mesa 1.5 jose luis lopez campos

Mesa 1. EPOC epidemiología y diagnóstico

Dr. José Luis

López-CamposHospital Virgen del Rocío. Sevilla


[ATS] Correlates Of 5 Year

Decline In 6-Minute Walk

Distance In The

COPDGene Cohort

Gordon JA

COPDGene Investigators


La P6MM es un test submaximal simple, objetivo y clínicamente útil que permite estimar

la capacidad funcional del paciente con EPOC, y aporta información de 3 variables

principales:

• Distancia recorrida (D6MM).

• Desaturación de O2.

• Disnea percibida por el propio paciente evaluada con la escala de Borg, como reflejo de

diferentes dimensiones de la enfermedad.

Titular tabla


El análisis multivariante demostró que

las siguientes variables tenían un valor predictivo

estadísticamente significativo de la D6MM: sexo,

edad, VEMS (% de su teórico), puntuación en la

escala de disnea de la MRC, comorbilidades (índice

de Charlson) y limitación al esfuerzo físico.


D6MM se asocia con la frecuencia de exacerbaciones, la

gravedad de la enfermedad (según criterios GOLD), la difusión

(TLCO), el atrapamiento aéreo y grado de enfisema

cuantificado por la TC torácica.

Estudio NETT y ECLIPSE


Correlates Of 5 Year Decline In 6-Minute Walk Distance

In The COPDGene Cohort

We utilized a large cohort studied over a 5-year interval to determine epidemiologic

and clinical variables that predict 6MWD decline.

Methods: We sought correlates of 6MWD decline in a large longitudinal cohort of

current or ex-smokers; subjects with and without spirometric evidence of COPD were

included. Data were gathered in the COPDGene study, at baseline and 5-year follow-

up, at 21 United States hospitals.

Predictors of 6MWD decline from among baseline assessments, and also among

changes seen over the 5-year follow-up period, were sought using univariable and

multivariable linear regression.




Results: 1837 subjects were assessed: 797 with normal spirometry, 177 GOLD 1,

389 GOLD 2, 205 GOLD 3, 62 GOLD 4, and 207 preserved ratio impaired

spirometry. 6MWD decline averaged 32.7 meters, which was highly significant

(p<0.0001), despite a large variance (SD=105.7 meters). There was greater

decrease (P <0.05) in 6MWD over 5 years in subjects with spirometric COPD

compared to those with normal spirometry. There was, however, no difference in 5-

year 6MWD decline among GOLD stages: median 6MWD decrease (in meters)

normal spirometry =23.2, GOLD 1 =44.2, GOLD 2 =46.6, GOLD 3 =47.5, GOLD 4

=62.8.




Results: In multivariable regression analysis of 5-year change predictors, only 5 %

of variance in 6MWD decline was predicted by change in (in order of significance)

total SGRQ, FEV1, BMI, and FEV1 /FVC. A regression analysis restricted to the 656

GOLD 2-4 subjects yielded qualitatively similar results.

Conclusion: These results demonstrate that 6MWD declines significantly over a 5-

year period in a large cohort of smokers and ex-smokers, but the decline is highly

variable. Spirometric, CT, health status and anthropometric measures account for

only modest portions of this variance.


[SEPAR] ¿Es el fenotipo

exacerbador de la EPOC

un fenotipo estable en el

tiempo?

Serrano L


Título de la diapositiva

Subtítulo de la diapositiva

•Cabecera párrafo

Titular tabla


Subtítulo de la diapositiva

Cabecera párrafo

Tercer apartado

• Tercer apartado

• Tercer apartado


• 78 pacientes inician el estudio.

• 13 fallecieron y 1 se abandonó en los 2 años seguimiento.

• A los 2 años, 18/64 (28 %) no ingresan y 46/64 (72 %) habían

precisado al menos una hospitalización.


Lange P, et al 2012. Am J Respir Crit Care Med. 2012;186(10):975-81.


Hurst et al. NEJM 2010; 363: 1128-38

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Year 3Year 2Year 1

n = 1679

74 % de los pacientes sin exacerbaciones el año 1 y 2 no tuvieronexacerbaciones en el año 3

71 % de los pacientes con exacerbaciones frecuentes los años1 y 2 tuvieron exacerbaciones frecuentes en el año 3


[ERS] Co-morbidities of

adult smokers at risk of

COPD evaluated in a 6-

year prospective study

Toljamo T


Disfunción

mucociliar

(bronquitis

crónica)

Inflamación de la vía

aéreaOCFA

Inflamación

sistémica

Cambios

estructurales

(enfisema)

Agusti AGN. Respir Med 99 (6):670-682, 2005

•Pérdida de peso (caquexia)

• Disfunción muscular

• Enfermedad cardiovascular

• Otros

• Osteoporosis

• Depresión

• Cáncer

Efectos sistémicos de la EPOC

Las consecuencias de la inflamación


Hígado

Eventos

cardiovasculares OsteoporosisDisfunción

muscular

Inflamación

sistémica

Diabetes tipo II

IL-6

CRP

TNF-α, IL-8, IL-6

Cáncer de pulmón

Tabaco: factor de riesgo para la EPOC y sus

comorbilidades

http://upload.wikimedia.org/wikipedia/commons/9/9e/Lungs_diagram_simple.svg

http://upload.wikimedia.org/wikipedia/commons/9/9e/Lungs_diagram_simple.svg


La inflamación pulmonar y sistémica no se

correlacionan

0

1

2

3

4

50

100

150

200

250

Med

ian

valu

es

*

*

0

1

2

7

8

9

10

11

NDND

*(n=4)

*

IL-8

(pg/ml)

sTNF-R75

(pg/ml)

sTNF-R55

(pg/ml)

Total TNF

(pg/ml)

Med

ian

valu

es

Sputum

IL-8

(pg/ml)

sTNF-R75

(ng/ml)

sTNF-R55

(ng/ml)

Total TNF

(pg/ml)

Plasma

COPD (n=18, FEV1 56%)

Healthy smokers (n=17)

Vernooy JH et al. AJRCCM 2002; 166: 1218

Los valores no son diferentes entre fumadores activos y EPOC exfumadores


Titular tabla

Describe the co-morbidities of adult smokers at risk of COPD during a 6-year

follow-up

Methods:

•Healthy asymptomatic subjects (n = 513) with >20 years of smoking history

and no chronic diseases were followed longitudinally for six years.

•Smoking, symptoms and COPD status were assessed during the follow-up

period. Daily medications for possible comorbidities were self-reported. Co-

morbidities that emerged during the follow-up causes of death were

ascertained from hospital discharge records.

Co-morbidities of adult smokers at risk of COPD

evaluated in a 6-year prospective study


Titular tabla

Results: •As many as 43.1 % suffered from at least one co-morbidity during daily medication

after the 6-year follow up.

•As many as 20 % of these smokers were taking daily medication for metabolic

syndrome diseases e.g. high blood pressure, adult-onset diabetes or

hypercholesterolemia, and 9.7 % were taking drugs for arteriosclerotic disease such

as coronary artery heart disease.

•At the end of the study, only 8.4 % of COPD subjects admitted to having used

some type of inhalers on a daily basis.

•Overall, 4 % (n= 27) of all smokers died during the 6 year follow-up, half of them

from cancers and the others mainly from arteriosclerosis disease.




Titular tabla



Discussion: After the 6-year period approximately nearly half of the middle-

aged heavy smokers who had considered themselves symptom-free and

healthy at the baseline had been diagnosed with some chronic disease; this

may increase the risk of all-cause mortality in the long run.

Conclusion: There are as many co-morbidities in adult daily smokers as

encountered in COPD patients.

Muchas gracias

por su atención

mesa 1.5 jose luis lopez campos

Health & Medicine