array:24 [
  "pii" => "S217351151600018X"
  "issn" => "21735115"
  "doi" => "10.1016/j.rppnen.2016.02.002"
  "estado" => "S300"
  "fechaPublicacion" => "2016-03-01"
  "aid" => "1140"
  "copyright" => "Sociedade Portuguesa de Pneumologia"
  "copyrightAnyo" => "2016"
  "documento" => "simple-article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "edi"
  "cita" => "Rev Port Pneumol. 2016;22:73-4"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 1816
    "formatos" => array:3 [
      "EPUB" => 218
      "HTML" => 1039
      "PDF" => 559
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173511515001906"
    "issn" => "21735115"
    "doi" => "10.1016/j.rppnen.2015.09.009"
    "estado" => "S300"
    "fechaPublicacion" => "2016-03-01"
    "aid" => "1110"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Pneumol. 2016;22:75-81"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1856
      "formatos" => array:3 [
        "EPUB" => 219
        "HTML" => 1030
        "PDF" => 607
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Effectiveness and safety of mouthpiece ventilation and nocturnal non-invasive ventilation in patients with kyphoscoliosis&#58; Short and long-term outcomes after an episode of acute respiratory failure"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "75"
          "paginaFinal" => "81"
        ]
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A&#46; Nicolini, C&#46; Barlascini, I&#46;M&#46;G&#46; Piroddi, G&#46; Garuti, P&#46;I&#46; Banfi"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Nicolini"
            ]
            1 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Barlascini"
            ]
            2 => array:2 [
              "nombre" => "I&#46;M&#46;G&#46;"
              "apellidos" => "Piroddi"
            ]
            3 => array:2 [
              "nombre" => "G&#46;"
              "apellidos" => "Garuti"
            ]
            4 => array:2 [
              "nombre" => "P&#46;I&#46;"
              "apellidos" => "Banfi"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511515001906?idApp=UINPBA00004E"
    "url" => "/21735115/0000002200000002/v2_201704020101/S2173511515001906/v2_201704020101/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2173511516000440"
    "issn" => "21735115"
    "doi" => "10.1016/j.rppnen.2016.03.001"
    "estado" => "S300"
    "fechaPublicacion" => "2016-03-01"
    "aid" => "1149"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "edi"
    "cita" => "Rev Port Pneumol. 2016;22:70-2"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1670
      "formatos" => array:3 [
        "EPUB" => 211
        "HTML" => 918
        "PDF" => 541
      ]
    ]
    "en" => array:9 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">EDITORIAL</span>"
      "titulo" => "How to handle IPF &#8211; the new Portuguese consensus document"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "70"
          "paginaFinal" => "72"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Ulrich Costabel, Francesco Bonella"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "Ulrich"
              "apellidos" => "Costabel"
            ]
            1 => array:2 [
              "nombre" => "Francesco"
              "apellidos" => "Bonella"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511516000440?idApp=UINPBA00004E"
    "url" => "/21735115/0000002200000002/v2_201704020101/S2173511516000440/v2_201704020101/en/main.assets"
  ]
  "en" => array:10 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
    "titulo" => "Towards a patient-oriented treatment of COPD"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "73"
        "paginaFinal" => "74"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "M&#46; Miravitlles"
        "autores" => array:1 [
          0 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Miravitlles"
            "email" => array:1 [
              0 => "mmiravitlles&#64;vhebron&#46;net"
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Pneumology Department&#44; Hospital General Universitari Vall d&#8217;Hebron&#44; Ciber de Enfermedades Respiratorias &#40;CIBERES&#41;&#44; Barcelona&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Ambition is a strong desire to do or achieve something and being ambitious is having or showing a strong desire and determination to succeed&#46; Ambition is really required to try to summarise the new advances in management of chronic obstructive pulmonary disease &#40;COPD&#41; in a series of articles&#44; but the Portuguese Journal of Pulmonology has demonstrated to be ambitious and is publishing four articles that provide an overview of the new concepts that are important for the clinician that cares for patients with this disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1&#8211;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The first topic is the evaluation of the patient in order to select the best treatment option&#46; COPD is characterised by non-fully reversible airflow obstruction&#46; However&#44; apart from this common characteristic&#44; patients may have absolutely different clinical characteristics and symptoms&#46; Moreover&#44; these different clinical characteristics may reflect different responses to the available treatments&#46; The concept of a clinical phenotype of COPD was introduced to identify patients that share clinical characteristics and response to therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a> But&#44; which are the relevant phenotypes&#63; How many are they&#63; Fragoso et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> propose an answer to these questions&#46; Basically&#44; they propose the same phenotypes previously described in the Spanish Guidelines for COPD&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a> and later adopted in other guidelines such as the Czech<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a> and the Finnish&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a> namely non-exacerbators&#44; exacerbators with chronic bronchitis&#44; exacerbators with emphysema and asthma-COPD overlap syndrome &#40;ACOS&#41;&#44; with the addition of the COPD-bronchiectasis phenotype&#46; This classification makes a lot of sense because it is based on clinical grounds and is easy to apply in general clinical practice&#46; Furthermore&#44; these phenotypes identify patients that require a different therapeutic approach&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a> Non-exacerbators must be treated only with bronchodilators&#44; ACOS must receive a combination of bronchodilators and inhaled corticosteroids &#40;ICS&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a> patients with chronic bronchitis may respond to drugs such as roflumilast or N-acetylcystein and patients with bronchiectasis may respond to long-term macrolides&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a> Obviously these phenotypes are not clear-cut&#44; but they are a good guidance for the type of treatment that must be chosen as first-line&#46; In any case&#44; we need to remember that no classification will ever substitute the clinical judgement made by the experienced physician&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The second step after initiating a treatment is to acess the response&#46; It is not clear how to evaluate the response to therapy in COPD&#59; we can evaluate the improvement in lung function&#44; in symptoms&#44; the absence of exacerbations&#44; the reduction in the use of rescue medication and the increase in the levels of physical activity&#44; but some of these indicators may not change despite successful treatment and not all of them may mean the same&#46; This is why there has been a growing interest in the concept of control of COPD&#46; Soler-Catalu&#241;a et al&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> published a proposal for a standardisation of control that is in the process of validation&#46; Guimaraes et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a> present an interesting review of the concept of control in COPD and indicate that unfortunately there are no available biomarkers about the response to treatment and no consensus exists about the concept of control&#46; However&#44; it is quite likely that we will see some advances in this area in the future&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">But the key question is how can we provide the best treatment for our patients with COPD&#63; I really do not think that letters and numbers will help us &#40;A&#44; B&#44; C1&#44; D2&#44; etc&#46;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> The practice of medicine is based on observation and description and we have to describe the clinical phenotypes that predict response to treatment<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a> and don&#8217;t get lost in artificial classifications&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> This is in line of the proposal of a patient-oriented treatment as described by Ferreira et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a> Obviously&#44; we do not have all the answers&#44; but at least we know the questions and many groups are working to better identify responders to COPD treatments&#46; Ferreira et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a> describe an algorithm for treatment of COPD based on the existing evidence&#46; This algorithm recognises the central role of bronchodilators&#44; and in particular the association LABA&#47;LAMA&#44; which is &#40;or should be&#41; the basis of treatment of COPD&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">6&#8211;8</span></a> My only concern is the inclusion of ICS in individuals with exacerbations&#46; There is no doubt that ICS have an effect on reduction of exacerbations&#59; but in all patients&#63; There is accumulating evidence that only patients with a type of inflammation that is responsive to ICS &#40;Th2 or eosinophilic inflammation&#41; will respond to ICS with a reduction in exacerbations&#44;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">8&#44;14&#44;15</span></a> whereas patients with infective &#40;bacterial and neutrophilic&#41; exacerbations may be worse off with ICS compared with bronchodilators increasing the risk of pneumonia&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">15&#44;16</span></a> Therefore the role of ICS in the management of COPD must be revisited&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">17&#44;18</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Finally&#44; Ferreira et al&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a> introduce the debate about a stepwise approach to therapy or &#8220;hit hard&#8221;&#44; starting with a combination of drugs to obtain the maximum improvement from the beginning and then reduce therapy to maintain the same improvement with the minimum number of drugs&#46; This is an interesting topic&#44; and in fact&#44; guidelines differ in their interpretation and recommendations&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a> So far&#44; COPD has been considered a progressive disease and&#44; as such&#44; treatments have been added during the course of the disease&#46; Surprisingly&#44; even mild patients end up with triple therapy &#40;LABA&#47;LAMA&#47;ICS&#41; during the course of the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a> Clearly&#44; not all patients require triple therapy and in particular&#44; not all patients require ICS&#46; Therefore&#44; step down therapy must be possible and patients that do not suffer from exacerbations should have their ICS treatment discontinued&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">17&#44;18</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In summary&#44; there are a number of challenges in COPD management&#44; to mention only a few&#58; &#40;1&#41; reduce infradiagnosis&#44; &#40;2&#41; investigate if early therapy with maximal bronchodilatation &#40;LABA&#47;LAMA&#41; has long term benefits&#44; &#40;3&#41; better characterize the patients that require ICS&#44; &#40;4&#41; develop an easy to use tool to evaluate control in COPD&#44; &#40;5&#41; define the role of second-line therapies &#40;ICS&#44; mucolytics&#44; macrolides&#44; phosphodiesterase 4 inhibitors&#41;&#44; and &#40;6&#41; develop an algorithm based on clinical phenotypes&#44; easy to use in clinical practice&#46; I am sure that the intense research in COPD will give us some answers in the near future&#59; in the meantime I am sure that reading these articles will provide some &#8220;food for thought&#8221; in this very exciting field of research&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:20 [
            0 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Understanding COPD&#58; a vision on phenotypes&#44; comorbidities and treatment approach"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46; Fragoso"
                            1 => "S&#46; Andr&#233;"
                            2 => "J&#46;P&#46; Boleo-Tom&#233;"
                            3 => "V&#46; Areias"
                            4 => "J&#46; Munh&#225;"
                            5 => "J&#46; Cardoso"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Rev Port Pneumol"
                        "fecha" => "2016"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "COPD control&#58; can a consensus be found&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Guimar&#227;es"
                            1 => "A&#46; Bugalho"
                            2 => "A&#46;S&#46; Oliveira"
                            3 => "J&#46; Moita"
                            4 => "J&#46; Agostinho Marques"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Rev Port Pneumol"
                        "fecha" => "2016"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Optimal treatment sequence in COPD&#58; can a consensus be found&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Ferreira"
                            1 => "M&#46; Drummond"
                            2 => "N&#46; Pires"
                            3 => "G&#46; Reis"
                            4 => "C&#46; Alves"
                            5 => "C&#46; Robalo Cordeiro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Rev Port Pneumol"
                        "fecha" => "2016"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic obstructive pulmonary disease&#58; a stepwise or a hit hard approach&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;J&#46; Ferreira"
                            1 => "A&#46; Reis"
                            2 => "N&#46; Mar&#231;al"
                            3 => "P&#46; Pinto"
                            4 => "C&#46; B&#225;rbara"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Rev Port Pneumol"
                        "fecha" => "2016"
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673611604042"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic obstructive pulmonary disease phenotypes&#58; the future of COPD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;K&#46; Han"
                            1 => "A&#46; Agusti"
                            2 => "P&#46;M&#46; Calverley"
                            3 => "B&#46;R&#46; Celli"
                            4 => "G&#46; Criner"
                            5 => "J&#46;L&#46; Curtis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200912-1843CC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2010"
                        "volumen" => "182"
                        "paginaInicial" => "598"
                        "paginaFinal" => "604"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20522794"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spanish guideline for COPD &#40;GesEPOC&#41; update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Miravitlles"
                            1 => "J&#46;J&#46; Soler-Catalu&#241;a"
                            2 => "M&#46; Calle"
                            3 => "J&#46; Molina"
                            4 => "P&#46; Almagro"
                            5 => "J&#46;A&#46; Quintano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0300-2896(14)70070-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2014"
                        "volumen" => "50"
                        "paginaInicial" => "1"
                        "paginaFinal" => "16"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24507959"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic Obstructive Pulmonary Disease&#58; official diagnosis and treatment guidelines of the Czech Pneumological and Phthisiological Society&#58; a novel phenotypic approach to COPD with patient oriented care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46; Koblizek"
                            1 => "J&#46; Chlumsky"
                            2 => "V&#46; Zindr"
                            3 => "K&#46; Neumannova"
                            4 => "J&#46; Zatroukal"
                            5 => "J&#46; Zak"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5507/bp.2013.039"
                      "Revista" => array:6 [
                        "tituloSerie" => "Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub"
                        "fecha" => "2013"
                        "volumen" => "157"
                        "paginaInicial" => "189"
                        "paginaFinal" => "201"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23733084"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis and pharmacotherapy of Stable Chronic Obstructive Pulmonary Disease&#58; The Finish Guidelines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46; Kankaanranta"
                            1 => "T&#46; Harju"
                            2 => "M&#46; Kilpel&#228;inen"
                            3 => "W&#46; Mazur"
                            4 => "J&#46; Lehto"
                            5 => "M&#46; Katajisto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/bcpt.12366"
                      "Revista" => array:7 [
                        "tituloSerie" => "Basic Clin Pharmacol Toxicol"
                        "fecha" => "2015"
                        "volumen" => "116"
                        "paginaInicial" => "291"
                        "paginaFinal" => "307"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25515181"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109713060233"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical phenotypes of COPD&#46; Identification&#44; definition and implications for guidelines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Miravitlles"
                            1 => "M&#46; Calle"
                            2 => "J&#46;J&#46; Soler-Catalu&#241;a"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arbres.2011.10.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2012"
                        "volumen" => "48"
                        "paginaInicial" => "86"
                        "paginaFinal" => "98"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22196477"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The asthma COPD overlap syndrome &#40;ACOS&#41;&#46; Opportunities and challenges"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Barrecheguren"
                            1 => "C&#46; Esquinas"
                            2 => "M&#46; Miravitlles"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MCP.0000000000000118"
                      "Revista" => array:7 [
                        "tituloSerie" => "Curr Opin Pulm Med"
                        "fecha" => "2015"
                        "volumen" => "21"
                        "paginaInicial" => "74"
                        "paginaFinal" => "79"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25405671"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109704000919"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The concept of control of COPD in clinical practice"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;J&#46; Soler-Catalu&#241;a"
                            1 => "B&#46; Alcazar"
                            2 => "M&#46; Miravitlles"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Chron Obst Pulm Dis"
                        "fecha" => "2014"
                        "volumen" => "9"
                        "paginaInicial" => "1397"
                        "paginaFinal" => "1405"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Global strategy for the diagnosis&#44; management and prevention of chronic obstructive pulmonary disease&#44; GOLD executive summary"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Vestbo"
                            1 => "S&#46;S&#46; Hurd"
                            2 => "A&#46;G&#46; Agusti"
                            3 => "P&#46;W&#46; Jones"
                            4 => "C&#46; Vogelmeier"
                            5 => "A&#46; Anzueto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.201204-0596PP"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2013"
                        "volumen" => "187"
                        "paginaInicial" => "347"
                        "paginaFinal" => "365"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22878278"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "La BPCO et la perception du nouveau document GOLD en Europe&#46; Workshop de la Soci&#233;t&#233; de Pneumologie de Langue Fran&#231;aise &#40;SPLF&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Zysman"
                            1 => "M&#46; Patout"
                            2 => "M&#46; Miravitlles"
                            3 => "T&#46; van der Molen"
                            4 => "A&#46; Lokke"
                            5 => "T&#46; Hausen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rmr.2014.02.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Mal Respir"
                        "fecha" => "2014"
                        "volumen" => "31"
                        "paginaInicial" => "499"
                        "paginaFinal" => "510"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25012036"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Astha-COPD overlap&#58; clinical relevance of genomic signatures of Type 2 inflammation in COPD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;A&#46; Christenson"
                            1 => "K&#46; Steiling"
                            2 => "M&#46; van den Berge"
                            3 => "K&#46; Hijazi"
                            4 => "P&#46;S&#46; Hiemstra"
                            5 => "D&#46;S&#46; Postma"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.201408-1458OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2015"
                        "volumen" => "191"
                        "paginaInicial" => "758"
                        "paginaFinal" => "766"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25611785"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Blood eosinophil counts&#44; exacerbations and response to the addition of inhaled fluticasona furoate to vilanterol in patients with chronic obstructive pulmonary disease&#58; a secondary analysis of data from two parallel randomized controlled trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46; Pascoe"
                            1 => "N&#46; Locantore"
                            2 => "M&#46; Dransfield"
                            3 => "N&#46;C&#46; Barnes"
                            4 => "I&#46;D&#46; Pavord"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S2213-2600(15)00106-X"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet Respir Med"
                        "fecha" => "2015"
                        "volumen" => "3"
                        "paginaInicial" => "435"
                        "paginaFinal" => "442"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25878028"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Targeted therapy with inhaled corticosteroids in COPD according to blood eosinophil counts"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46;G&#46; Brusselle"
                            1 => "K&#46; Bracke"
                            2 => "L&#46; Lahousse"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S2213-2600(15)00145-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet Respir Med"
                        "fecha" => "2015"
                        "volumen" => "3"
                        "paginaInicial" => "416"
                        "paginaFinal" => "417"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25892351"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Correct use of inhaled corticosteroids in chronic obstructive pulmonary disease&#58; a consensus document"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46; Alc&#225;zar Navarrete"
                            1 => "C&#46; Casanova"
                            2 => "M&#46; Miravitlles"
                            3 => "P&#46; de Lucas"
                            4 => "J&#46;A&#46; Riesco"
                            5 => "J&#46;M&#46; Rodr&#237;guez Gonz&#225;lez-Moro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arbres.2014.11.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2015"
                        "volumen" => "51"
                        "paginaInicial" => "193"
                        "paginaFinal" => "198"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25540900"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A re-evaluation of the role of inhaled corticosteroids in the management of patients with COPD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; D&#8217;Urzo"
                            1 => "J&#46;F&#46; Donohue"
                            2 => "P&#46; Kardos"
                            3 => "M&#46; Miravitlles"
                            4 => "D&#46; Price"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1517/14656566.2015.1067682"
                      "Revista" => array:6 [
                        "tituloSerie" => "Expert Opin Pharmacother"
                        "fecha" => "2015"
                        "volumen" => "16"
                        "paginaInicial" => "1845"
                        "paginaFinal" => "1860"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26194213"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A review of national guidelines for management of COPD in Europe"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Miravitlles"
                            1 => "C&#46; Vogelmeier"
                            2 => "N&#46; Roche"
                            3 => "D&#46; Halpin"
                            4 => "J&#46; Cardoso"
                            5 => "A&#46;G&#46; Chuchalin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/13993003.01170-2015"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2016"
                        "volumen" => "47"
                        "paginaInicial" => "625"
                        "paginaFinal" => "637"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26797035"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The inevitable drift to triple therapy in COPD&#46; An analysis of prescribing pathways in the UK"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Brusselle"
                            1 => "D&#46; Price"
                            2 => "K&#46; Gruffydd-Jones"
                            3 => "M&#46; Miravitlles"
                            4 => "D&#46;L&#46; Keininger"
                            5 => "R&#46; Stewart"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Chron Obst Pulm Dis"
                        "fecha" => "2015"
                        "volumen" => "10"
                        "paginaInicial" => "2207"
                        "paginaFinal" => "2217"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735115/0000002200000002/v2_201704020101/S217351151600018X/v2_201704020101/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9716"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Editorials"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735115/0000002200000002/v2_201704020101/S217351151600018X/v2_201704020101/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217351151600018X?idApp=UINPBA00004E"
]
Share
Journal Information

Statistics

Follow this link to access the full text of the article

Editorial
Towards a patient-oriented treatment of COPD
M. Miravitlles
Pneumology Department, Hospital General Universitari Vall d’Hebron, Ciber de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
Read
1015
Times
was read the article
546
Total PDF
469
Total HTML
Share statistics
 array:24 [
  "pii" => "S217351151600018X"
  "issn" => "21735115"
  "doi" => "10.1016/j.rppnen.2016.02.002"
  "estado" => "S300"
  "fechaPublicacion" => "2016-03-01"
  "aid" => "1140"
  "copyright" => "Sociedade Portuguesa de Pneumologia"
  "copyrightAnyo" => "2016"
  "documento" => "simple-article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "edi"
  "cita" => "Rev Port Pneumol. 2016;22:73-4"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 1816
    "formatos" => array:3 [
      "EPUB" => 218
      "HTML" => 1039
      "PDF" => 559
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2173511515001906"
    "issn" => "21735115"
    "doi" => "10.1016/j.rppnen.2015.09.009"
    "estado" => "S300"
    "fechaPublicacion" => "2016-03-01"
    "aid" => "1110"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "fla"
    "cita" => "Rev Port Pneumol. 2016;22:75-81"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1856
      "formatos" => array:3 [
        "EPUB" => 219
        "HTML" => 1030
        "PDF" => 607
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Effectiveness and safety of mouthpiece ventilation and nocturnal non-invasive ventilation in patients with kyphoscoliosis&#58; Short and long-term outcomes after an episode of acute respiratory failure"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "75"
          "paginaFinal" => "81"
        ]
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "A&#46; Nicolini, C&#46; Barlascini, I&#46;M&#46;G&#46; Piroddi, G&#46; Garuti, P&#46;I&#46; Banfi"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Nicolini"
            ]
            1 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Barlascini"
            ]
            2 => array:2 [
              "nombre" => "I&#46;M&#46;G&#46;"
              "apellidos" => "Piroddi"
            ]
            3 => array:2 [
              "nombre" => "G&#46;"
              "apellidos" => "Garuti"
            ]
            4 => array:2 [
              "nombre" => "P&#46;I&#46;"
              "apellidos" => "Banfi"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511515001906?idApp=UINPBA00004E"
    "url" => "/21735115/0000002200000002/v2_201704020101/S2173511515001906/v2_201704020101/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2173511516000440"
    "issn" => "21735115"
    "doi" => "10.1016/j.rppnen.2016.03.001"
    "estado" => "S300"
    "fechaPublicacion" => "2016-03-01"
    "aid" => "1149"
    "copyright" => "Sociedade Portuguesa de Pneumologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "edi"
    "cita" => "Rev Port Pneumol. 2016;22:70-2"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 1670
      "formatos" => array:3 [
        "EPUB" => 211
        "HTML" => 918
        "PDF" => 541
      ]
    ]
    "en" => array:9 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">EDITORIAL</span>"
      "titulo" => "How to handle IPF &#8211; the new Portuguese consensus document"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "70"
          "paginaFinal" => "72"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Ulrich Costabel, Francesco Bonella"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "Ulrich"
              "apellidos" => "Costabel"
            ]
            1 => array:2 [
              "nombre" => "Francesco"
              "apellidos" => "Bonella"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173511516000440?idApp=UINPBA00004E"
    "url" => "/21735115/0000002200000002/v2_201704020101/S2173511516000440/v2_201704020101/en/main.assets"
  ]
  "en" => array:10 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
    "titulo" => "Towards a patient-oriented treatment of COPD"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "73"
        "paginaFinal" => "74"
      ]
    ]
    "autores" => array:1 [
      0 => array:3 [
        "autoresLista" => "M&#46; Miravitlles"
        "autores" => array:1 [
          0 => array:3 [
            "nombre" => "M&#46;"
            "apellidos" => "Miravitlles"
            "email" => array:1 [
              0 => "mmiravitlles&#64;vhebron&#46;net"
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Pneumology Department&#44; Hospital General Universitari Vall d&#8217;Hebron&#44; Ciber de Enfermedades Respiratorias &#40;CIBERES&#41;&#44; Barcelona&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Ambition is a strong desire to do or achieve something and being ambitious is having or showing a strong desire and determination to succeed&#46; Ambition is really required to try to summarise the new advances in management of chronic obstructive pulmonary disease &#40;COPD&#41; in a series of articles&#44; but the Portuguese Journal of Pulmonology has demonstrated to be ambitious and is publishing four articles that provide an overview of the new concepts that are important for the clinician that cares for patients with this disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">1&#8211;4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The first topic is the evaluation of the patient in order to select the best treatment option&#46; COPD is characterised by non-fully reversible airflow obstruction&#46; However&#44; apart from this common characteristic&#44; patients may have absolutely different clinical characteristics and symptoms&#46; Moreover&#44; these different clinical characteristics may reflect different responses to the available treatments&#46; The concept of a clinical phenotype of COPD was introduced to identify patients that share clinical characteristics and response to therapy&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a> But&#44; which are the relevant phenotypes&#63; How many are they&#63; Fragoso et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> propose an answer to these questions&#46; Basically&#44; they propose the same phenotypes previously described in the Spanish Guidelines for COPD&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a> and later adopted in other guidelines such as the Czech<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a> and the Finnish&#44;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a> namely non-exacerbators&#44; exacerbators with chronic bronchitis&#44; exacerbators with emphysema and asthma-COPD overlap syndrome &#40;ACOS&#41;&#44; with the addition of the COPD-bronchiectasis phenotype&#46; This classification makes a lot of sense because it is based on clinical grounds and is easy to apply in general clinical practice&#46; Furthermore&#44; these phenotypes identify patients that require a different therapeutic approach&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a> Non-exacerbators must be treated only with bronchodilators&#44; ACOS must receive a combination of bronchodilators and inhaled corticosteroids &#40;ICS&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a> patients with chronic bronchitis may respond to drugs such as roflumilast or N-acetylcystein and patients with bronchiectasis may respond to long-term macrolides&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a> Obviously these phenotypes are not clear-cut&#44; but they are a good guidance for the type of treatment that must be chosen as first-line&#46; In any case&#44; we need to remember that no classification will ever substitute the clinical judgement made by the experienced physician&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The second step after initiating a treatment is to acess the response&#46; It is not clear how to evaluate the response to therapy in COPD&#59; we can evaluate the improvement in lung function&#44; in symptoms&#44; the absence of exacerbations&#44; the reduction in the use of rescue medication and the increase in the levels of physical activity&#44; but some of these indicators may not change despite successful treatment and not all of them may mean the same&#46; This is why there has been a growing interest in the concept of control of COPD&#46; Soler-Catalu&#241;a et al&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a> published a proposal for a standardisation of control that is in the process of validation&#46; Guimaraes et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a> present an interesting review of the concept of control in COPD and indicate that unfortunately there are no available biomarkers about the response to treatment and no consensus exists about the concept of control&#46; However&#44; it is quite likely that we will see some advances in this area in the future&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">But the key question is how can we provide the best treatment for our patients with COPD&#63; I really do not think that letters and numbers will help us &#40;A&#44; B&#44; C1&#44; D2&#44; etc&#46;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> The practice of medicine is based on observation and description and we have to describe the clinical phenotypes that predict response to treatment<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a> and don&#8217;t get lost in artificial classifications&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> This is in line of the proposal of a patient-oriented treatment as described by Ferreira et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a> Obviously&#44; we do not have all the answers&#44; but at least we know the questions and many groups are working to better identify responders to COPD treatments&#46; Ferreira et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a> describe an algorithm for treatment of COPD based on the existing evidence&#46; This algorithm recognises the central role of bronchodilators&#44; and in particular the association LABA&#47;LAMA&#44; which is &#40;or should be&#41; the basis of treatment of COPD&#46;<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">6&#8211;8</span></a> My only concern is the inclusion of ICS in individuals with exacerbations&#46; There is no doubt that ICS have an effect on reduction of exacerbations&#59; but in all patients&#63; There is accumulating evidence that only patients with a type of inflammation that is responsive to ICS &#40;Th2 or eosinophilic inflammation&#41; will respond to ICS with a reduction in exacerbations&#44;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">8&#44;14&#44;15</span></a> whereas patients with infective &#40;bacterial and neutrophilic&#41; exacerbations may be worse off with ICS compared with bronchodilators increasing the risk of pneumonia&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">15&#44;16</span></a> Therefore the role of ICS in the management of COPD must be revisited&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">17&#44;18</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Finally&#44; Ferreira et al&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a> introduce the debate about a stepwise approach to therapy or &#8220;hit hard&#8221;&#44; starting with a combination of drugs to obtain the maximum improvement from the beginning and then reduce therapy to maintain the same improvement with the minimum number of drugs&#46; This is an interesting topic&#44; and in fact&#44; guidelines differ in their interpretation and recommendations&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a> So far&#44; COPD has been considered a progressive disease and&#44; as such&#44; treatments have been added during the course of the disease&#46; Surprisingly&#44; even mild patients end up with triple therapy &#40;LABA&#47;LAMA&#47;ICS&#41; during the course of the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a> Clearly&#44; not all patients require triple therapy and in particular&#44; not all patients require ICS&#46; Therefore&#44; step down therapy must be possible and patients that do not suffer from exacerbations should have their ICS treatment discontinued&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">17&#44;18</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">In summary&#44; there are a number of challenges in COPD management&#44; to mention only a few&#58; &#40;1&#41; reduce infradiagnosis&#44; &#40;2&#41; investigate if early therapy with maximal bronchodilatation &#40;LABA&#47;LAMA&#41; has long term benefits&#44; &#40;3&#41; better characterize the patients that require ICS&#44; &#40;4&#41; develop an easy to use tool to evaluate control in COPD&#44; &#40;5&#41; define the role of second-line therapies &#40;ICS&#44; mucolytics&#44; macrolides&#44; phosphodiesterase 4 inhibitors&#41;&#44; and &#40;6&#41; develop an algorithm based on clinical phenotypes&#44; easy to use in clinical practice&#46; I am sure that the intense research in COPD will give us some answers in the near future&#59; in the meantime I am sure that reading these articles will provide some &#8220;food for thought&#8221; in this very exciting field of research&#46;</p></span>"
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:20 [
            0 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Understanding COPD&#58; a vision on phenotypes&#44; comorbidities and treatment approach"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46; Fragoso"
                            1 => "S&#46; Andr&#233;"
                            2 => "J&#46;P&#46; Boleo-Tom&#233;"
                            3 => "V&#46; Areias"
                            4 => "J&#46; Munh&#225;"
                            5 => "J&#46; Cardoso"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Rev Port Pneumol"
                        "fecha" => "2016"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "COPD control&#58; can a consensus be found&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Guimar&#227;es"
                            1 => "A&#46; Bugalho"
                            2 => "A&#46;S&#46; Oliveira"
                            3 => "J&#46; Moita"
                            4 => "J&#46; Agostinho Marques"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Rev Port Pneumol"
                        "fecha" => "2016"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Optimal treatment sequence in COPD&#58; can a consensus be found&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Ferreira"
                            1 => "M&#46; Drummond"
                            2 => "N&#46; Pires"
                            3 => "G&#46; Reis"
                            4 => "C&#46; Alves"
                            5 => "C&#46; Robalo Cordeiro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Rev Port Pneumol"
                        "fecha" => "2016"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic obstructive pulmonary disease&#58; a stepwise or a hit hard approach&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;J&#46; Ferreira"
                            1 => "A&#46; Reis"
                            2 => "N&#46; Mar&#231;al"
                            3 => "P&#46; Pinto"
                            4 => "C&#46; B&#225;rbara"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Rev Port Pneumol"
                        "fecha" => "2016"
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673611604042"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic obstructive pulmonary disease phenotypes&#58; the future of COPD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;K&#46; Han"
                            1 => "A&#46; Agusti"
                            2 => "P&#46;M&#46; Calverley"
                            3 => "B&#46;R&#46; Celli"
                            4 => "G&#46; Criner"
                            5 => "J&#46;L&#46; Curtis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.200912-1843CC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2010"
                        "volumen" => "182"
                        "paginaInicial" => "598"
                        "paginaFinal" => "604"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20522794"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spanish guideline for COPD &#40;GesEPOC&#41; update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Miravitlles"
                            1 => "J&#46;J&#46; Soler-Catalu&#241;a"
                            2 => "M&#46; Calle"
                            3 => "J&#46; Molina"
                            4 => "P&#46; Almagro"
                            5 => "J&#46;A&#46; Quintano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0300-2896(14)70070-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2014"
                        "volumen" => "50"
                        "paginaInicial" => "1"
                        "paginaFinal" => "16"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24507959"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chronic Obstructive Pulmonary Disease&#58; official diagnosis and treatment guidelines of the Czech Pneumological and Phthisiological Society&#58; a novel phenotypic approach to COPD with patient oriented care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46; Koblizek"
                            1 => "J&#46; Chlumsky"
                            2 => "V&#46; Zindr"
                            3 => "K&#46; Neumannova"
                            4 => "J&#46; Zatroukal"
                            5 => "J&#46; Zak"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5507/bp.2013.039"
                      "Revista" => array:6 [
                        "tituloSerie" => "Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub"
                        "fecha" => "2013"
                        "volumen" => "157"
                        "paginaInicial" => "189"
                        "paginaFinal" => "201"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23733084"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diagnosis and pharmacotherapy of Stable Chronic Obstructive Pulmonary Disease&#58; The Finish Guidelines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "H&#46; Kankaanranta"
                            1 => "T&#46; Harju"
                            2 => "M&#46; Kilpel&#228;inen"
                            3 => "W&#46; Mazur"
                            4 => "J&#46; Lehto"
                            5 => "M&#46; Katajisto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/bcpt.12366"
                      "Revista" => array:7 [
                        "tituloSerie" => "Basic Clin Pharmacol Toxicol"
                        "fecha" => "2015"
                        "volumen" => "116"
                        "paginaInicial" => "291"
                        "paginaFinal" => "307"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25515181"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109713060233"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical phenotypes of COPD&#46; Identification&#44; definition and implications for guidelines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Miravitlles"
                            1 => "M&#46; Calle"
                            2 => "J&#46;J&#46; Soler-Catalu&#241;a"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arbres.2011.10.007"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2012"
                        "volumen" => "48"
                        "paginaInicial" => "86"
                        "paginaFinal" => "98"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22196477"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The asthma COPD overlap syndrome &#40;ACOS&#41;&#46; Opportunities and challenges"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Barrecheguren"
                            1 => "C&#46; Esquinas"
                            2 => "M&#46; Miravitlles"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MCP.0000000000000118"
                      "Revista" => array:7 [
                        "tituloSerie" => "Curr Opin Pulm Med"
                        "fecha" => "2015"
                        "volumen" => "21"
                        "paginaInicial" => "74"
                        "paginaFinal" => "79"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25405671"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0735109704000919"
                          "estado" => "S300"
                          "issn" => "07351097"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The concept of control of COPD in clinical practice"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;J&#46; Soler-Catalu&#241;a"
                            1 => "B&#46; Alcazar"
                            2 => "M&#46; Miravitlles"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Chron Obst Pulm Dis"
                        "fecha" => "2014"
                        "volumen" => "9"
                        "paginaInicial" => "1397"
                        "paginaFinal" => "1405"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Global strategy for the diagnosis&#44; management and prevention of chronic obstructive pulmonary disease&#44; GOLD executive summary"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Vestbo"
                            1 => "S&#46;S&#46; Hurd"
                            2 => "A&#46;G&#46; Agusti"
                            3 => "P&#46;W&#46; Jones"
                            4 => "C&#46; Vogelmeier"
                            5 => "A&#46; Anzueto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.201204-0596PP"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2013"
                        "volumen" => "187"
                        "paginaInicial" => "347"
                        "paginaFinal" => "365"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22878278"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "La BPCO et la perception du nouveau document GOLD en Europe&#46; Workshop de la Soci&#233;t&#233; de Pneumologie de Langue Fran&#231;aise &#40;SPLF&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Zysman"
                            1 => "M&#46; Patout"
                            2 => "M&#46; Miravitlles"
                            3 => "T&#46; van der Molen"
                            4 => "A&#46; Lokke"
                            5 => "T&#46; Hausen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rmr.2014.02.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Mal Respir"
                        "fecha" => "2014"
                        "volumen" => "31"
                        "paginaInicial" => "499"
                        "paginaFinal" => "510"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25012036"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Astha-COPD overlap&#58; clinical relevance of genomic signatures of Type 2 inflammation in COPD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;A&#46; Christenson"
                            1 => "K&#46; Steiling"
                            2 => "M&#46; van den Berge"
                            3 => "K&#46; Hijazi"
                            4 => "P&#46;S&#46; Hiemstra"
                            5 => "D&#46;S&#46; Postma"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1164/rccm.201408-1458OC"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Respir Crit Care Med"
                        "fecha" => "2015"
                        "volumen" => "191"
                        "paginaInicial" => "758"
                        "paginaFinal" => "766"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25611785"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Blood eosinophil counts&#44; exacerbations and response to the addition of inhaled fluticasona furoate to vilanterol in patients with chronic obstructive pulmonary disease&#58; a secondary analysis of data from two parallel randomized controlled trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46; Pascoe"
                            1 => "N&#46; Locantore"
                            2 => "M&#46; Dransfield"
                            3 => "N&#46;C&#46; Barnes"
                            4 => "I&#46;D&#46; Pavord"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S2213-2600(15)00106-X"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet Respir Med"
                        "fecha" => "2015"
                        "volumen" => "3"
                        "paginaInicial" => "435"
                        "paginaFinal" => "442"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25878028"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Targeted therapy with inhaled corticosteroids in COPD according to blood eosinophil counts"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46;G&#46; Brusselle"
                            1 => "K&#46; Bracke"
                            2 => "L&#46; Lahousse"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S2213-2600(15)00145-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet Respir Med"
                        "fecha" => "2015"
                        "volumen" => "3"
                        "paginaInicial" => "416"
                        "paginaFinal" => "417"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25892351"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Correct use of inhaled corticosteroids in chronic obstructive pulmonary disease&#58; a consensus document"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46; Alc&#225;zar Navarrete"
                            1 => "C&#46; Casanova"
                            2 => "M&#46; Miravitlles"
                            3 => "P&#46; de Lucas"
                            4 => "J&#46;A&#46; Riesco"
                            5 => "J&#46;M&#46; Rodr&#237;guez Gonz&#225;lez-Moro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.arbres.2014.11.001"
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol"
                        "fecha" => "2015"
                        "volumen" => "51"
                        "paginaInicial" => "193"
                        "paginaFinal" => "198"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25540900"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A re-evaluation of the role of inhaled corticosteroids in the management of patients with COPD"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; D&#8217;Urzo"
                            1 => "J&#46;F&#46; Donohue"
                            2 => "P&#46; Kardos"
                            3 => "M&#46; Miravitlles"
                            4 => "D&#46; Price"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1517/14656566.2015.1067682"
                      "Revista" => array:6 [
                        "tituloSerie" => "Expert Opin Pharmacother"
                        "fecha" => "2015"
                        "volumen" => "16"
                        "paginaInicial" => "1845"
                        "paginaFinal" => "1860"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26194213"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A review of national guidelines for management of COPD in Europe"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Miravitlles"
                            1 => "C&#46; Vogelmeier"
                            2 => "N&#46; Roche"
                            3 => "D&#46; Halpin"
                            4 => "J&#46; Cardoso"
                            5 => "A&#46;G&#46; Chuchalin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/13993003.01170-2015"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2016"
                        "volumen" => "47"
                        "paginaInicial" => "625"
                        "paginaFinal" => "637"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26797035"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The inevitable drift to triple therapy in COPD&#46; An analysis of prescribing pathways in the UK"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Brusselle"
                            1 => "D&#46; Price"
                            2 => "K&#46; Gruffydd-Jones"
                            3 => "M&#46; Miravitlles"
                            4 => "D&#46;L&#46; Keininger"
                            5 => "R&#46; Stewart"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Chron Obst Pulm Dis"
                        "fecha" => "2015"
                        "volumen" => "10"
                        "paginaInicial" => "2207"
                        "paginaFinal" => "2217"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/21735115/0000002200000002/v2_201704020101/S217351151600018X/v2_201704020101/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "9716"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Editorials"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/21735115/0000002200000002/v2_201704020101/S217351151600018X/v2_201704020101/en/main.pdf?idApp=UINPBA00004E&text.app=https://journalpulmonology.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217351151600018X?idApp=UINPBA00004E"
]
Article information
ISSN: 21735115
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2024 November 5 4 9
2024 October 32 39 71
2024 September 26 33 59
2024 August 49 41 90
2024 July 30 39 69
2024 June 35 28 63
2024 May 41 33 74
2024 April 24 26 50
2024 March 30 18 48
2024 February 23 25 48
2024 January 18 36 54
2023 December 25 23 48
2023 November 24 41 65
2023 October 12 33 45
2023 September 19 38 57
2023 August 11 13 24
2023 July 18 30 48
2023 June 13 9 22
2023 May 19 27 46
2023 April 15 10 25
Show all

Follow this link to access the full text of the article

Pulmonology

Are you a health professional able to prescribe or dispense drugs?