Spanish COPD Guidelines (GesEPOC) 2021: Updated Pharmacological treatment of stable COPD
Por:
Miravitlles M, Calle M, Molina J, Almagro P, Gómez JT, Trigueros JA, Cosío BG, Casanova C, López-Campos JL, Riesco JA, Simonet P, Rigau D, Soriano JB, Ancochea J and Soler-Cataluña JJ
Publicada:
1 ene 2022
Ahead of Print:
1 ene 2022
Categoría:
Pulmonary and respiratory medicine
Resumen:
The Spanish COPD Guidelines (GesEPOC) were first published in 2012, and since then have undergone a series of updates incorporating new evidence on the diagnosis and treatment of COPD. GesEPOC was drawn up in partnership with scientific societies involved in the treatment of COPD and the Spanish Patients' Forum. Their recommendations are based on an evaluation of the evidence using GRADE methodology, and a narrative description of the evidence in areas in which GRADE cannot be applied. In this article, we summarize the recommendations on the pharmacological treatment of stable COPD based on 9 PICO questions. COPD treatment is a 4-step process: 1) diagnosis, 2) determination of the risk level, 3) initial and subsequent inhaled therapy, and 4) identification and management of treatable traits. For the selection of inhaled therapy, high-risk patients are divided into 3 phenotypes: non-exacerbator, eosinophilic exacerbator, and non-eosinophilic exacerbator. Some treatable traits are general and should be investigated in all patients, such as smoking or inhalation technique, while others affect severe patients in particular, such as chronic hypoxemia and chronic bronchial infection. COPD treatment is based on long-acting bronchodilators with single agents or in combination, depending on the patient's risk level. Eosinophilic exacerbators must receive inhaled corticosteroids, while non-eosinophilic exacerbators require a more detailed evaluation to choose the best therapeutic option. The new GesEPOC also includes recommendations on the withdrawal of inhaled corticosteroids and on indications for alpha-1 antitrypsin treatment. GesEPOC offers a more individualized approach to COPD treatment tailored according to the clinical characteristics of patients and their level of complexity. (c) 2021 SEPAR. Published by Elsevier Espana, S.L.U. All rights reserved.
Filiaciones:
Miravitlles M:
Servicio de Neumología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, España
CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España
Calle M:
Servicio de Neumología, Hospital Clínico San Carlos. Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid. Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
Molina J:
Centro de Salud Francia. Madrid, España
Almagro P:
Servicio de Medicina Interna, Hospital Universitario Mutua de Terrassa, Terrassa, España
Gómez JT:
Centro de salud de Nájera, La Rioja, España
Trigueros JA:
Centro de Salud Menasalbas, Toledo, España
Cosío BG:
CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España
Servicio de Neumología, Hospital Universitario Son Espases-IdISBa, Palma de Mallorca, España
Casanova C:
Servicio de Neumología-Unidad de Investigación, Hospital Universitario Nuestra Señora de La Candelaria. Universidad de La Laguna, Tenerife, España
López-Campos JL:
CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España
Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS). Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, España
Riesco JA:
CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España
Servicio de Neumología, Hospital San Pedro de Alcántara, Cáceres, España
Simonet P:
Centro de Salud Viladecans-2, Atención Primaria Costa de Ponent-Institut Català de la Salut. Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Departament de Ciències Clíniques, Universitat Barcelona, Barcelona, España
Rigau D:
Centro Cochrane Iberoamericano, Barcelona, España
Soriano JB:
CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España
Servicio de Neumología, Hospital Universitario de La Princesa. Universidad Autónoma de Madrid, Madrid, España
Ancochea J:
CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España
Servicio de Neumología, Hospital Universitario de La Princesa. Universidad Autónoma de Madrid, Madrid, España
:
CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España
Servicio de Neumología, Hospital Arnau de Vilanova-Lliria, Valencia, España
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