Actualización 2021 de la guía española de la EPOC (GesEPOC). Diagnóstico y tratamiento del síndrome de agudización de la EPOC

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Actualización 2021 de la guía española de la EPOC (GesEPOC). Diagnóstico y tratamiento del síndrome de agudización de la EPOC

Publicated to:ARCHIVOS DE BRONCONEUMOLOGIA. 58 (2): 159-170 - 2022-02-14 58(2), DOI: 10.1016/j.arbres.2021.05.011

Authors: Soler-Cataluna, Juan Jose; Pinera, Pascual; Antonio Trigueros, Juan; Calle, Myriam; Casanova, Ciro; Cosio, Borja G; Lopez-Campos, Jose Luis; Molina, Jesus; Almagro, Pere; Gomez, Jose-Tomas; Antonio Riesco, Juan; Simonet, Pere; Rigau, David; Soriano, Joan B; Ancochea, Julio; Miravitlles, Marc

Affiliations

CENTRO COCHRANE IBEROAMERICANO - Author

Centro de Investigacion Biomedica en Red de Enfermedades Respiratorias - Author

Centro de Salud de Nájera - Author

Centro de Salud Francia - Author

Centro de Salud Menasalbas - Author

CIBER Enfermedades Resp CIBERES, Madrid, Spain - Author

Ctr Cochrane Iberoamer, Barcelona, Spain - Author

Ctr Salud Menasalbas, Toledo, Spain - Author

Ctr Salud Najera, Najera, La Rioja, Spain - Author

Direcc Asistencial Oeste, Ctr Salud Francia, Madrid, Spain - Author

Hosp Arnau de Vilanova Lliria, Serv Neumol, Valencia, Spain - Author

Hosp Gen Univ Reina Sofia, Serv Urgencias, Murcia, Spain - Author

Hosp San Pedro Alcantara, Serv Neumol, Caceres, Spain - Author

Hosp Univ Mutua Terrassa, Serv Med Interna, Barcelona, Spain - Author

Hosp Univ Son Espases IdISBa, Serv Neumol, Palma de Mallorca, Spain - Author

Hosp Univ Vall dHebron, Vall dHebron Inst Recerca VHIR, Serv Neumol, Vall dHebron Barcelona Hosp Campus, Barcelona, Spain - Author

Hospital Arnau de Vilanova - Author

Hospital General Universitario Reina Sofia - Author

Hospital San Pedro de Alcántara - Author

Hospital Universitario de la Princesa - Author

Hospital Universitario Nuestra Senora de Candelaria - Author

Hospital Universitario Son Espases - Author

HOSPITAL UNIVERSITARIO VIRGEN DEL ROCIO - Author

Inst Univ Invest Atencio Primaria Jordi Gol IDIAP, Ctr Salud Viladecans 2, Direcc Atenc Primaria Costa Ponent, Inst Catala Salut, Barcelona, Spain - Author

Institut dInvestigació en Atenció Primària Jordi Go - Author

Mutua de Terrassa - Author

Univ Autonoma Madrid, Hosp Univ La Princesa, Serv Neumol, Madrid, Spain - Author

Univ Barcelona, Dept Ciencies Clin, Barcelona, Spain - Author

Univ Complutense Madrid, Inst Invest Sanitaria Hosp Clin San Carlos IdISSC, Dept Med, Fac Med,Serv Neumol,Hosp Clin San Carlos, Madrid, Spain - Author

Univ La Laguna, Serv Neumol, Unidad Invest, Hosp Univ Nuestra Senora de La Candelaria, Tenerife, Spain - Author

Univ Seville, Hosp Univ Virgen del Rocio, Inst Biomed Sevilla IBiS, Unidad Med Quirurg Enfermedades Resp, Seville, Spain - Author

Universidad Complutense de Madrid, Facultad de Medicina - Author

Vall d'Hebron Institut de Recerca - Author

Abstract

This article details the GesEPOC 2021 recommendations on the diagnosis and treatment of COPD exacerbation syndrome (CES). The guidelines propose a definition-based syndromic approach, a new classification of severity, and the recognition of different treatable traits (TT), representing a new step toward personalized medicine. The evidence is evaluated using GRADE methodology, with the incorporation of 6 new PICO questions. The diagnostic process comprises four stages: 1) establish a diagnosis of CES, 2) assess the severity of the episode, 3) identify the trigger, and 4) address TTs. This diagnostic process differentiates an outpatient approach, that recommends the inclusion of a basic battery of tests, from a more comprehensive hospital approach, that includes the study of different biomarkers and imaging tests. Bronchodilator treatment for immediate relief of symptoms is considered essential for all patients, while the use of antibiotics, systemic corticosteroids, oxygen therapy, and assisted ventilation and the treatment of comorbidities will vary depending on severity and possible TTs. The use of antibiotics will be indicated particularly if sputum color changes, when ventilatory assistance is required, in cases involving pneumonia, and in patients with elevated C-reactive protein (≥ 20 mg/L). Systemic corticosteroids are recommended in CES that requires admission and are suggested in moderate CES. These drugs are more effective in patients with blood eosinophil counts ≥ 300 cells/mm3. Acute-phase non-invasive mechanical ventilation is specified primarily for patients with CES who develop respiratory acidosis despite initial treatment.

Keywords

agudizaciónconsequencescopddecaf scoreexacerbationhospital mortalitynasal high-flowrasgos tratablesrespiratory-failuresíndromesyndrometherapytreatable traitsvalidationventilationCopdEnfermedad pulmonar obstructiva cronicaExacerbationObstructive pulmonary-diseaseSyndromeTreatable traits

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Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal ARCHIVOS DE BRONCONEUMOLOGIA due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2022, it was in position 10/66, thus managing to position itself as a Q1 (Primer Cuartil), in the category Respiratory System.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 9.85. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 14, 2024)

This information is reinforced by other indicators of the same type, which, although dynamic over time and dependent on the set of average global citations at the time of their calculation, consistently position the work at some point among the top 50% most cited in its field:

Weighted Average of Normalized Impact by the Scopus agency: 13.17 (source consulted: FECYT Feb 2024)
Field Citation Ratio (FCR) from Dimensions: 16.01 (source consulted: Dimensions Jun 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-06-26, the following number of citations:

WoS: 40
Scopus: 54
OpenCitations: 27

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