dc.creator | López-Campos Bodineau, José Luis | es |
dc.creator | Carrasco Hernández, L. | es |
dc.creator | Ruiz-Duque, B. | es |
dc.creator | Reinoso-Arija, R. | es |
dc.creator | Caballero-Eraso, C. | es |
dc.date.accessioned | 2022-11-22T15:36:54Z | |
dc.date.available | 2022-11-22T15:36:54Z | |
dc.date.issued | 2021-07-12 | |
dc.identifier.citation | López-Campos Bodineau, J.L., Carrasco Hernández, L., Ruiz-Duque, B., Reinoso-Arija, R. y Caballero-Eraso, C. (2021). Step-up and step-down treatment approaches for COPD: a holistic view of progressive therapies. International Journal of Chronic Obstructive Pulmonary Disease, 16, 2065-2076. https://doi.org/10.2147/COPD.S275943. | |
dc.identifier.issn | 1178-2005 | es |
dc.identifier.uri | https://hdl.handle.net/11441/139688 | |
dc.description.abstract | Recent advances in inhaled drugs and a clearer definition of the disease have
made the task of managing COPD more complex. Different proposals have been put forward
which combine all the available treatments and the different clinical presentations in an effort
to select the best therapeutic options for each clinical context. As COPD is a chronic
progressive disease, the escalation of therapy has traditionally been considered the most
natural way to tackle it. However, the notion of COPD as a constantly progressing disease
has recently been challenged and, in specific areas, this points to the possibility of a de escalation in treatment. In this context, the clinician requires simple, specific recommenda tions to guide these changes in treatment in their daily clinical practice. To accomplish this,
the first step must be a correct evaluation and an accurate initial preliminary diagnosis of the
patient’s condition. Thereafter, the first escalation in therapy must be introduced with caution
as the disease progresses, since clinical trials are not designed with clinical decision-making
in mind. During this escalation, three possibilities are open to change the current treatment
for a different one within the same family, to increase non-pharmacological interventions or
to increase the pharmacological therapies. Beyond that point, a patient with persistent
symptoms represents a complex clinical scenario which requires a specialized approach,
including the evaluation of different respiratory and non-respiratory comorbidities.
Unfortunately, there are few de-escalation studies available, and these are mainly observa tional in nature. The debate on de-escalation in pharmacological treatment, therefore,
involves two main discussion points: the withdrawal of bronchodilators and the withdrawal
of inhaled steroids. Altogether, the scheme for modifying treatment must be more persona lized than just adding molecules, and the therapeutic response and its conditioning factors
should be evaluated at each step before proceeding further. | es |
dc.format | application/pdf | es |
dc.format.extent | 12 p. | es |
dc.language.iso | eng | es |
dc.publisher | DOVE MEDICAL PRESS LTD | es |
dc.relation.ispartof | International Journal of Chronic Obstructive Pulmonary Disease, 16, 2065-2076. | |
dc.rights | Atribución-NoComercial 4.0 Internacional | * |
dc.rights.uri | http://creativecommons.org/licenses/by-nc/4.0/ | * |
dc.subject | COPD | es |
dc.subject | Escalation of treatment | es |
dc.subject | Pharmacological therapies | es |
dc.subject | Precision medicine | es |
dc.title | Step-up and step-down treatment approaches for COPD: a holistic view of progressive therapies | es |
dc.type | info:eu-repo/semantics/article | es |
dcterms.identifier | https://ror.org/03yxnpp24 | |
dc.type.version | info:eu-repo/semantics/publishedVersion | es |
dc.rights.accessRights | info:eu-repo/semantics/openAccess | es |
dc.contributor.affiliation | Universidad de Sevilla. Departamento de Medicina | es |
dc.relation.publisherversion | https://www.dovepress.com/step-up-and-step-down-treatment-approaches-for-copd-a-holistic-view-of-peer-reviewed-fulltext-article-COPD | es |
dc.identifier.doi | 10.2147/COPD.S275943 | es |
dc.journaltitle | International Journal of Chronic Obstructive Pulmonary Disease | es |
dc.publication.volumen | 16 | es |
dc.publication.initialPage | 2065 | es |
dc.publication.endPage | 2076 | es |