Editorial
No more hic sunt dracones: Portugal is in the COPD map
Sem mais hic sunt dracones: Portugal encontra-se no mapa da DPOC
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Soriano, B. Lamprecht" "autores" => array:2 [ 0 => array:4 [ "nombre" => "J.B." "apellidos" => "Soriano" "email" => array:1 [ 0 => "jbsoriano@caubet-cimera.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "B." "apellidos" => "Lamprecht" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Program of Epidemiology and Clinical Research, Fundación Caubet-CIMERA Illes Balears, Recinte Hospital Joan March, Bunyola, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Pulmonary Medicine, General Hospital Linz, Austria" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Paracelsus Medical University, Salzburg, Austria" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Sem mais <span class="elsevierStyleItalic">hic sunt dracones:</span> Portugal encontra-se no mapa da DPOC" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Oceanic explorers used to denote dangerous or unexplored territories with the Latin quote “Hic sunt dracones”, that is “Here be dragons”, in imitation of the medieval practice of putting dragons, sea serpents and other mythological creatures into uncharted areas of maps. We do not know whether Fernão de Magalhães (1480–1521) and his acolytes ever smoked, and it is very unlikely that he ever performed any archaic lung function testing, but now the analogy would no longer pertain to COPD in Portugal. This is why the first Burden of Lung Disease (BOLD) study report in Portugal is so welcome.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The European Community Respiratory Health Survey (ECRHS),<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> initially studied the prevalence of asthma in young adults, and then the International Study of Asthma and Allergies in Children (ISAAC) analyzed the child population,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and the Portuguese participation provided valuable data widely used elsewhere.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–7</span></a> In the very same way BOLD has aimed to obtain population prevalence data of COPD using standardized spirometry and definitions. From its onset in 2004,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> and up to December 2012, BOLD was completed in 23 centres worldwide, and another six sites are expected to complete data collection in 2013.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The highly cited, influential Global Burden of Disease (GBD) studies estimated that COPD causes the death of at least 2.9 million people annually. Estimates of COPD as sixth in the global mortality ranking in 1990,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> were revised upwards to fourth in 2006 and were projected to be the third by 2020.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> To many people's surprise, a GBD 2010 new update, which has just been released, identified some mortality trends were declining.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> So, from all the non-communicable diseases (NCDs) at a global level, only COPD and congenital anomalies have declined, yet chronic respiratory diseases as a group accounted for 4.7% of global DALYs, with COPD making up two-thirds of the total and asthma nearly a fifth of the total.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Data from Barbara et al.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> are expected to be included in any new GBD update.</p><p id="par0020" class="elsevierStylePara elsevierViewall">It is a fact, as discussed in their introductory remarks,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> that there were very little previous data on COPD in Portugal; they had been minimally represented by a small non-comparative study, which only had pre-BD spirometry data, from 2002.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Now, using data with the highest validity, clinicians, investigators and health administrators can start quoting figures about the prevalence of COPD in Portugal; it is 14.2%, 18.7% in men and 10.5% in women, and the vast majority (86.8%) is as yet undiagnosed. Using back of an envelope calculations, one can extrapolate that from a total population of 10.5 million, among 5.4 million Portuguese adults aged 40 years and older,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> at least 750,000 suffer from COPD, and more than 660,000 are still undiagnosed.</p><p id="par0025" class="elsevierStylePara elsevierViewall">These estimates, using the COPD GOLD fixed ratio definition of post-BD FEV<span class="elsevierStyleInf">1</span>/FVC<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.70, place Portugal in the European average. COPD in Portugal is more frequent in men, and it increases with age, and with more smoking exposure. These very basic, confirmatory estimates of descriptive epidemiology have been long awaited. As well as its novelty factor, the use of a random digit dialling (RDD) telephone sampling to screen for potential responders is innovative and appropriate. However, critical appraisal of limitations include the 27% response rate, although the non-response study seems reassuring in relation to the final representativity of the obtained sample to the general population, with no differences in responders vs. non-responders in terms of age, smoking, previous respiratory diseases, or comorbidities; only for gender. Overall, the 20.2% crude prevalence was downgraded to 14.2%. Data only relates to Lisbon, while high heterogeneity is seen in other national studies with multiple centres and areas.<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15,16</span></a> Given that the fieldwork was carried out in 2008, an update will be deemed necessary in due course. Of interest are the high frequency of airflow limitation in never-smokers, to exploring other centres within the Portuguese geography, and local determinants of COPD in women,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> all are potential avenues for future research.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Monitoring epidemiological trends is an arduous, lengthy undertaking. With an estimated 210 million people worldwide suffering from COPD, but with 80% or higher yet undiagnosed, there remain many large areas in the Globe with blank data regarding spirometry-based COPD estimates.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Since you cannot manage what you do not measure, the first step to counter any major health problem is to measure its burden. This very basic, fundamental Public Health principle applies well to COPD. Thanks to Barbara et al.,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Portugal is no longer a blank spot in the COPD map.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:2 [ "identificador" => "xack184921" "titulo" => "Acknowledgment" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Barbara C, Rodrigues F, Dias H, Cardoso J, Almeida J, Matos MJ, et al. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 5 | 13 |
| 2024 October | 65 | 35 | 100 |
| 2024 September | 83 | 27 | 110 |
| 2024 August | 108 | 42 | 150 |
| 2024 July | 104 | 32 | 136 |
| 2024 June | 61 | 49 | 110 |
| 2024 May | 57 | 37 | 94 |
| 2024 April | 73 | 37 | 110 |
| 2024 March | 54 | 20 | 74 |
| 2024 February | 71 | 30 | 101 |
| 2024 January | 53 | 34 | 87 |
| 2023 December | 53 | 29 | 82 |
| 2023 November | 37 | 34 | 71 |
| 2023 October | 36 | 32 | 68 |
| 2023 September | 26 | 35 | 61 |
| 2023 August | 39 | 32 | 71 |
| 2023 July | 27 | 22 | 49 |
| 2023 June | 25 | 22 | 47 |
| 2023 May | 47 | 23 | 70 |
| 2023 April | 42 | 17 | 59 |
| 2023 March | 74 | 24 | 98 |
| 2023 February | 27 | 21 | 48 |
| 2023 January | 37 | 32 | 69 |
| 2022 December | 51 | 22 | 73 |
| 2022 November | 66 | 36 | 102 |
| 2022 October | 60 | 44 | 104 |
| 2022 September | 36 | 29 | 65 |
| 2022 August | 48 | 38 | 86 |
| 2022 July | 57 | 42 | 99 |
| 2022 June | 31 | 31 | 62 |
| 2022 May | 43 | 34 | 77 |
| 2022 April | 41 | 27 | 68 |
| 2022 March | 33 | 60 | 93 |
| 2022 February | 41 | 36 | 77 |
| 2022 January | 32 | 45 | 77 |
| 2021 December | 29 | 42 | 71 |
| 2021 November | 43 | 37 | 80 |
| 2021 October | 21 | 39 | 60 |
| 2021 September | 22 | 27 | 49 |
| 2021 August | 18 | 13 | 31 |
| 2021 July | 19 | 19 | 38 |
| 2021 June | 30 | 24 | 54 |
| 2021 May | 27 | 25 | 52 |
| 2021 April | 42 | 47 | 89 |
| 2021 March | 57 | 14 | 71 |
| 2021 February | 65 | 16 | 81 |
| 2021 January | 31 | 13 | 44 |
| 2020 December | 36 | 9 | 45 |
| 2020 November | 37 | 12 | 49 |
| 2020 October | 27 | 18 | 45 |
| 2020 September | 68 | 18 | 86 |
| 2020 August | 95 | 26 | 121 |
| 2020 July | 117 | 25 | 142 |
| 2020 June | 106 | 20 | 126 |
| 2020 May | 94 | 22 | 116 |
| 2020 April | 74 | 18 | 92 |
| 2020 March | 61 | 14 | 75 |
| 2020 February | 82 | 25 | 107 |
| 2020 January | 86 | 11 | 97 |
| 2019 December | 74 | 17 | 91 |
| 2019 November | 91 | 14 | 105 |
| 2019 October | 98 | 12 | 110 |
| 2019 September | 67 | 19 | 86 |
| 2019 August | 189 | 10 | 199 |
| 2019 July | 208 | 15 | 223 |
| 2019 June | 231 | 16 | 247 |
| 2019 May | 211 | 6 | 217 |
| 2019 April | 160 | 22 | 182 |
| 2019 March | 225 | 16 | 241 |
| 2019 February | 199 | 8 | 207 |
| 2019 January | 195 | 24 | 219 |
| 2018 December | 142 | 14 | 156 |
| 2018 November | 56 | 0 | 56 |
| 2018 October | 67 | 8 | 75 |
| 2018 September | 32 | 3 | 35 |
| 2018 August | 42 | 26 | 68 |
| 2018 July | 54 | 17 | 71 |
| 2018 June | 79 | 14 | 93 |
| 2018 May | 113 | 21 | 134 |
| 2018 April | 92 | 20 | 112 |
| 2018 March | 88 | 22 | 110 |
| 2018 February | 38 | 18 | 56 |
| 2018 January | 33 | 12 | 45 |
| 2017 December | 54 | 22 | 76 |
| 2017 November | 50 | 17 | 67 |
| 2017 October | 47 | 23 | 70 |
| 2017 September | 52 | 28 | 80 |
| 2017 August | 57 | 19 | 76 |
| 2017 July | 50 | 19 | 69 |
| 2017 June | 41 | 18 | 59 |
| 2017 May | 65 | 73 | 138 |
| 2017 April | 21 | 30 | 51 |
| 2017 March | 25 | 16 | 41 |
| 2017 February | 15 | 6 | 21 |
| 2017 January | 18 | 6 | 24 |
| 2016 December | 29 | 21 | 50 |
| 2016 November | 33 | 8 | 41 |
| 2016 October | 26 | 18 | 44 |
| 2016 September | 20 | 3 | 23 |
| 2016 August | 23 | 5 | 28 |
| 2016 July | 7 | 5 | 12 |
| 2016 June | 0 | 6 | 6 |
| 2016 April | 13 | 3 | 16 |
| 2016 March | 37 | 13 | 50 |
| 2016 February | 40 | 26 | 66 |
| 2016 January | 41 | 15 | 56 |
| 2015 December | 30 | 11 | 41 |
| 2015 November | 24 | 15 | 39 |
| 2015 October | 14 | 13 | 27 |
| 2015 September | 26 | 9 | 35 |
| 2015 August | 28 | 11 | 39 |
| 2015 July | 21 | 3 | 24 |
| 2015 June | 19 | 5 | 24 |
| 2015 May | 30 | 6 | 36 |
| 2015 April | 32 | 9 | 41 |
| 2015 March | 16 | 13 | 29 |
| 2015 February | 34 | 6 | 40 |
| 2015 January | 32 | 7 | 39 |
| 2014 December | 31 | 17 | 48 |
| 2014 November | 24 | 8 | 32 |
| 2014 October | 39 | 11 | 50 |
| 2014 September | 27 | 15 | 42 |
| 2014 August | 29 | 12 | 41 |
| 2014 July | 34 | 9 | 43 |
| 2014 June | 37 | 7 | 44 |
| 2014 May | 43 | 7 | 50 |
| 2014 April | 34 | 12 | 46 |
| 2014 March | 34 | 10 | 44 |
| 2014 February | 37 | 10 | 47 |
| 2014 January | 51 | 8 | 59 |
| 2013 December | 55 | 12 | 67 |
| 2013 November | 40 | 10 | 50 |
| 2013 October | 29 | 16 | 45 |
| 2013 September | 45 | 15 | 60 |
| 2013 August | 58 | 20 | 78 |
| 2013 July | 76 | 53 | 129 |
| 2013 June | 83 | 33 | 116 |
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