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Graphical abstract, Highlights • The survival rate is high (94% vs 72%) if tocilizumab is administered with a FiO2 ≤ 0.5%. • There are very limited side effects and secondary infections. • A significant decrease in the median serum ferritin and the median HSCRP was observed., Introduction Tocilizumab is an interleukin 6 receptor antagonist which has been used for the treatment of severe SARS-CoV-2 pneumonia (SSP), aiming to ameliorate the cytokine release syndrome (CRS) -induced acute respiratory distress syndrome (ARDS). However, there are no consistent data whom might benefit most from it. Methods We provided tocilizumab on a compassionate-use basis to patients with SSP hospitalized (excluding intensive care and intubated cases) who required oxygen support to have a saturation >93%. Primary endpoint was intubation or death after 24 hours of its administration. Patients received at least one dose of 400 mg intravenous tocilizumab during March 8-2020, through April 20-2020. Results A total of 207 patients were studied and 186 analysed. The mean age was 65 years and 68% were male. A co-existing condition was present in 68 % of cases. Death prognostic factors were older age, higher IL-6, D-dimer and high sensitivity C reactive protein (HSCRP), lower total lymphocytes and severe disease requiring higher oxygen support. The primary endpoint (intubation or death) was significantly worst (37% vs 13%, p 0.5%). Conclusions Tocilizumab is well tolerated in patients with severe SARS-CoV-2 pneumonia, but it has a limited effect on the evolution of cases with high oxygen support needs.

Background Several studies suggest that statins, besides reducing cardiovascular disease, have anti-inflammatory properties which might provide a benefit in downregulating the immune response after a respiratory viral infection (RVI) and, hence, decreasing subsequent complications. We aim to analyse the effect of statins on mortality after RVI. Methods A single-centre, observational and retrospective study was carried out including all adult patients with a RVI confirmed by PCR tests from October 2, 2017 to May 20, 2018. Patients were divided between statin users and non-statin users and followed-up for 1 year, and all causes of death were recorded. In order to analyse the effect of statin treatment on mortality after RVI we planned two different approaches, a multivariate Cox regression model with the overall population and a univariate Cox model with a propensity-score matched population. Results We included 448 patients, 154 (34.4%) of whom were under statin treatment. Statin users had a worse clinical profile (older population with more comorbidities). During the 1-year follow-up, 67 patients died, 17 (11.0%) in the statin group and 50 (17.1%) in the non-statin group. Multivariate Cox analysis showed that statins were associated with mortality benefit (HR 0.47, 95% CI 0.26–0.83; p=0.01). In a matched population (101 statins users and 101 non-statins users) statins also remained associated with mortality benefit (HR 0.32, 95% CI 0.14–0.72; p=0.006). Differences were mainly driven by non-cardiovascular mortality (HR 0.31, 95% CI 0.13–0.73; p=0.004). Conclusions Chronic statin treatment was associated with reduced 1-year mortality in patients with laboratory-confirmed RVI. Further studies are needed to determine the exact role of statin therapy after RVI., Statin treatment is associated with reduced 1-year mortality after respiratory viral infections, despite the higher risk profile of patients on statins. Statins seem a good candidate to be tested during the current global pandemic. https://bit.ly/36t0tDh

REIPI-SEIMC COVID-19 group and COVID@HULP group., [Background] The clinical presentation of COVID-19 in patients admitted to hospital is heterogeneous. We aimed to determine whether clinical phenotypes of patients with COVID-19 can be derived from clinical data, to assess the reproducibility of these phenotypes and correlation with prognosis, and to derive and validate a simplified probabilistic model for phenotype assignment. Phenotype identification was not primarily intended as a predictive tool for mortality., [Methods] In this study, we used data from two cohorts: the COVID-19@Spain cohort, a retrospective cohort including 4035 consecutive adult patients admitted to 127 hospitals in Spain with COVID-19 between Feb 2 and March 17, 2020, and the COVID-19@HULP cohort, including 2226 consecutive adult patients admitted to a teaching hospital in Madrid between Feb 25 and April 19, 2020. The COVID-19@Spain cohort was divided into a derivation cohort, comprising 2667 randomly selected patients, and an internal validation cohort, comprising the remaining 1368 patients. The COVID-19@HULP cohort was used as an external validation cohort. A probabilistic model for phenotype assignment was derived in the derivation cohort using multinomial logistic regression and validated in the internal validation cohort. The model was also applied to the external validation cohort. 30-day mortality and other prognostic variables were assessed in the derived phenotypes and in the phenotypes assigned by the probabilistic model., [Findings] Three distinct phenotypes were derived in the derivation cohort (n=2667)—phenotype A (516 [19%] patients), phenotype B (1955 [73%]) and phenotype C (196 [7%])—and reproduced in the internal validation cohort (n=1368)—phenotype A (233 [17%] patients), phenotype B (1019 [74%]), and phenotype C (116 [8%]). Patients with phenotype A were younger, were less frequently male, had mild viral symptoms, and had normal inflammatory parameters. Patients with phenotype B included more patients with obesity, lymphocytopenia, and moderately elevated inflammatory parameters. Patients with phenotype C included older patients with more comorbidities and even higher inflammatory parameters than phenotype B. We developed a simplified probabilistic model (validated in the internal validation cohort) for phenotype assignment, including 16 variables. In the derivation cohort, 30-day mortality rates were 2·5% (95% CI 1·4–4·3) for patients with phenotype A, 30·5% (28·5–32·6) for patients with phenotype B, and 60·7% (53·7–67·2) for patients with phenotype C (log-rank test p, [Interpretation] Patients admitted to hospital with COVID-19 can be classified into three phenotypes that correlate with mortality. We developed and validated a simplified tool for the probabilistic assignment of patients into phenotypes. These results might help to better classify patients for clinical management, but the pathophysiological mechanisms of the phenotypes must be investigated., [Funding] Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, and Fundación SEIMC/GeSIDA., Funding: Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation, and Fundación SEIMC/GeSIDA.

Introduction Within the pathogenesis of the chronic obstructive pulmonary disease (COPD) there are interactions between different inflammatory mediators that are enhanced during an exacerbation. Arginase is present in bronchial epithelial cells, endothelial, fibroblasts and alveolar macrophages, which make it a probable key enzyme in the regulation of inflammation and remodelling. We aimed to find a potential relationship between arginase activity, inflammatory mediators in COPD patients in stable phase and during exacerbations. Methods We performed a prospective, observational study of cases and controls, with 4 study groups (healthy controls, stable COPD, COPD during an exacerbation and COPD 3 months after exacerbation). We measured arginase, inflammation markers (IL-6, IL-8, TNF-∝, IFN-γ and C reactive protein), and mediators of immunity: neutrophils, monocytes, total TCD3 + lymphocytes (CD3ζ), CD4 + T cells, CD8 + T cells, NK cells. Results A total of 49 subjects were recruited, average age of 69.73 years (59.18% male). Arginase activity is elevated during an exacerbation of COPD, and this rise is related to an increase in IL-6 production. The levels of IL-6 and IL-8 remained elevated in patients with COPD at 3 months after hospital exacerbation. We did not find a clear relationship between arginase activity, immunity or with the degree of obstruction in COPD patients. Conclusions Arginase activity is elevated during an exacerbation of COPD, and it could be related to an increase in the production of IL-6. Levels of IL-6, IL-8, and arginase activity remain elevated in patients with COPD at 3 months after hospital exacerbation. Arginase activity could contribute to the development of COPD.

Introduction: The objective of this study was to assess the reduction of readmissions at 30 days in severe and fragile patients discharged by COPD exacerbations and included in our home follow-up program. Methods: An observational study was performed. We analyzed patients who had a hospital admission due to COPD exacerbation from January 2015 to October 2019. From these, we included in our follow-up program those who required at least two hospital admissions in the last year or had a score higher that seven in our Re-entry Risk Scale. Nursery followed these patients at home for 30 days after discharge. Finally, we compared data of subjects included in the program with those not included and those who had criteria for follow-up but were not included for other reasons. Results: 1334 cases were analyzed. The average number of COPD exacerbations in previous year was 1,8 and, of these, 1,3 required hospital admission with a mean stay of 6,6 days. The readmission rate at 30 days was 15,7%. Patients included in our follow-up program (n: 507, 38%) were older (mean age of 74,7), with a longer average stay (7,9 vs 5,8) and a higher number of previous exacerbations (2,5 vs 1,4). They also had lower FEV1 (45,7% vs 48,8%) and higher readmission rate (18,9% vs 13,7%) compared to individuals without follow-up. Patients with follow-up criteria but not included in the program (n: 260, 19,4%) had a higher readmission rate than those included in the program (23,8% vs 18,9%). Conclusion: Our follow-up program could be useful to reduce readmissions rate. Readmissions are related to a greater number of previous exacerbations and worse lung function.

Background: current algorithms for the detection of heart failure (HF) and chronic obstructive pulmonary disease (COPD) exacerbations have poor performance. Methods: this study was designed as a prospective longitudinal trial. Physiological parameters were evaluated at rest and effort (walking) in patients who were in the exacerbation or stable phases of HF or COPD. Parameters with relevant discriminatory power (sensitivity (Sn) or specificity (Sp) &ge, 80%, and Youden index &ge, 0.2) were integrated into diagnostic algorithms. Results: the study included 127 patients (COPD: 56, HF: 54, both: 17). The best algorithm for COPD included: oxygen saturation (SaO2) decrease &ge, 2% in minutes 1 to 3 of effort, end-of-effort heart rate (HR) increase &ge, 10 beats/min and walking distance decrease &ge, 35 m (presence of one criterion showed Sn: 0.90 (95%, CI(confidence interval): 0.75&ndash, 0.97), Sp: 0.89 (95%, CI: 0.72&ndash, 0.96), and area under the curve (AUC): 0.92 (95%, CI: 0.85&ndash, 0.995)), and for HF: SaO2 decrease &ge, 2% in the mean-of-effort, HR increase &ge, 10 beats/min in the mean-of-effort, and walking distance decrease &ge, 40 m (presence of one criterion showed Sn: 0.85 (95%, CI: 0.69&ndash, 0.93), Sp: 0.75 (95%, CI: 0.57&ndash, 0.87) and AUC 0.84 (95%, CI: 0.74&ndash, 0.94)). Conclusions: effort situations improve the validity of physiological parameters for detection of HF and COPD exacerbation episodes.

Resumen: La Sociedad Española de Neumología y Cirugía Torácica (SEPAR) ha elaborado este documento de recomendaciones sobre la vacuna para la COVID-19 en las enfermedades respiratorias, con el objetivo de ayudar al personal sanitario en la toma de decisiones sobre cómo actuar en la vacunación de estos pacientes.Las recomendaciones han sido elaboradas por un grupo de expertos en la materia, tras la revisión de la literatura recopilada hasta el 7 de marzo del 2021, y de la información aportada por distintas sociedades científicas, agencias del medicamento y estrategias de organismos gubernamentales hasta esa fecha.Podemos concluir que las vacunas para la COVID-19 no solo son seguras y eficaces, sino que, en aquellos pacientes vulnerables con enfermedades respiratorias crónicas, son prioritarias. Además, la implicación activa de los profesionales sanitarios que manejan estas patologías en la estrategia de vacunación es clave para lograr una buena adherencia y coberturas vacunales elevadas. Abstract: The Spanish Society of Pneumonology and Thoracic Surgery (SEPAR) has elaborated this document of recommendations for COVID-19 vaccination in patients with respiratory diseases aimed to help healthcare personnel make decisions about how to act in case of COVID-19 vaccination in these patients.The recommendations have been developed by a group of experts in this field after reviewing the materials published up to March 7, 2021, the information provided by different scientific societies, drug agencies and the strategies of the governmental bodies up to this date.We can conclude that COVID-19 vaccines are not only safe and effective, but also prior in vulnerable patients with chronic respiratory diseases. In addition, an active involvement of healthcare professionals, who manage these diseases, in the vaccination strategy is the key to achieve good adherence and high vaccination coverage.

Objectives: This study aims to determine similarities and differences in clinical characteristics between the patients from two waves of severe acute respiratory syndrome coronavirus-2 infection at the time of hospital admission, as well as to identify risk biomarkers of coronavirus disease 2019 severity. Design: Retrospective observational study. Setting: A single tertiary-care center in Madrid. Patients: Coronavirus disease 2019 adult patients admitted to hospital from March 4, 2020, to March 25, 2020 (first infection wave), and during July 18, 2020, and August 20, 2020 (second infection wave). Interventions: Treatment with a hospital-approved drug cocktail during hospitalization. Measurements and Main Results: Demographic, clinical, and laboratory data were compared between the patients with moderate and critical/fatal illness across both infection waves. The median age of patients with critical/fatal coronavirus disease 2019 was 67.5 years (interquartile range, 56.75–78.25 yr; 64.5% male) in the first wave and 59.0 years (interquartile range, 48.25–80.50 yr; 70.8% male) in the second wave. Hypertension and dyslipidemia were major comorbidities in both waves. Body mass index over 25 and presence of bilateral pneumonia were common findings. Univariate logistic regression analyses revealed an association of a number of blood parameters with the subsequent illness progression and severity in both waves. However, some remarkable differences were detected between both waves that prevented an accurate extrapolation of prediction models from the first wave into the second wave. Interleukin-6 and d-dimer concentrations at the time of hospital admission were remarkably higher in patients who developed a critical/fatal condition only during the first wave (p < 0.001), although both parameters significantly increased with disease worsening in follow-up studies from both waves. Multivariate analyses from wave 1 rendered a predictive signature for critical/fatal illness upon hospital admission that comprised six blood biomarkers: neutrophil-to-lymphocyte ratio (≥ 5; odds ratio, 2.684 [95% CI, 1.143–6.308]), C-reactive protein (≥ 15.2 mg/dL; odds ratio, 2.412 [95% CI, 1.006–5.786]), lactate dehydrogenase (≥ 411.96 U/L; odds ratio, 2.875 [95% CI, 1.229–6.726]), interleukin-6 (≥ 78.8 pg/mL; odds ratio, 5.737 [95% CI, 2.432–13.535]), urea (≥ 40 mg/dL; odds ratio, 1.701 [95% CI, 0.737–3.928]), and d-dimer (≥ 713 ng/mL; odds ratio, 1.903 [95% CI, 0.832–4.356]). The predictive accuracy of the signature was 84% and the area under the receiver operating characteristic curve was 0.886. When the signature was validated with data from wave 2, the accuracy was 81% and the area under the receiver operating characteristic curve value was 0.874, albeit most biomarkers lost their independent significance. Follow-up studies reassured the importance of monitoring the biomarkers included in the signature, since dramatic increases in the levels of such biomarkers occurred in critical/fatal patients over disease progression. Conclusions: Most parameters analyzed behaved similarly in the two waves of coronavirus disease 2019. However, univariate logistic regression conducted in both waves revealed differences in some parameters associated with poor prognosis in wave 1 that were not found in wave 2, which may reflect a different disease stage of patients on arrival to hospital. The six-biomarker predictive signature reported here constitutes a helpful tool to classify patient’s prognosis on arrival to hospital.

Resumen La Sociedad Espanola de Neumologia y Cirugia Toracica (SEPAR), a traves de las areas de Cirugia Toracica y de Oncologia Toracica, ha promovido la realizacion de un manual de recomendaciones para el diagnostico y el tratamiento del cancer de pulmon de celulas no pequenas. Las elevadas incidencia y mortalidad de esta patologia hacen necesaria una constante actualizacion de las mejores evidencias cientificas para su consulta por parte de los profesionales de la salud. Para su confeccion se ha contado con un amplio grupo de profesionales de distintas especialidades que han elaborado una revision integral, que se ha concretado en 4 apartados principales. En el primero se ha estudiado la prevencion y el cribado de la enfermedad, incluyendo los factores de riesgo, el papel de la deshabituacion tabaquica y el diagnostico precoz mediante programas de cribado. En un segundo apartado se ha analizado la presentacion clinica, los estudios de imagen y el riesgo quirurgico, incluyendo el cardiologico y la evaluacion funcional respiratoria. Un tercero trata sobre los estudios de confirmacion cito-histologica y de estadificacion, con un analisis de las clasificaciones TNM e histologica, metodos no invasivos y minimamente invasivos, asi como las tecnicas quirurgicas para el diagnostico y estadificacion. En un cuarto y ultimo capitulo se han abordado aspectos del tratamiento, como el papel de las tecnicas quirurgicas, la quimioterapia, la radioterapia, el abordaje multidisciplinar por estadios y otros tratamientos dirigidos frente a dianas especificas, terminando con recomendaciones acerca del seguimiento del cancer de pulmon y los tratamientos paliativos quirurgicos y endoscopicos en estadios avanzados.

Felipe Villar-Álvarez,1 Raúl Moreno-Zabaleta,2 Jose Joaquin Mira-Solves,3 Eduardo Calvo-Corbella,4 Salvador Díaz-Lobato,5 Fernando González-Torralba,6 Ascensión Hernando-Sanz,7 Sara Núñez-Palomo,8 Sergio Salgado-Aranda,9 Beatriz Simón-Rodríguez,10 Paz Vaquero-Lozano,11 Isabel María Navarro-Soler12On behalf of “Do not do in COPD” Working Group of the Madrid Society of Pulmonology and Thoracic Surgery (Neumomadrid)1Department of Pulmonology, IIS–Fundación Jiménez Díaz, CIBERES, UAM, 2Pulmonology, Inpatient and Noninvasive Mechanical Ventilation, Hospital Universitario Infanta Sofía, Madrid, 3Alicante-Sant Joan Health District, Alicante/Universidad Miguel Hernández Elche/REDISEC, 4Family and Community Medicine, CSU Pozuelo Estación, School of Medicine, UAM, 5Department of Pulmonology, Hospital Ramón y Cajal, Madrid, 6Pulmonology Section, Hospital Universitario del Tajo, Aranjuez, 7Department of Pulmonology, Hospital Universitario 12 de Octubre, 8C.S. Torrelaguna, 9Pulmonology Section, Hospital del Sureste, 10FisioRespiración-Respiratory Physiotherapy Unit, Escuela Universitaria Gimbernat Cantabria, 11S. Pulmonology, CEP Hnos. Sangro HGU Gregorio Marañón, Madrid, 12Calitè Research Group, Universidad Miguel Hernández de Elche, Elche, SpainBackground: To identify practices that do not add value, cause harm, or subject patients with chronic obstructive pulmonary disease (COPD) to a level of risk that outweighs possible benefits (overuse).Methods: A qualitative approach was applied. First, a multidisciplinary group of healthcare professionals used the Metaplan technique to draft and rank a list of overused procedures as well as self-care practices in patients with stable and exacerbated COPD. Second, in successive consensus-building rounds, description files were created for each “do not do” (DND) recommendation, consisting of a definition, description, quality of supporting evidence for the recommendation, and the indicator used to measure the degree of overuse. The consensus group comprised 6 pulmonologists, 2 general practitioners, 1 nurse, and 1 physiotherapist.Results: In total, 16 DND recommendations were made for patients with COPD: 6 for stable COPD, 6 for exacerbated COPD, and 4 concerning self-care.Conclusion: Overuse poses a risk for patients and jeopardizes care quality. These 16 DND recommendations for COPD will lower care risks and improve disease management, facilitate communication between physicians and patients, and bolster patient ability to provide self-care.Keywords: COPD, consensus, patient safety, quality assurance

Introduction: The advancement in the pathophysiology of COPD regarding inflammation has led to new questions and research lines.Our objectives were to establish new pathogenic mechanisms of COPD in stable and exacerbated phases, through inflammation and immunosuppression, and describe the role of arginase in these phases. Patients and Methods: Prospective and case control study with three groups: healthy subjects (15), COPD in stable phase (18) and COPD in exacerbated phase (14). This last one was reassessed 3 months later in stable phase and were included in the COPD stable group (total number: 32). Biometrical data, respiratory function and blood analytical data were obtained. Arginase activity in serum, total lymphocyte subpopulations count and CD3z expression were measured. Results: There were no differences between control group and stable COPD group regarding arginase activity but CD3z expression was lower in stable COPD group (p 0.081) Regarding control and exacerbated COPD group, arginase activity was higher in exacerbated COPD group (p 0.039). CD3z expression, CD3, CD4 and NK-CD56++ count were lower in the exacerbated COPD group (p Arginase activity was higher in exacerbated COPD group compared to stable COPD group (p 0.110). CD3z expression, CD3, CD4, CD8 and NK-CD56++ count were lower in exacerbated COPD group (p Conclusion: A trend towards higher values of arginase activity and lower CD3z expression was noted in COPD patients in stable and exacerbated phases.

Introduction: There are new prognostic classifications in COPD exacerbation, BAP-65 and DeCOPD. Our objective was to evaluate the usefulness of this severity predictive scores in COPD exacerbations in hospitalized patients and determinate their relation with other factors. Methods: One year observational retrospective study in hospitalized patients with COPD exacerbation. The patients were classified according to the severity predictive scores BAP-65 and DeCOPD. We measured average stay in hospital, readmission at first and third month, FEV1, Karnofsky Index, C reactive protein and peripheral eosinophilia. Results: 183 patients were included in our study, all of them with de diagnostic of COPD exacerbation. In BAP-65 score (I: 14,8%, II: 46,4%, III: 33,3%, IV: 5,5% and V:0%), the mean stay (days) was higher in groups with worse prognosis (IV: 7,1), readmissions at first and third month higher in IV (55,5% and 77,7%), FEV1 lower in I (44,4%), Karnofsky Index lower in IV (73), C reactive protein higher in IV (14,9mg/dl) and peripheral eosinophilia higher in I (1,6%). In DeCOPD score (mild: 30,6%, moderate: 54,7%, severe: 14,2% and very severe: 0,5%) the mean stay was higher in groups with worse prognosis (7,48 days), readmission at first and third month higher in severe group (53,8% and 57,6%), FEV1 lower in moderate group (44,1%), Karnofsky Index lower in severe group (74,4), C reactive protein higher in severe group (12,4mg/dl) and peripheral eosinophilia higher in moderate group (1,1%). Conclusion: In hospitalized patients with COPD exacerbation a worse prognosis in BAP-65 and DeCOPD scores was related with higher average stay, more readmissions, lower Karnofsky Index and higher C reactive protein.

Introduction: Inflammation, eosinophilia or FEV1 could play a role in readmissions after a COPD exacerbation. Our aim was to identify which factors could facilitate readmissions during the first and third month after a hospitalization by COPD exacerbation. Methods: One year observational retrospective study of hospitalized patients with COPD exacerbation. After hospital discharge we measured FEV1, Karnofsky Index, exacerbations (hospitalization or not) in the last year, GOLD and GesEPOC classifications, cardiovascular comorbidity, C reactive protein, peripheral eosinophilia and exacerbation severity scores BAP-65 and DeCOPD. Results: From 181 discharged patients with COPD exacerbation. The values at first month in 65 (36%) readmitted patients were: GOLD D (55%), GesEPOC exacerbator with enphysema (52%), BAP-65 II and moderate DeCOPD. In no readmitted patients were: GOLD D (39%), gesEPOC non-exacerbator (65%), BAP-65 II and moderate DeCOPD (53%). We observed differences (p 0,05). Conclusions: Readmissions at the first and third month were more frequent in GOLD D, exacerbators with emphysema, BAP-65 II and moderate DeCOPD. The number of previous hospitalizations, FEV1 and Karfnosky Index were the most related factors with readmissions.

INTRODUCTION: With the objective of reducing the rate of readmissions of discharged for COPD exacerbation, our chronic outpatient respiratory care unit (UCCRA) was created. METHODS: Observational study in which we compared data of patient included in UCCRA from January to October 2015 with patients with not home care, and with the patients included in UCCRA in the same period in 2014 with only telephone follow-up. Patients were admitted in UCCRA if they fit our criteria, based on our Readmission Risk Scale (RRS) that incorporates these variables: age, exacerbations (hospitalization or not) in the last year, FEV1, bacterial colonization, chronic bronchitis, Karnofsky index and cardiovascular comorbidity. Patients were included in UCCRA if they had suffered > 2 hospitalizations in the last year or > 7 points in our RRS. RESULTS: We included 399 patients, 234 patients were discharged after an exacerbation of COPD in 2015, with a mean age (MA) of 71.8 years, mean stay (MS) of 7.4 days and 13.3% of readmissions. 108 were included in UCCRA, who had significantly higher MS and previous exacerbations, reduced FEV1 and Karnofsky, and higher percentage of readmissions than not included (22.2 vs 6.3%). Patients with home care in 2015, compared with 2014 with telephone follow-up (165 patients, MA: 72.6, MS: 6.2), had more previous non-hospital exacerbations (p CONCLUSIONS: UCCRA with home care was valid to reduce readmissions in COPD patients, compared with telephone follow-up. Previous hospitalizations was the variable that better predict readmission.

Resumen Existen dos grandes ensayos clinicos realizados con la combinacion de budesonida-formoterol en la EPOC estable a largo plazo que han mostrado unos claros datos acerca de la eficacia de esta combinacion sobre la mejoria de la funcion pulmonar, los sintomas, la calidad de vida relacionada con la salud y sobre la reduccion del numero de exacerbaciones. Previamente a estos estudios, ya existia informacion acerca de la eficacia de sus monocomponentes sobre esta misma enfermedad, aunque los principales datos clinicos obtenidos con formoterol y budesonida por separado en el tratamiento de la EPOC provienen del estudio de las respectivas ramas de estos farmacos en los dos grandes ensayos clinicos que se describen en este articulo. Con respecto a la mejoria encontrada en las variables de funcion pulmonar (FEV1, FVC y PEF), siempre era mayor con la combinacion de budesonida-formoterol. La puntuacion obtenida en los cuestionarios de calidad de vida tambien fue mas favorable en las ramas de tratamiento combinado ya desde la primera semana de tratamiento y mantenida hasta los 12 meses de seguimiento, asi como en la mejoria de los sintomas y en el uso de medicacion de rescate. La frecuencia de exacerbaciones leves y graves, asi como el uso de corticoides orales, fue menor en el grupo tratado con budesonida-formoterol. De igual modo, el tiempo transcurrido hasta la primera exacerbacion tambien fue mas prolongado en este mismo grupo. En esta revision se ponen de manifiesto los principales hallazgos demostrados acerca de la eficacia de la combinacion de budesonida-formoterol en la EPOC estable.

Resumen La enfermedad pulmonar obstructiva cronica (EPOC) es una enfermedad frecuentemente asociada a la insuficiencia cardiaca (IC). El riesgo de desarrollar IC en los pacientes con EPOC es 4,5 veces superior al de los sujetos sin este trastorno. Distintos marcadores biologicos, entre los que se encuentran el peptido natriuretico tipo B y el fragmento N-terminal del propetpido natriuretico tipo B, pueden aumentar la sensibilidad y la especificidad del propio juicio clinico a la hora de establecer el diagnostico de IC en los pacientes con EPOC. La interpretacion correcta de las tecnicas de imagen (fundamentalmente el ecocardiograma) y de las pruebas de funcion pulmonar puede ayudar tambien a diagnosticar la concurrencia de ambos procesos. Existen pocas evidencias acerca del tratamiento combinado de la EPOC y la IC. Lo que es incuestionable es que el tratamiento de la EPOC puede influir en la evolucion clinica de la IC, y viceversa.

Chronic obstructive pulmonary disease (COPD) is commonly associated with heart failure. Individuals with COPD have a 4.5-fold greater risk of developing heart failure than those without. The sensitivity and specificity of clinical judgment in the diagnosis of heart failure in patients with COPD can be enhanced by biological markers such as B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide. Correct interpretation of imaging results (mainly echocardiographic findings) and lung function tests can also help establish the co-occurrence of both conditions. There is little evidence on the management of patients with COPD and heart failure, although treatment of COPD undeniably affects the clinical course of patients with heart failure and viceversa.