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De Miguel-Díez J, Fernández-Villar A, Doña Díaz E, Padilla Bernáldez M, Trillo-Calvo E, Molina París J, Barrecheguren M, Valero Pérez JM, Ramírez Prieto MT. Chronic Obstructive Lung Disease: Treatment Guidelines and Recommendations for Referral and Multidisciplinary Continuity of Care. J Clin Med 2024; 13:303. [PMID: 38256437 PMCID: PMC10815941 DOI: 10.3390/jcm13020303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/25/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
Chronic Obstructive Pulmonary Disease (COPD) constitutes a major public health problem, and it is anticipated that its prevalence will continue to increase in the future. Its progressive nature requires a continuous and well-coordinated care approach. The follow-up for COPD should primarily focus on disease screening and control, which includes monitoring of pulmonary function, prevention of exacerbations, identification of aggravating factors and comorbidities, as well as ensuring treatment adequacy and adherence. However, existing clinical practice guidelines and consensus documents offer limited recommendations for the follow-up. In this context, we undertake a review of COPD treatment and the continuity of care recommendations endorsed by several scientific societies. Moreover, we underscore the importance of the involvement of nursing and community pharmacy in this process, as well as the utilization of quality indicators in the provision of care for the disease.
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Affiliation(s)
- Javier De Miguel-Díez
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28007 Madrid, Spain
- Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
| | - Alberto Fernández-Villar
- Servicio de Neumología, Hospital Álvaro Cunqueiro, Grupo NeumoVigo, Instituto de Investigación Sanitaria Galicia Sur, Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), 36312 Vigo, Spain;
| | - Esperanza Doña Díaz
- Unidad de Asistencia al Paciente EPOC, UGC Médico-Quirúrgica de Enfermedades Respiratorias, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain;
| | | | - Eva Trillo-Calvo
- Institute for Health Research Aragón, Centro de Salud Campo de Belchite, 50130 Belchite, Spain;
| | - Jesús Molina París
- Centro de Salud Francia, Dirección Asistencial Oeste, 28943 Fuenlabrada, Spain;
| | - Miriam Barrecheguren
- Servicio de Neumología, Hospital Universitari Vall d’Hebron, 08035 Barcelona, Spain;
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Doña E, Reinoso-Arija R, Carrasco-Hernandez L, Doménech A, Dorado A, Lopez-Campos JL. Exploring Current Concepts and Challenges in the Identification and Management of Early-Stage COPD. J Clin Med 2023; 12:5293. [PMID: 37629335 PMCID: PMC10455125 DOI: 10.3390/jcm12165293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/06/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
The need to improve health outcomes, as well as disease prognosis, has led clinicians and researchers to propose new ways of identifying COPD in its earliest forms. This initiative is based on the hypothesis that an earlier intervention would have a greater prognostic impact. However, the operational definition of a patient in the initial stages of the disease is complex, and there is still no unanimously accepted definition. GOLD has recently proposed different concepts to identify COPD in its early stages, such as COPD in young people or COPD with mild functional impairment. In addition, GOLD proposes two other concepts, called pre-COPD (symptomatic non-obstructive patients) and PRISm (preserved ratio with impaired spirometry), which aim to identify the patient at risk of developing this chronic airflow obstruction. However, despite the attractiveness of these concepts, none have been taken up universally by the medical community. A universally accepted identification of how to define COPD in its early stages is necessary as a preliminary step in order to design clinical trials to find out the best way to treat these patients. This review deals with these concepts of COPD at the onset of the disease, highlighting their importance and the problems involved in identifying them as therapeutic targets in real clinical practice.
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Affiliation(s)
- Esperanza Doña
- Unidad Médico-Quirúrgico de Enfermedades Respiratorias, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain; (E.D.); (A.D.); (A.D.)
| | - Rocío Reinoso-Arija
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, 41013 Sevilla, Spain; (R.R.-A.); (L.C.-H.)
| | - Laura Carrasco-Hernandez
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, 41013 Sevilla, Spain; (R.R.-A.); (L.C.-H.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Adolfo Doménech
- Unidad Médico-Quirúrgico de Enfermedades Respiratorias, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain; (E.D.); (A.D.); (A.D.)
| | - Antonio Dorado
- Unidad Médico-Quirúrgico de Enfermedades Respiratorias, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain; (E.D.); (A.D.); (A.D.)
| | - José Luis Lopez-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla, IBiS, Hospital Universitario Virgen del Rocío, CSIC, Universidad de Sevilla, 41013 Sevilla, Spain; (R.R.-A.); (L.C.-H.)
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Troosters T, Janssens W, Demeyer H, Rabinovich RA. Pulmonary rehabilitation and physical interventions. Eur Respir Rev 2023; 32:32/168/220222. [PMID: 37286219 DOI: 10.1183/16000617.0222-2022] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/23/2023] [Indexed: 06/09/2023] Open
Abstract
Pulmonary rehabilitation has established a status of evidence-based therapy for patients with symptomatic COPD in the stable phase and after acute exacerbations. Rehabilitation should have the possibility of including different disciplines and be offered in several formats and lines of healthcare. This review focusses on the cornerstone intervention, exercise training, and how training interventions can be adapted to the limitations of patients. These adaptations may lead to altered cardiovascular or muscular training effects and/or may improve movement efficiency. Optimising pharmacotherapy (not the focus of this review) and oxygen supplements, whole-body low- and high-intensity training or interval training, and resistance (or neuromuscular electrical stimulation) training are important training modalities for these patients in order to accommodate cardiovascular and ventilatory impairments. Inspiratory muscle training and whole-body vibration may also be worthwhile interventions in selected patients. Patients with stable but symptomatic COPD, those who have suffered exacerbations and patients waiting for or who have received lung volume reduction or lung transplantation are good candidates. The future surely holds promise to further personalise exercise training interventions and to tailor the format of rehabilitation to the individual patient's needs and preferences.
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Affiliation(s)
- Thierry Troosters
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
| | - Wim Janssens
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
- KU Leuven, Department of Chronic Disease and Metabolism, Leuven, Belgium
| | - Heleen Demeyer
- KU Leuven, Department of Rehabilitation Sciences, Leuven, Belgium
- Respiratory Division, University Hospitals Leuven, Leuven, Belgium
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Roberto A Rabinovich
- University of Edinburgh, MRC Centre for Information Research, Edinburgh, UK
- Respiratory Department, Royal Infirmary of Edinburgh, Edinburgh, UK
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Garcia-Rio F, Miravitlles M, Soriano JB, Cosío BG, Soler-Cataluña JJ, Casanova C, de Lucas P, Alfageme I, Rodríguez González-Moro JM, Sánchez Herrero MG, Ancochea J. Prevalence of reduced lung diffusing capacity and CT scan findings in smokers without airflow limitation: a population-based study. BMJ Open Respir Res 2023; 10:e001468. [PMID: 36707127 PMCID: PMC9884864 DOI: 10.1136/bmjresp-2022-001468] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/22/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Population distribution of reduced diffusing capacity of the lungs for carbon monoxide (DLCO) in smokers and main consequences are not properly recognised. The objectives of this study were to describe the prevalence of reduced DLCO in a population-based sample of current and former smoker subjects without airflow limitation and to describe its morphological, functional and clinical implications. METHODS A sample of 405 subjects aged 40 years or older with postbronchodilator forced expiratory volume in 1 s/forced vital capacity (FVC) >0.70 was obtained from a random population-based sample of 9092 subjects evaluated in the EPISCAN II study. Baseline evaluation included clinical questionnaires, exhaled carbon monoxide (CO) measurement, spirometry, DLCO determination, 6 min walk test, routine blood analysis and low-dose CT scan with evaluation of lung density and airway wall thickness. RESULTS In never, former and current smokers, prevalence of reduced DLCO was 6.7%, 14.4% and 26.7%, respectively. Current and former smokers with reduced DLCO without airflow limitation were younger than the subjects with normal DLCO, and they had greater levels of dyspnoea and exhaled CO, greater pulmonary artery diameter and lower spirometric parameters, 6 min walk distance, daily physical activity and plasma albumin levels (all p<0.05), with no significant differences in other chronic respiratory symptoms or CT findings. FVC and exhaled CO were identified as independent risk factors for low DLCO. CONCLUSION Reduced DLCO is a frequent disorder among smokers without airflow limitation, associated with decreased exercise capacity and with CT findings suggesting that it may be a marker of smoking-induced early vascular damage. TRIAL REGISTRATION NUMBER NCT03028207.
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Affiliation(s)
- Francisco Garcia-Rio
- Servicio de Neumología, Hospital Universitario La Paz-IdiPAZ, Universidad Autónoma de Medicina, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Marc Miravitlles
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Pneumology Department, Hospital Universitary Vall d'Hebron/Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Joan B Soriano
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Servicio de Neumología, Hospital Universitario La Princesa; Universidad Autónoma de Madrid, Madrid, Spain
| | - Borja G Cosío
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Servicio de Neumología, Hospital Universitario Son Espases-IdiSBa, Palma de Mallorca, Spain
| | - Juan José Soler-Cataluña
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Servicio de Neumología, Hospital Arnau de Vilanova-Lliria, Departamento de Medicina, Universitat de València, Valencia, Spain
| | - Ciro Casanova
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Pulmonary Deparment-Research Unit, Hospital Universitario Nuestra Señora de Candelaria, Universidad de La Laguna, Tenerife, Spain
| | - Pilar de Lucas
- Servicio de Neumología, Hospital General Gregorio Marañón, Madrid, Spain
| | - Inmaculada Alfageme
- Unidad de Gestión Clínica de Neumología, Hospital Universitario Virgen de Valme, Universidad de Sevilla, Sevilla, Spain
| | | | | | - Julio Ancochea
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain
- Servicio de Neumología, Hospital Universitario La Princesa; Universidad Autónoma de Madrid, Madrid, Spain
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Soler-Cataluña JJ, Lopez-Campos JL. COPD Exacerbation Syndrome: The Spanish Perspective on an Old Dilemma. Int J Chron Obstruct Pulmon Dis 2022; 17:3139-3149. [PMID: 36601561 PMCID: PMC9807017 DOI: 10.2147/copd.s393535] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/30/2022] [Indexed: 12/29/2022] Open
Abstract
The definition of exacerbation of COPD as a syndrome, as proposed by the Spanish COPD guidelines (GesEPOC) 2021 update, and the consequences that this implies, have direct implications on patient care. This review analyzes this novel vision of the COPD exacerbation syndrome, its rationale, and its clinical implications, as opposed to the traditional symptoms-based or event-based definitions. An exacerbation conceived as a syndrome provides us with an umbrella term to include a set of diverse alterations, which, either in isolation or more frequently in combination, are clinically expressed in a similar way in patients with COPD. In patients with COPD, this occurs as a consequence of worsening expiratory airflow limitation or the underlying inflammatory process, producing a worsening in symptoms with respect to the baseline situation. This definition therefore assumes a worsening in at least one of the two key physiopathological markers, lung function and inflammation. The main features of this new physiopathological proposal include a syndromic approach with narrower differential diagnosis, the use of several biomarkers, treatable traits to better guide treatment, and a new severity classification. Further research is needed to examine the role of eosinophils in this context, but currently, the early results are promising. The evaluation of severity is key in the multidimensional characterization of exacerbation and the GesEPOC 2021 proposes new approaches and also recommends the use of multidisciplinary scores for severity categorization in patients. Finally, another innovation in the GesEPOC 2021 refers to the recurrence of exacerbations, which has implications for disease prognosis or long-term clinical impact which need to be elucidated in further studies.
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Affiliation(s)
- Juan Jose Soler-Cataluña
- Servicio de Neumología, Hospital Arnau de Vilanova-Lliria, Valencia, Departamento de Medicina, Universitat de València, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Jose Luis Lopez-Campos
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain
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Miravitlles M, García-Rivero JL, Ribera X, Galera J, García A, Palomino R, Pomares X. Exercise capacity and physical activity in COPD patients treated with a LAMA/LABA combination: a systematic review and meta-analysis. Respir Res 2022; 23:347. [PMID: 36522735 PMCID: PMC9753337 DOI: 10.1186/s12931-022-02268-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Persistent airflow limitation and dyspnoea may reduce chronic obstructive pulmonary disease (COPD) patients exercise capacity and physical activity, undermining their physical status and quality of life. Long-acting muscarinic antagonists and long-acting beta-2 agonists (LAMA/LABA) combinations are amongst moderate-to-severe COPD recommended treatments. This article analyses LAMA/LABA combinations effect on COPD patients exercise capacity and physical activity outcomes. METHODS A systematic review and meta-analysis of double-blind randomized controlled trials comparing LAMA/LABA combinations against monotherapy or placebo was conducted. RESULTS Seventeen articles were identified (N = 4041 patients). In endurance shuttle walk test and constant work rate cycle ergometry, LAMA/LABA combinations obtained better results than placebo, but not monotherapy, whereas in 6-min walking test, results favoured LAMA/LABA over monotherapy (four studies), but not over placebo (one study). Moreover, LAMA/LABA combinations obtained better results than placebo in number of steps per day, reduction in percentage of inactive patients and daily activity-related energy expenditure, and better than monotherapy when measuring time spent on ≥ 1.0-1.5, ≥ 2.0 and ≥ 3.0 metabolic equivalents of task activities. CONCLUSIONS LAMA/LABA combinations in COPD patients provided better results than monotherapy or placebo in most exercise capacity and physical activity outcomes.
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Affiliation(s)
- Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'HebronVall d'Hebron Institut de Recerca, Vall d'Hebron Barcelona Hospital Campus, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Juan Luís García-Rivero
- Pneumology Department, President of ACINAR, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | | | | | - Xavier Pomares
- Pneumology Department, Hospital de Sabadell, Hospital Universitari Parc TaulíInstitut Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain
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Vázquez-Gandullo E, Hidalgo-Molina A, Montoro-Ballesteros F, Morales-González M, Muñoz-Ramírez I, Arnedillo-Muñoz A. Inspiratory Muscle Training in Patients with Chronic Obstructive Pulmonary Disease (COPD) as Part of a Respiratory Rehabilitation Program Implementation of Mechanical Devices: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5564. [PMID: 35564959 PMCID: PMC9099727 DOI: 10.3390/ijerph19095564] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/29/2022] [Accepted: 04/29/2022] [Indexed: 01/20/2023]
Abstract
Chronic Obstructive Pulmonary Disease (COPD) is a complex and heterogeneous disease, with pulmonary and extrapulmonary manifestations, which leads to the need to personalize the assessment and treatment of these patients. The latest updates of national and international guidelines for the management of COPD reveal the importance of respiratory rehabilitation (RR) and its role in improving symptoms, quality of life, and psychosocial sphere of patients. Within RR, the inspiratory muscle training (IMT) has received special interest, showing benefits in maximum inspiratory pressure, perception of well-being, and health status in patients with chronic heart disease, respiratory diseases, and dyspnea during exercise. The aim of this review is to assess the efficacy of IMT in COPD patients through the use of inspiratory muscle training devices, compared with respiratory rehabilitation programs without inspiratory muscle training. In the last years, many mechanical devices focused on inspiratory muscle training have been developed, some of them, such as the AirOFit PRO™, PowerBreath®, or FeelBreathe®, have shown clear benefits. The active search for candidate patients to undergo the RR program with inspiratory muscle training using this type of device in COPD patients represents an advance in the treatment of this disease, with direct benefits on the quality of life of the patients. In this article, we review the available evidence on IMT in these patients and describe the different devices used for it.
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Affiliation(s)
- Eva Vázquez-Gandullo
- Pneumology, Allergology and Thoracic Surgery Department, University Hospital Puerta del Mar, 11009 Cádiz, Spain; (A.H.-M.); (F.M.-B.); (I.M.-R.)
| | - Antonio Hidalgo-Molina
- Pneumology, Allergology and Thoracic Surgery Department, University Hospital Puerta del Mar, 11009 Cádiz, Spain; (A.H.-M.); (F.M.-B.); (I.M.-R.)
| | - Francisca Montoro-Ballesteros
- Pneumology, Allergology and Thoracic Surgery Department, University Hospital Puerta del Mar, 11009 Cádiz, Spain; (A.H.-M.); (F.M.-B.); (I.M.-R.)
| | | | - Isabel Muñoz-Ramírez
- Pneumology, Allergology and Thoracic Surgery Department, University Hospital Puerta del Mar, 11009 Cádiz, Spain; (A.H.-M.); (F.M.-B.); (I.M.-R.)
| | - Aurelio Arnedillo-Muñoz
- Pneumology, Allergology and Thoracic Surgery Department, University Hospital Puerta del Mar, 11009 Cádiz, Spain; (A.H.-M.); (F.M.-B.); (I.M.-R.)
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