epoc deberes hechos asignaturas pendientes

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EPOC:DEBERES HECHOS ASIGNATURAS PENDIENTES

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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

ÍNDICE

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Deberes hechosDerrota del nihilismo terapéutico

Matera MG, Cazzola MTreatment of COPD: no longer nihilism, but there is still an urgent need for new therapies.Curr Opin Pharmacol.. 2012 Jun;12(3):225-8

http://www.ncbi.nlm.nih.gov/pubmed/22497842%23

4Thorax. 2010 Apr;65(4):298-302


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7N Engl J Med. 2007 Feb 22;356(8):775-89


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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

EPOC: Evaluación de la función pulmonar durante 24 horas

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

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


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CHEST 2014; 145(4):695–703

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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.

17Am J Respir Crit Care Med. 2012 Jan 15;185(2):152-9


18Chest. 2012 Nov;142(5):1300-7.


19Chest. 2012 Nov;142(5):1300-7.


Thorax 2006;61:772-778


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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.

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.

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24N Engl J Med. 2010 Sep 23;363(13):1233-44


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N Engl J Med. 2011 Sep 29;365(13):1184-92.

Deberes hechos:Conocimiento de la historia natural

Am J Respir Crit Care Med. 2011 Aug 11.


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38Chest. 2006 Aug;130(2):318-25


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42Am J Respir Crit Care Med. 2012 Nov 15;186(10):975-81


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Inspirado en: Dornhorst AC. Lancet. 1955 Jun 11;268(6876):1185-7.44

Deberes hechos:Refinamiento de los fenotipos

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John R. Hurst, Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE)Susceptibility to Exacerbation in Chronic Obstructive Pulmonary DiseaseNew engl j med 363;12 september 16, 2010


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P.G. Gibson, J.L. Simpson.Thorax 2009;64:728-735The overlap syndrome of asthma and COPD: what are its features and how important is it?


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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.


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Miguel-Angel Martínez-García, et al.Prognostic Value of Bronchiectasis in Patients with Moderate-to-Severe Chronic Obstructive Pulmonary DiseaseAmerican Journal of Respiratory and Critical Care Medicine 2013 187: 823-831


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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.


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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

Morera Prat J, Martinez –Ortiz MLChronic obstructive pulmonary disease in the elderly: next phenotypeMed Clin (Barc)2012 Apr 28;138(11):478-9.


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Inspirado en: Dornhorst AC. Lancet. 1955 Jun 11;268(6876):1185-7.

“Blue Bloater / Blow-up”55


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Deberes hechos:Tecnificación de la imagen

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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


Han MK, et al.Chronic Obstructive Pulmonary Disease Exacerbations in the COPDGene Study: Associated Phenotypes. Radiology. 2011 Oct;261(1):274-82

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Basat en J. G. Scadding.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.

Descripción ClínicaDescripción Clínica11

Lesión AnatómicaCaracterística

Lesión AnatómicaCaracterística22

Desorden FuncionalCaracterístico

Desorden FuncionalCaracterístico33

Causa - EtiologíaCausa - Etiología44

SÍNDROME

SÍNDROME

ENFERMEDADENFERMEDAD

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Asignaturas pendientesDefinición/Nosología

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. !!!!!

• Host Factors– Genes– Airway Hyperresponsiveness– Lung Growth

• Exposures– Tobacco Smoke– Occupational Dust and Chemicals– Outdoor and Indoor Air Pollution– Infections– Socioeconomic Status

Am J Respir Crit Care Med Vol 163. pp 1256–1276, 200160


Necesidad de criterio único

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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.

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Causas EPOC-SíndromeCausas EPOC-Síndrome

200-500 Causas ?!200-500

Causas ?!200-500

Causas ?!200-500

Causas ?!


55 años, nunca fumador

Am Rev Resp Dis, 1971

Wilcox, respir Med, 1989

Hnziido, Thorax 2000

Pasipanodya, 2007

Menezes, ERJ, 2008

Asignaturas pendientes:Definición/Nosología


First published on line 29 Aug 2014

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PLoS Med. 2006 Nov;3(11):e442.Projections of global mortality and burden of disease from 2002 to 2030.Mathers CD, Loncar D.

Asignaturas pendientes:Erradicación

68PLoS Med. 2006 Nov;3(11):e442.Projections of global mortality and burden of disease from 2002 to 2030 Mathers CD, Loncar D.


69Noncommunicable 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


http://www.nejm.org/toc/nejm/369/14/

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Eriksen M. Judith Mackay Hana Ross EL ATLAS DEL TABACO cuarta edición. http://www.tobaccoatlas.org/uploads/Images/PDFs/TA4Spanish.pdf


http://www.tobaccoatlas.org/uploads/Images/PDFs/TA4Spanish.pdf

http://www.tobaccoatlas.org/uploads/Images/PDFs/TA4Spanish.pdf

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Manila (Filipinas) 31 octubre 2011 Nace Danica May Manila Camacho Es la ciudadana número 7mil millones del planeta

2011


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Sarajevo(Bosnia) 13 octubre, 1999Nace Adnan Nevic, el ciudadano número 6 millones


73N Engl J Med. 2013 Jan 24;368(4):351-64


74N Engl J Med. 2013 Jan 24;368(4):341-50


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76Thorax. 2011 Aug;66(8):643-5


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.

77Thorax. 2011 Aug;66(8):645-6


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Biochem. Soc. Trans. (2009) 37, 814–818;

Am J Respir Crit Care Med Vol 176. pp 1281–1288, 2007

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Asignaturas pendientes:“Peso” de la genética

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Asignaturas pendientes“Peso” de la genética

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Asignatura pendiente“Peso” de la genética

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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

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MUCHAS GRACIAS

epoc deberes hechos asignaturas pendientes

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