A new approach to grading and treating COPD based on clinical phenotypes: summary of the Spanish COPD guidelines (GesEPOC).

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.

Spanish COPD Guidelines (GesEPOC): pharmacological treatment of stable COPD. Spanish Society of Pulmonology and Thoracic Surgery.

Recognizing the clinical heterogeneity of COPD suggests a specific therapeutic approach directed by the so-called clinical phenotypes of the disease. The Spanish COPD Guidelines (GesEPOC) is an initiative of SEPAR, which, together with the scientific societies involved in COPD patient care, and the Spanish Patient Forum, has developed these new clinical practice guidelines. This present article describes the severity classification and the pharmacological treatment of stable COPD. GesEPOC identifies four clinical phenotypes with differential treatment: non-exacerbator, mixed COPD-asthma, exacerbator with emphysema and exacerbator with chronic bronchitis. Pharmacological treatment of COPD is based on bronchodilation in addition to other drugs depending on the clinical phenotype and severity. Severity is established by the BODE/BODEx multidimensional scales. Severity can also be approximated by assessing airflow obstruction, dyspnea, level of physical activity and history of exacerbations. GesEPOC is a new, more individualized approach to COPD treatment according to the clinical characteristics of the patients.

Perfil antropométrico das crianças atendidas no Programa Crescimento e Desenvolvimento no Centro de Saúde nº 1 da Regional de São Sebastião / Anthropometric Profile of Children Assisted by the Growth and Development Program of Centro de Saude 1 of the Sao Sebastiao Region

Foram estudadas 271 crianças no Centro de Saúde nº 01 da Regional de Saúde de São Sebastião atendidas no Programa Crescimento e Desenvolvimento, no período de outubro de 2003 a fevereiro de 2004, com idades entre 1 e 60 meses, para avaliar seu perfil antropométrico. Essa região foi escolhida em virtude de ser considerada um área de baixo poder aquisitivo de relativa fragilidade social. A análise foi realizada por meio das medidas de peso e estatura, correlacionando-as com idade, sexo e fatores socioecônomicos como aleitamento materno, renda per capita, densidade demográfica residencial e escolaridade materna. Foram utilizadas as seguintes avaliações do estado nutricional: critério de Gomez em crianças menores de 2 anos e os escores Z (Peso/Idade, Peso/Estatura e Estatura/Idade) para todas as idades. Para a comparação estatística entre o estado nutricional e os diferentes fatores de risco foi utilizado o teste qui-quadrado. Observou-se um elevado risco populacional para desnutrição, sendo que a proporção de crianças com défict estatural grave foi maior nas crianças com idade mais elevada. Esse fato reflete o grau de cronicidade da desnutrição encontrada na população do estudo. Dentre os fatores de risco avaliados, somente o sexo masculino mostrou-se estatisticamente significativo para desnutrição. Na análise do estudo, constatou-se que o risco de desnutrição aumentou com o crescer da idade e que, apesar da prevalência de desnutridos graves ser baixa, ela foi maior que a esperada.