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      Tratamiento antibiótico oral de la exacerbación de la EPOC. Más allá de la COVID-19 Translated title: Oral antibiotic treatment of exacerbation of COPD. Beyond COVID-19

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          RESUMEN

          La enfermedad pulmonar obstructiva crónica (EPOC) incluye a los pacientes con bronquitis crónica y/o enfisema que tienen en común a presencia de una obstrucción crónica y progresiva al flujo aéreo, con clínica de disnea y cuya historia natural se ve modificada por episodios agudos de exacerbaciones. La exacerbación (EAEPOC) se define como un episodio agudo de inestabilidad clínica caracterizado por un empeoramiento mantenido de síntomas respiratorios. Es necesario distinguir una nueva EAEPOC de un fracaso terapéutico previo o de una recaída. Las EAEPOC se hacen con el tiempo más frecuentes e intensas deteriorando la función pulmonar y la calidad de vida. El diagnóstico de una EAEPOC consta de 3 pasos esenciales: a) diagnóstico diferencial; b) establecer la gravedad, y c) identificar su etiología. La principal causa las agudizaciones es la infección, tanto bacteriana como viral. Los antibióticos están especialmente indicados en las EAEPOC grave y la presencia de esputo purulento. Los betalactámicos (amoxicilina-clavulánico y cefditoreno) y las fluoroquinolonas (levofloxacino) son los antimicrobianos más utilizados. Esta revisión realiza una actualización del problema de la exacerbación aguda con origen infeccioso desde una perspectiva de la etiología, resistencias a los antimicrobianos, estudios microbiológicos, la estratificación del riesgo y el manejo antimicrobiano. Se analiza el riesgo, pronóstico y características de los pacientes con EPOC que desarrollan COVID19.

          ABSTRACT

          COPD (chronic obstructive pulmonary disease) includes patients with chronic bronchitis and / or emphysema who have in common the presence of a chronic and progressive airflow obstruction, with symptoms of dyspnea and whose natural history is modified by acute episodes of exacerbations. Exacerbation (EACOPD) is defined as an acute episode of clinical instability characterized by a sustained worsening of respiratory symptoms. It is necessary to distinguish a new EACOPD from a previous treatment failure or a relapse. EACOPD become more frequent and intense over time, deteriorating lung function and quality of life. The diagnosis of EACOPD consists of 3 essential steps: a) differential diagnosis; b) establish the severity, and c) identify its etiology. The main cause of exacerbations is infection, both bacterial and viral. Antibiotics are especially indicated in severe EACOPD and the presence of purulent sputum. Beta-lactams (amoxicillin-clavulanate and cefditoren) and fluoroquinolones (levofloxacin) are the most widely used antimicrobials. This review updates the problem of acute exacerbation with infectious origin from the perspective of etiology, antimicrobial resistance, microbiological studies, risk stratification, and antimicrobial management. The risk, prognosis and characteristics of COPD patients who develop COVID19 are analyzed.

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          ACE-2 Expression in the Small Airway Epithelia of Smokers and COPD Patients: Implications for COVID-19

          The World Health Organization (WHO) has declared coronavirus disease 2019 (COVID-19) as a pandemic [1]. COVID-19 is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). COVID-19 displays symptoms ranging from mild to severe (pneumonia) that can lead to death in some individuals [2–4]. As of March 24, 2020, there have been 422 566 cases of COVID-19 worldwide and 18 887 deaths [5]. SARS-CoV-2 uses the angiotensin converting enzyme II (ACE-2) as the cellular entry receptor [6]. While the virus can infect individuals of any age, to date, most of the severe cases have been described in those over the age of 55 years and with significant co-morbidities such as chronic obstructive pulmonary disease (COPD) [7]. Here, we determined whether patients with COPD have increased expression of ACE-2 in bronchial epithelial cells in lower respiratory tract.
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            Prevalence, Severity and Mortality associated with COPD and Smoking in patients with COVID-19: A Rapid Systematic Review and Meta-Analysis

            Background Coronavirus disease 2019 (COVID-19) is an evolving infectious disease that dramatically spread all over the world in the early part of 2020. No studies have yet summarized the potential severity and mortality risks caused by COVID-19 in patients with chronic obstructive pulmonary disease (COPD), and we update information in smokers. Methods We systematically searched electronic databases from inception to March 24, 2020. Data were extracted by two independent authors in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study quality was assessed using a modified version of the Newcastle-Ottawa Scale. We synthesized a narrative from eligible studies and conducted a meta-analysis using a random-effects model to calculate pooled prevalence rates and 95% confidence intervals (95%CI). Results In total, 123 abstracts were screened and 61 full-text manuscripts were reviewed. A total of 15 studies met the inclusion criteria, which included a total of 2473 confirmed COVID-19 patients. All studies were included in the meta-analysis. The crude case fatality rate of COVID-19 was 7.4%. The pooled prevalence rates of COPD patients and smokers in COVID-19 cases were 2% (95% CI, 1%–3%) and 9% (95% CI, 4%–14%) respectively. COPD patients were at a higher risk of more severe disease (risk of severity = 63%, (22/35) compared to patients without COPD 33.4% (409/1224) [calculated RR, 1.88 (95% CI, 1.4–2.4)]. This was associated with higher mortality (60%). Our results showed that 22% (31/139) of current smokers and 46% (13/28) of ex-smokers had severe complications. The calculated RR showed that current smokers were 1.45 times more likely [95% CI: 1.03–2.04] to have severe complications compared to former and never smokers. Current smokers also had a higher mortality rate of 38.5%. Conclusion Although COPD prevalence in COVID-19 cases was low in current reports, COVID-19 infection was associated with substantial severity and mortality rates in COPD. Compared to former and never smokers, current smokers were at greater risk of severe complications and higher mortality rate. Effective preventive measures are required to reduce COVID-19 risk in COPD patients and current smokers.
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              The impact of COPD and smoking history on the severity of COVID‐19: A systemic review and meta‐analysis

              Abstract Comorbidities are associated with the severity of coronavirus disease 2019 (COVID‐19). This meta‐analysis aimed to explore the risk of severe COVID‐19 in patients with pre‐existing chronic obstructive pulmonary disease (COPD) and ongoing smoking history. A comprehensive systematic literature search was carried out to find studies published from December 2019 to 22 March 2020 from five databases. The languages of literature included English and Chinese. The point prevalence of severe COVID‐19 in patients with pre‐existing COPD and those with ongoing smoking was evaluated with this meta‐analysis. Overall 11 case series, published either in Chinese or English language with a total of 2002 cases, were included in this study. The pooled OR of COPD and the development of severe COVID‐19 was 4.38 (fixed‐effects model; 95% CI: 2.34‐8.20), while the OR of ongoing smoking was 1.98 (fixed‐effects model; 95% CI: 1.29‐3.05). There was no publication bias as examined by the funnel plot and Egger's test (P = not significant). The heterogeneity of included studies was moderate for both COPD and ongoing smoking history on the severity of COVID‐19. COPD and ongoing smoking history attribute to the worse progression and outcome of COVID‐19.
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                Author and article information

                Journal
                Rev Esp Quimioter
                Rev Esp Quimioter
                Sociedad Española de Quimioterapia
                Revista Española de Quimioterapia
                Sociedad Española de Quimioterapia
                0214-3429
                1988-9518
                17 September 2021
                2021
                : 34
                : 5
                : 429-440
                Affiliations
                [1 ]Servicio de neumología. Hospital Universitario “Príncipe de Asturias” Alcalá de Henares. Hospitales Vithas Madrid
                [2 ]Servicio de neumología. Hospital Universitario de Guadalajara. Universidad de Alcalá.
                Author notes
                Correspondencia: José Miguel Rodríguez González-Moro Servicio de neumología. Hospital Universitario Príncipe de Asturias Campus Universitario. Alcalá de Henares E-mail: rodriguezgmjm@ 123456vithas.es
                Article
                revespquimioter-34-429
                10.37201/req/125.2021
                8638829
                34533020
                9875266a-d393-44b7-b391-30234f837f89
                © The Author 2021

                Published by Sociedad Española de Quimioterapia. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)( https://creativecommons.org/licenses/by-nc/4.0/).

                History
                : 06 September 2021
                : 10 September 2021
                Categories
                Revisión

                epoc,exacerbación,antimicrobianos,resistencias,cefditoreno,fluoroquinolonas,covid-19,copd,exacerbation,antimicrobials,resistance,cefditoren,fluoroquinolones

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