title: A new approach to grading and treating COPD based on clinical phenotypes: summary of the Spanish COPD guidelines (GesEPOC).
abstract: After the development of the COPD Strategy of the National Health Service in Spain, all scientific societies, patient organisations, and central and regional governments formed a partnership to enhance care and research in COPD. At the same time, the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) took the initiative to convene the various scientific societies involved in the National COPD Strategy and invited them to participate in the development of the new Spanish guidelines for COPD (Guía Española de la EPOC; GesEPOC). Probably the more innovative approach of GesEPOC is to base treatment of stable COPD on clinical phenotypes, a term which has become increasingly used in recent years to refer to the different clinical forms of COPD with different prognostic implications. The proposed phenotypes are: (A) infrequent exacerbators with either chronic bronchitis or emphysema; (B) overlap COPD-asthma; (C) frequent exacerbators with emphysema predominant; and (D) frequent exacerbators with chronic bronchitis predominant. The assessment of severity has also been updated with the incorporation of multidimensional indices. The severity of the obstruction, as measured by forced expiratory volume in 1 second, is essential but not sufficient. Multidimensional indices such as the BODE index have shown excellent prognostic value. If the 6-minute walking test is not performed routinely, its substitution by the frequency of exacerbations (BODEx index) provides similar prognostic properties. This proposal aims to achieve a more personalised management of COPD according to the clinical characteristics and multidimensional assessment of severity.
authors: Servei de Pneumologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain. marcm@separ.es
authors: Marc
authors: M
authors: Miravitlles
authors: Juan José
authors: JJ
authors: Soler-Cataluña
authors: Myriam
authors: M
authors: Calle
authors: Jesús
authors: J
authors: Molina
authors: Pere
authors: P
authors: Almagro
authors: José Antonio
authors: JA
authors: Quintano
authors: Juan Antonio
authors: JA
authors: Trigueros
authors: Pascual
authors: P
authors: Piñera
authors: Adolfo
authors: A
authors: Simón
authors: Juan Antonio
authors: JA
authors: Riesco
authors: Julio
authors: J
authors: Ancochea
authors: Joan B
authors: JB
authors: Soriano
mesh_terms: D003663:Decision Trees; D006801:Humans; D010641:Phenotype; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000235:genetics / Q000628:therapy*; D012720:Severity of Illness Index