development of the new Spanish guidelines for COPD (Guía Española de la EPOC; GesEPOC). Probably the more innovative approach of GesEPOC is to base treatment of stable COPD on clinical phenotypes, a term which has become increasingly used in recent years to refer to the different clinical forms of COPD with different prognostic implications. The proposed phenotypes are: (A) infrequent exacerbators with either chronic bronchitis or emphysema; (B) overlap COPD-asthma; (C) frequent exacerbators with emphysema predominant; and (D) frequent exacerbators with chronic bronchitis predominant. The assessment of severity has also been updated with the incorporation of multidimensional indices. The severity of the obstruction, as measured by forced expiratory volume in 1 second, is essential but not sufficient. Multidimensional indices such as the BODE index have shown excellent prognostic value. If the 6-minute walking test is not performed routinely, its substitution by the frequency of exacerbations (BODEx index) provides similar prognostic properties. This proposal aims to achieve a more personalised management of COPD according to the clinical characteristics and multidimensional assessment of severity.
    Primary care respiratory journal: journal of the General Practice Airways Group 03/2013; 22(1):117-21.
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    ABSTRACT: Guidelines recommend to define COPD by airflow obstruction and other factors, but no studies evaluated the ability of existing multicomponent indices to predict mortality up to 10 years.We conducted a patient-based pooled analysis. Survival analysis and C-statistics were used to determine the best COPD index/indices according to several construct variables and by varying time points. Individual data of 3,633 patients from eleven COPD cohorts were collected, totalling the experience of 15,878 person-years.Overall, there were 1,245 death events within our cohorts, with a K-M survival of 0.963 at 6-months, down to 0.432 at 10 years. In all patients, ADO, BODE and e-BODE were the best indices to predict 6-months mortality. The ADO index was the best to predict 12-month mortality (C-statistic 0.702), 5-yr mortality (C-statistic 0.695), and 10-yr mortality (C-statistic 0.698), significantly better than BODE (all p<0.05). The best indices to predict death by C-statistics when adjusting by age were eBODE, BODEx, and BODE.No index predicts well short-term survival. All BODE modifications score better than ADO after age adjustment.. The ADO and BODE indices are overall the most valid multicomponent indices to predict time to death in all COPD patients.
    European Respiratory Journal 12/2012; · 6.36 Impact Factor
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    ABSTRACT: IntroductionThis present paper describes the method and the organization of the study known as the COPD History Assessment In SpaiN (CHAIN), whose main objective is to evaluate the long-term natural history of a chronic obstructive pulmonary disease (COPD) patient cohort from a multidimensional standpoint and to identify clinical phenotypes, in comparison with another non-COPD control cohort.Patients and methodsCHAIN is a multicenter, observational study of prospective cohorts carried out at 36 Spanish hospitals. Both cohorts will be followed-up during a 5-year study period with complete office visits every 12 months and telephone interviews every 6 months in order to evaluate exacerbations and the vital state of the subjects. The recruitment period for cases was between 15 January 2010 and 31 March 2012. At each annual visit, information will be collected on: (i) clinical aspects (socio-economic situation, anthropometric data, comorbidities, smoking, respiratory symptoms, exacerbations, quality of life, anxiety-depression scale, daily life activities, treatments); (ii) respiratory function (spirometry, blood gases, hyperinflation, diffusion, respiratory pressures); (iii) BODE index (main study variable); (iv) peripheral muscle function, and (v) blood work-up (including IgE and cardiovascular risk factors). In addition, a serum bank will be created for the future determination of biomarkers. The data of the patients are anonymized in a database with a hierarchical access control in order to guarantee secure information access. The CHAIN study will provide information about the progression of COPD and it will establish a network of researchers for future projects related with COPD.
    Archivos de Bronconeumología 12/2012; 48(12):453–459. · 2.17 Impact Factor
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    ABSTRACT: IntroductionThis present paper describes the method and the organization of the study known as the COPD History Assessment In SpaiN (CHAIN), whose main objective is to evaluate the long-term natural history of a chronic obstructive pulmonary disease (COPD) patient cohort from a multidimensional standpoint and to identify clinical phenotypes, in comparison with another non-COPD control cohort.Patients and methodsCHAIN is a multicenter, observational study of prospective cohorts carried out at 36 Spanish hospitals. Both cohorts will be followed-up during a 5-year study period with complete office visits every 12 months and telephone interviews every 6 months in order to evaluate exacerbations and the vital state of the subjects. The recruitment period for cases was between 15 January 2010 and 31 March 2012. At each annual visit, information will be collected on: (i) clinical aspects (socio-economic situation, anthropometric data, comorbidities, smoking, respiratory symptoms, exacerbations, quality of life, anxiety-depression scale, daily life activities, treatments); (ii) respiratory function (spirometry, blood gases, hyperinflation, diffusion, respiratory pressures); (iii) BODE index (main study variable); (iv) peripheral muscle function, and (v) blood work-up (including IgE and cardiovascular risk factors). In addition, a serum bank will be created for the future determination of biomarkers. The data of the patients are anonymized in a database with a hierarchical access control in order to guarantee secure information access. The CHAIN study will provide information about the progression of COPD and it will establish a network of researchers for future projects related with COPD.ResumenIntroducciónEl presente trabajo describe el método y la organización del trabajo del estudio COPD History Assessment in SpaiN (CHAIN), cuyo objetivo principal es evaluar a largo plazo la historia natural de una cohorte de pacientes con enfermedad pulmonar obstructiva crónica (EPOC) desde un punto de vista multidimensional y la identificación de fenotipos clínicos comparándola con otra cohorte control sin EPOC.Pacientes y métodoCHAIN es un estudio observacional multicéntrico de cohortes prospectivas realizado en 36 hospitales españoles. Ambas cohortes se seguirán durante un periodo de 5 años con visitas completas cada 12 meses y controles telefónicos cada 6 meses para valorar las exacerbaciones y el estado vital del sujeto. El periodo de reclutamiento de casos se realizó entre el 15 de enero de 2010 y el 31 de marzo de 2012. En cada visita anual se recoge información sobre: (a) aspectos clínicos (situación socioeconómica, datos antropométricos, comorbilidades, tabaquismo, clínica respiratoria, exacerbaciones, calidad de vida, escala ansiedad-depresión, actividades de la vida diaria, tratamientos); (b) función respiratoria (espirometría, gasometría arterial, hiperinsuflación, difusión, presiones respiratorias); (c) índice BODE (variable principal del estudio); (d) función muscular periférica, y (e) analítica sanguínea (incluida IgE y factores de riesgo cardiovascular). Además, se creará una seroteca para la futura determinación de biomarcadores. Los datos de los pacientes son anonimizados en una base de datos con un acceso jerárquico para garantizar la seguridad en los accesos a la información. El estudio CHAIN aportará información sobre la progresión de la EPOC y establecerá una red de investigadores para futuros proyectos relacionados con la enfermedad.
    Archivos de Bronconeumología (English Edition). 12/2012; 48(12):453–459.
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    ABSTRACT: Respiratory rehabilitation (RR) has been shown to be effective with a high level of evidence in terms of improving symptoms, exertion capacity and health-related quality of life (HRQL) in patients with COPD and in some patients with diseases other than COPD. According to international guidelines, RR is basically indicated in all patients with chronic respiratory symptoms, and the type of program offered depends on the symptoms themselves. As requested by the Spanish Society of Pneumology and Thoracic Surgery (SEPAR), we have created this document with the aim to unify the criteria for quality care in RR. The document is organized into sections: indications for RR, evaluation of candidates, program components, characteristics of RR programs and the role of the administration in the implementation of RR. In each section, we have distinguished 5 large disease groups: COPD, chronic respiratory diseases other than COPD with limiting dyspnea, hypersecretory diseases, neuromuscular diseases with respiratory symptoms and patients who are candidates for thoracic surgery for lung resection.
    Archivos de Bronconeumología. 11/2012; 48(11):396–404.
  • Marc Miravitlles, Juan José Soler-Cataluña, Myriam Calle, Joan B Soriano
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    ABSTRACT: The new GOLD update has moved forward the principles of treatment of stable COPD by including the concepts of symptoms and risks into the decision of therapy; however, no mention of the concept of clinical phenotypes was included. It is recognized that COPD is a very heterogeneous disease and not all patients respond to all the drugs available for treatment. The identification of responders to therapies is crucial in chronic diseases to provide the most appropriate treatment and avoid unnecessary medications. The classically defined phenotypes of chronic bronchitis and emphysema, together with the newly described phenotypes of overlap COPD-asthma and frequent exacerbator allow a simple classification of patients that share clinical characteristics and outcomes and, more importantly, similar responses to existing treatments.These clinical phenotypes can help clinicians identify patients that respond to specific pharmacologic interventions. As an example, frequent exacerbators are the only subjects with an indication for anti-inflammatory treatment in COPD. Among them, those with chronic bronchitis are the only candidates to receive PDE4 inhibitors. Patients with overlap COPD-asthma phenotype show an enhanced response to inhaled corticosteroids and infrequent exacerbators should only receive bronchodilators. These well defined clinical phenotypes could potentially be incorporated into treatment guidelines.
    European Respiratory Journal 10/2012; · 6.36 Impact Factor
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    ABSTRACT: ABSTRACT BACKGROUND: The new GOLD update includes airflow limitation, history of COPD exacerbations and symptoms to classify and grade COPD severity. We aimed to determine their distribution in eleven, well defined COPD cohorts, and their prognostic validity up to 10 years to predict time to death. METHODS: Spirometry in all eleven cohors was post-bronchodilator. Survival analysis and C-statistics were used to compare the two GOLD systems by varying time points. RESULTS: Of 3,633 patients, 1,064 (33.6%) were in new GOLD patient group A (low risk, less symptoms); 515 (16.3%) were B (low risk, more symptoms); 561 (17.7%) were C (high risk, less symptoms); and 1,023 (32.3%) were D (high risk, more symptoms). There was great heterogeneity of this distribution within the cohorts (Chi2 p value < 0.01). No differences were seen in the C statistics of old versus new GOLD grading to predict mortality at one year (0.635 vs. 0.639, p=0.53, at three years (0.637 vs. 0.645, p=0.21) or at 10 years (0.639 vs. 0.642, p=0.76). CONCLUSIONS: The new GOLD grading produces an uneven split of the COPD population, one third each in A and D patient groups, and its prognostic validity to predict time to death is no different than the old GOLD staging based in spirometry only.1Fundación Caubet-Cimera Illes Balears, Bunyola, Spain; 2Hospital Universitario Valme, Sevilla; 3Internal Medicine, Hospital Universitari Mutua de Terrassa, Universitat de Barcelona, Barcelona; 4Hospital Nuestra Señora de la Candelaria, Tenerife; 5Hospital Galdakao-Usansolo, Galdakao, Bizkaia 6Unidad de Neumología, Servicio de Medicina Interna, Hospital General de Requena, Valencia; 7Clınica Universidad de Navarra, Pamplona; 8CAIBER, Oficina de Investigación Biosanitaria de Asturias, Oviedo; 9Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Spain; 10Harvard University, Brigham and Women's Hospital, Pulmonary and Critical Care Medicine, Boston, MA, USA; 11Hospital Universitario Miguel Servet, Zaragoza, SpainAuthor for correspondence: Dr. Joan B Soriano Director, Program of Epidemiology & Clinical Research CIMERA. Recinte Hospital Joan March, Carretera Soller Km 12. 07110 - Bunyola, Illes Balears; Spain Email: jbsoriano@caubet-cimera.esFINANCIAL DISCLOSURE INFORMATION: No funding was required/available for COCOMICS.
    Chest 09/2012; · 5.85 Impact Factor
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    ABSTRACT: IntroductionAlthough asthma and COPD are different pathologies, many patients share characteristics from both entities. These cases can have different evolutions and responses to treatment. Nevertheless, the evidence available is limited, and it is necessary to evaluate whether they represent a differential phenotype and provide recommendations about diagnosis and treatment, in addition to identifying possible gaps in our understanding of asthma and COPD.MethodsA nation-wide consensus of experts in COPD in two stages: 1) during an initial meeting, the topics to be dealt with were established and a first draft of statements was elaborated with a structured «brainstorming» method; 2) consensus was reached with two rounds of e-mails, using a Likert-type scale.ResultsConsensus was reached about the existence of a differential clinical phenotype known as «Overlap Phenotype COPD-Asthma», whose diagnosis is made when 2 major criteria and 2 minor criteria are met. The major criteria include very positive bronchodilator test (increase in FEV1 ≥ 15% and ≥ 400 ml), eosinophilia in sputum and personal history of asthma. Minor criteria include high total IgE, personal history of atopy and positive bronchodilator test (increase in FEV1 ≥ 12% and ≥ 200 ml) on two or more occasions. The early use of individually-adjusted inhaled corticosteroids is recommended, and caution must be taken with their abrupt withdrawal. Meanwhile, in severe cases the use of triple therapy should be evaluated. Finally, there is an obvious lack of specific studies about the natural history and the treatment of these patients.Conclusions It is necessary to expand our knowledge about this phenotype in order to establish adequate guidelines and recommendations for its diagnosis and treatment.
    Archivos de Bronconeumología. 09/2012; 48(9):331–337.
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    ABSTRACT: PURPOSE: Several studies have analyzed factors associated to hospitalization in chronic obstructive pulmonary disease (COPD) patients. However, data are lacking on the quality of treatment received by patients prior to hospital admission. The present study analyzed how often patients requiring hospitalization for a COPD exacerbation had received previous treatment for the exacerbation, particularly antibiotics. METHODS: This was a multicenter, cross-sectional, observational study conducted in 30 Spanish hospitals among COPD patients aged >40 years who were hospitalized for an acute exacerbation. Patients were grouped according to whether or not they had received treatment prior to admission and, subsequently, according to whether or not they had received antibiotics. Patient eligibility for antibiotic therapy was assessed using both national and European guidelines. RESULTS: The study population consisted of 298 patients, of which 277 (93 %) were men, with a mean [standard deviation (SD)] age of 69.1 (9.5) years. One hundred and thirty-three patients (45 %) had received treatment prior to admission; among these, 76/133 (57 %) had received antibiotic therapy. However, 81-91 % of these patients fulfilled criteria for this therapy. Antibiotic use was significantly associated with yellow or green-yellow sputum prior to the exacerbation, a higher number of exacerbations in the previous year, more visits to emergency departments, and bronchiectasis. On the other hand, 10-20 % of patients who did receive antibiotics were not eligible for this therapy according to guidelines. CONCLUSIONS: This study demonstrates a low rate of previous outpatient treatment and antibiotic use among patients with a COPD exacerbation requiring hospital admission.
    Infection 08/2012; · 2.44 Impact Factor
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    ABSTRACT: Respiratory rehabilitation (RR) has been shown to be effective with a high level of evidence in terms of improving symptoms, exertion capacity and health-related quality of life (HRQL) in patients with COPD and in some patients with diseases other than COPD. According to international guidelines, RR is basically indicated in all patients with chronic respiratory symptoms, and the type of program offered depends on the symptoms themselves. As requested by the Spanish Society of Pneumology and Thoracic Surgery (SEPAR), we have created this document with the aim to unify the criteria for quality care in RR. The document is organized into sections: indications for RR, evaluation of candidates, program components, characteristics of RR programs and the role of the administration in the implementation of RR. In each section, we have distinguished 5 large disease groups: COPD, chronic respiratory diseases other than COPD with limiting dyspnea, hypersecretory diseases, neuromuscular diseases with respiratory symptoms and patients who are candidates for thoracic surgery for lung resection.
    Archivos de Bronconeumología 07/2012; 48(11):396-404. · 2.17 Impact Factor
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    ABSTRACT: INTRODUCTION: The objective of the present study was to validate the Spanish version of the SAQLI, which is a health-related quality of life (HRQL) questionnaire specific for sleep apnea-hypopnea syndrome (SAHS), and to assess its sensitivity to change. MATERIAL AND METHODS: A multicenter study performed in a group of patients with SAHS (apnea-hypopnea index [AHI] ≥5) who had been referred to the centers' Sleep Units. All patients completed the following questionnaires: SF-36, FOSQ, SAQLI and Epworth scale. The psychometric properties (internal consistency, construct validity, concurrent validity, predictive value, repeatability and responsiveness to change) of the SAQLI were assessed (four domains: daily function, social interactions, emotional function and symptoms; an optional fifth domain is treatment-related symptoms). RESULTS: One hundred sixty-two patients were included for study (mean age: 58±12; Epworth: 10±4; BMI: 33±5.9kg m(-2); AHI: 37±15hour(-1)). The factorial analysis showed a construct of four factors with similar distribution to the original questionnaire domains. Internal consistency (Cronbach's alpha between 0.78 and 0.82 for the different domains), concurrent validity for SF-36, Epworth scale and FOSQ, and test-retest reliability were appropriate. The predictive validity of the questionnaire showed no significant correlations with the severity of SAHS. SAQLI showed good sensitivity to change in all the domains of the questionnaire (p<0,01). CONCLUSIONS: The Spanish version of the SAQLI is a valid HRQL measurement with appropriate psychometric properties for use in patients with SAHS and it is sensitive to change.
    Archivos de Bronconeumología 07/2012; · 2.17 Impact Factor
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    ABSTRACT: Recognizing the clinical heterogeneity of COPD suggests a specific therapeutic approach directed by the so-called clinical phenotypes of the disease. The Spanish COPD Guidelines (GesEPOC) is an initiative of SEPAR, which, together with the scientific societies involved in COPD patient care, and the Spanish Patient Forum, has developed these new clinical practice guidelines. This present article describes the severity classification and the pharmacological treatment of stable COPD. GesEPOC identifies four clinical phenotypes with differential treatment: non-exacerbator, mixed COPD-asthma, exacerbator with emphysema and exacerbator with chronic bronchitis. Pharmacological treatment of COPD is based on bronchodilation in addition to other drugs depending on the clinical phenotype and severity. Severity is established by the BODE/BODEx multidimensional scales. Severity can also be approximated by assessing airflow obstruction, dyspnea, level of physical activity and history of exacerbations. GesEPOC is a new, more individualized approach to COPD treatment according to the clinical characteristics of the patients.
    Atención Primaria. 07/2012; 44(7):425–437.
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    ABSTRACT: Recognizing the clinical heterogeneity of COPD suggests a specific therapeutic approach directed by the so-called clinical phenotypes of the disease. The Spanish COPD Guidelines (GesEPOC) is an initiative of SEPAR, which, together with the scientific societies involved in COPD patient care, and the Spanish Patient Forum, has developed these new clinical practice guidelines. This present article describes the severity classification and the pharmacological treatment of stable COPD. GesEPOC identifies four clinical phenotypes with differential treatment: non-exacerbator, mixed COPD-asthma, exacerbator with emphysema and exacerbator with chronic bronchitis. Pharmacological treatment of COPD is based on bronchodilation in addition to other drugs depending on the clinical phenotype and severity. Severity is established by the BODE/BODEx multidimensional scales. Severity can also be approximated by assessing airflow obstruction, dyspnea, level of physical activity and history of exacerbations. GesEPOC is a new, more individualized approach to COPD treatment according to the clinical characteristics of the patients.
    Atención Primaria 06/2012; 44(7):425-37. · 0.96 Impact Factor
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    Marc Miravitlles, Myriam Calle, Juan José Soler-Cataluña
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    ABSTRACT: The term phenotype in the field of COPD is defined as “a single or combination of disease attributes that describe differences between individuals with COPD as they relate to clinically meaningful outcomes”. Among all phenotypes described, there are three that are associated with prognosis and especially are associated with a different response to currently available therapies. There phenotypes are: the exacerbator, the overlap COPD-asthma and the emphysema-hyperinflation.The exacerbator is characterised by the presence of, at least, two exacerbations the previous year, and on top of long-acting bronchodilators, may require the use of antiinflammatory drugs. The overlap phenotype presents symptoms of increased variability of airflow and incompletely reversible airflow obstruction. Due to the underlying inflammatory profile, it uses to have a good therapeutic response to inhaled corticosteroids in addition to bronchodilators. Lastly, the emphysema phenotype presents a poor therapeutic response to the existing antiinflammatory drugs and long-acting bronchodilators together with rehabilitation are the treatments of choice.Identifying the peculiarities of the different phenotypes of COPD will allow us to implement a more personalised treatment, in which the characteristics of the patients, together with their severity will be key to choose the best treatment option.
    Archivos de Bronconeumología. 03/2012; 48(3):86–98.
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    ABSTRACT: Although asthma and COPD are different pathologies, many patients share characteristics from both entities. These cases can have different evolutions and responses to treatment. Nevertheless, the evidence available is limited, and it is necessary to evaluate whether they represent a differential phenotype and provide recommendations about diagnosis and treatment, in addition to identifying possible gaps in our understanding of asthma and COPD. A nation-wide consensus of experts in COPD in two stages: 1) during an initial meeting, the topics to be dealt with were established and a first draft of statements was elaborated with a structured "brainstorming" method; 2) consensus was reached with two rounds of e-mails, using a Likert-type scale. Consensus was reached about the existence of a differential clinical phenotype known as"Overlap Phenotype COPD-Asthma", whose diagnosis is made when 2 major criteria and 2 minor criteria are met. The major criteria include very positive bronchodilator test (increase in FEV(1) ≥ 15% and ≥ 400ml), eosinophilia in sputum and personal history of asthma. Minor criteria include high total IgE, personal history of atopy and positive bronchodilator test (increase in FEV(1) ≥ 12% and ≥ 200ml) on two or more occasions. The early use of individually-adjusted inhaled corticosteroids is recommended, and caution must be taken with their abrupt withdrawal. Meanwhile, in severe cases the use of triple therapy should be evaluated. Finally, there is an obvious lack of specific studies about the natural history and the treatment of these patients. It is necessary to expand our knowledge about this phenotype in order to establish adequate guidelines and recommendations for its diagnosis and treatment.
    Archivos de Bronconeumología 02/2012; 48(9):331-7. · 2.17 Impact Factor
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    Marc Miravitlles, Myriam Calle, Juan José Soler-Cataluña
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    ABSTRACT: The term phenotype in the field of COPD is defined as "a single or combination of disease attributes that describe differences between individuals with COPD as they relate to clinically meaningful outcomes". Among all phenotypes described, there are three that are associated with prognosis and especially are associated with a different response to currently available therapies. There phenotypes are: the exacerbator, the overlap COPD-asthma and the emphysema-hyperinflation. The exacerbator is characterised by the presence of, at least, two exacerbations the previous year, and on top of long-acting bronchodilators, may require the use of antiinflammatory drugs. The overlap phenotype presents symptoms of increased variability of airflow and incompletely reversible airflow obstruction. Due to the underlying inflammatory profile, it uses to have a good therapeutic response to inhaled corticosteroids in addition to bronchodilators. Lastly, the emphysema phenotype presents a poor therapeutic response to the existing antiinflammatory drugs and long-acting bronchodilators together with rehabilitation are the treatments of choice. Identifying the peculiarities of the different phenotypes of COPD will allow us to implement a more personalised treatment, in which the characteristics of the patients, together with their severity will be key to choose the best treatment option.
    Archivos de Bronconeumología 12/2011; 48(3):86-98. · 2.17 Impact Factor

Publication Stats

968 Citations
119.77 Total Impact Points

Institutions

  • 2013
    • University Hospital Vall d'Hebron
      Barcino, Catalonia, Spain
  • 2012
    • Hospital Universitario Virgen del Rocío
      Hispalis, Andalusia, Spain
    • Hospital Universitario Miguel Servet
      Caesaraugusta, Aragon, Spain
    • Hospital de la Santa Creu i Sant Pau
      Barcino, Catalonia, Spain
    • Institut Marqués, Spain, Barcelona
      Barcino, Catalonia, Spain
  • 2011–2012
    • Hospital Clínic de Barcelona
      • Servicio de Neumología
      Barcino, Catalonia, Spain
  • 2003–2012
    • Requena General Hospital
      Valenza, Valencia, Spain
  • 2005–2011
    • Hospital Universitari i Politècnic la Fe
      • Servicio de Neumología
      Valenza, Valencia, Spain
  • 2010
    • Fundación Caubet-Cimera Centro Internacional de Medicina Respiratoria Avanzada
      Bunyola, Balearic Islands, Spain