RESUMEN
COPD is a slowly progressive chronic respiratory disease causing an irreversible decrease in air flow. The main cause is smoking, which provokes inflammatory phenomena in the respiratory tract. COPD is a serious public health issue, causing high morbidity, mortality and disability. Related comorbidities are linked to ageing, common risk factors and genetic predispositions. A combination of comorbidities increases healthcare costs. For instance, patients with more than two comorbidities represent a quarter of all COPD sufferers but account for half the related health costs. Our review describes different comorbidities and their impact on the COPD prognosis. The comorbidities include: cardiovascular diseases, osteoporosis, denutrition, obesity, ageing, anemia, sleeping disorders, diabetes, metabolic syndrome, anxiety-depression and lung cancer. The prognosis worsens with one or more comorbidities. Clinicians are faced with the challenge of finding practical and appropriate ways of treating these comorbidities, and there is increasing interest in developing a global, multidisciplinary approach to management. Managing this chronic disease should be based on a holistic, patient-centred approach and smoking cessation remains the key factor in the care of COPD patients.
Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Anemia/complicaciones , Anemia/terapia , Trastornos de Ansiedad/complicaciones , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/terapia , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/terapia , Depresión/complicaciones , Depresión/diagnóstico , Depresión/terapia , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/terapia , Humanos , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/terapia , Desnutrición/complicaciones , Desnutrición/terapia , Síndrome Metabólico/complicaciones , Síndrome Metabólico/terapia , Obesidad/complicaciones , Obesidad/terapia , Osteoporosis/complicaciones , Osteoporosis/terapia , Apnea Obstructiva del Sueño/complicaciones , Apnea Obstructiva del Sueño/terapiaRESUMEN
Since 1970, 168 patients, mostly of the obstructive type, received an apparatus of assisted ventilation at home, according to the degree of their hypoxia-hypercapnia, following one or several acute failures. Oral ventilation, at a daily minimum of 90 min, distributed in 4 to 8 sessions, was continued for variable duration, from 1 to 5 years. The results, analysed statistically for 40 subjects, show a blood-gas improvement greater in patients whose PaO2, PaCO2 and RV/TC ratio were initially lower. For 17 patients controlled before and after assisted ventilation at home, a reduction in the number of days of hospitalization and acute failures was observed. The cost involved was particulary economical because of the simplicity of the equipment and the possibilities of control of patients and apparatus at the C.H.U. (20 F monthly in 1977 for 145 selected patients).