title: [Complexity in chronic obstructive pulmonary disease. Individualized treatment, new approaches, phenotypes and comorbidities].
abstract: The current definition and severity stages of chronic obstructive pulmonary disease (COPD) focus excessively on spirometric criteria alone. Measurement of chronic airflow obstruction and its degree of reversibility is complex. The etiology of this disease cannot be fully explained in relation to smoking and the heterogeneity of this systemic disease that affects mainly the lung cannot be expressed through forced expiratory volume in 1 second (FEV(1)) alone. This simplification was useful for a period but the loss of clinical subtlety in large studies hampers interpretation of their results and their conclusions lose external validity. Accepting the complexity of COPD requires substituting the analytic focus centered on FEV(1) for a multifaceted approach that integrates other aspects in the analysis of real COPD patients. Identifying and classifying clinically significant subgroups or "COPD phenotypes" may help to guide treatment more efficiently. In patients with COPD, mortality due to cardiovascular diseases or malignancies occurs earlier than that due to respiratory causes; that is, deaths from COPD occur in patients not succumbing to cardiovascular diseases or cancer. To prolong survival in these patients, comorbidity should be evaluated and treated. COPD treatment based on severity measured by lung function can no longer be recommended. The various therapeutic options should be individualized according to the patient's other characteristics.
authors: Servicio de Medicina Interna, Hospital Universitario Río Hortega, Valladolid, España. escudero@med.uva.es
authors: J C
authors: JC
authors: Martín-Escudero