Conferencia en XII Reunión de la Sociedad Aragonesa del Aparato Respiratorio (SADAR), Calatayud, 11/12 de Noviembre 2016

1. 1
DE
VUELTAS
CON
EL
FUTURO
Dr.
Josep
Morera

2. 2
“Nunca hago predicciones y nunca las
haré”
Paul Gascoigne
De
vueltas
con
el
futuro

3. 3
Eriksen M. Judith Mackay Hana Ross EL ATLAS
DEL TABACO cuarta edición.
http://www.tobaccoatlas.org/uploads/Images/PDFs/
TA4Spanish.pdf
!
De
vueltas
con
el
futuro

4. 4
The
art
of
medicine
The
cigareDe
catastrophe
conEnues
The
lancet
Vol
385
March14,2015
Robert
N
Proctor
De
vueltas
con
el
futuro

5. 5
Manila
(Filipinas)
31
octubre
2011
Nace
Danica
May
Manila
Camacho.
la
ciudadana
número
7mil
millones
del
planeta
Sarajevo(Bosnia)
13
octubre,
1999
Nace
Adnan
Nevic,
el
ciudadano
número
6
mil
millones
De
vueltas
con
el
futuro
¡Que
es
la
demograUa!

6. 6
! !
! !
El mundo en 2050.Todas las tendencias que cambiaran el planeta
(The Economist).ed Franklin D. y Andrews J. 2012
¡Que
es
la
demograUa!
De
vueltas
con
el
futuro

7. 7
Noncommunicable
Diseases
David
J.
Hunter,
M.B.,
B.S.,
M.P.H.,
Sc.D.,
and
K.
Srinath
Reddy,
M.D.,
D.M.N
New
Engl
J
Med
2013;
369:1336-­‐1343
October
3,
2013
!
!
De
vueltas
con
el
futuro

8. 8
N
Engl
J
Med.
2013
Jan
24;368(4):351-­‐64
De
vueltas
con
el
futuro

9. 9
N
Engl
J
Med.
2013
Jan
24;368(4):341-­‐50
De
vueltas
con
el
futuro

10. 10
Smoking
and
Mortality
—
Beyond
Established
Causes
Brian
D.
Carter,
ChrisXan
C.
Abnet,
Diane
Feskanich,
Neal
D.
Freedman.,
Patricia
Hartge,
Sc.D.,
Cora
E.
Lewis,
M.D.,
Judith
K.
Ockene,
Ross
L.
PrenXce.,
Frank
E.
Speizer,,
Michael
J.
Thun,
and
Eric
J.
Jacobs.
N
Engl
J
Med
2015;
372:
February
12,
In
conclusion,
this
comprehensive
examinaXon
of
cause-­‐specific
mortality
in
a
large
contemporary
populaXon
idenXfied
associaXons
between
smoking
and
increased
mortality
from
several
diseases
that
are
not
currently
established
as
caused
by
smoking.
Although
these
associaXons
should
be
invesXgated
further,
our
results
suggest
that
the
number
of
persons
in
the
United
States
who
die
each
year
as
a
result
of
smoking
cigareaes
may
be
substanXally
greater
than
currently
esXmated.
De
vueltas
con
el
futuro

11. 11
Kiley
J,
Mockrin
S,
Lauer
M,
Mensah
GA,
Hoots
K,
Patel
Y,
Cook
NL,
Paaerson
AP,
Gibbons
GH.
Am
J
Respir
Crit
Care
Med
2015;191:489–491.
The
NHLBI
in
2025:
What
If
.
.
.
Imagine
a
world
where
we
are
able
to
prevent
and
preempt
the
burden
of
cardiovascular,
lung,
and
blood
diseases;
a
world
where
we
are
able
to
capture
the
promise
of
personalized
precision
medicine,
where
each
person
receives
the
right
treatment,
tailored
to
their
needs,
at
the
right
Xme.
In
this
new
world,
what
if
we
were
able
to
realize
a
stroke-­‐free
generaXon
of
individuals
living
with
sickle
cell
disease
(SCD),
what
if
we
were
able
to
eliminate
health
inequiXes
(both
domesXc
and
global)
with
effecXve
and
rapid
uptake
of
evidence-­‐based
pracXces
and
tools,
and
what
if
we
could
expand
the
fronXers
of
scienXfic
knowledge
and
revoluXonize
how
we
diagnose,
prevent,
and
treat
disease
by
leveraging
the
power
of
big
scienXfic
data
systems?
This
vision
is
not
merely
a
collecXon
of
idle
dreams;
the
boundless
possibiliXes
of
this
bold
new
world
are
well
within
our
reach.
De
vueltas
con
el
futuro

12. 12
To
the
Editor:
In
their
nice
editorial
in
the
March
issue
of
the
Journal,
Kiley
and
colleagues
(1)
list
the
strategic
prioriXes
and
procedures
of
the
NaXonal
Heart,
Lung,
and
Blood
InsXtute
(NHLBI)
to
streamline
human
health
research
up
to
2025.
From
a
historical
perspecXve,
we
all
recognize
the
significant
achievements
of
the
U.S.
NaXonal
InsXtutes
of
Health
and
the
NHLBI,
with
decades
of
success,
that
have
facilitated
breakthroughs
in
promoXng
health
and
fighXng
disease
by
funding
key
research
both
internally
and
extramurally,
including
internaXonally.
However,
we
were
surprised
that
the
(magical)
keyword
“tobacco”
was
not
menEoned
at
all
within
this
short
document,
so
anyone
might
wonder,
what
if
.
.
.
the
NHLBI
considers
tobacco?
Likely,
beyond
your
pages,
some
readers
in
the
sister,
simultaneous
publicaXons
in
the
American
Journal
of
Public
Health,
Blood,
CirculaXon,
or
the
Journal
of
the
American
College
of
Cardiology
might
consider
that
tobacco
affects
paXents
in
most
(all?)
respiratory
and
nonrespiratory
condiXons.
We
must
keep
reminding
ourselves
that
tobacco
is
the
first
and
foremost
causal,
avoidable
risk
factor
for
human
disease.
Perhaps
it
has
been
neglected
too
ojen
in
the
past
in
many
medical
venues
(2,
3).
Therefore,
the
NHLBI
should
welcome
iniXaXves
on
key
tobacco-­‐related
translaXonal
issues
as
well
as
on
the
efficacy
and
the
effecXveness
of
any
smoking
reducXon
and/or
avoidance
intervenXons,
in
addiXon
to
iniXaXves
on
any
other
risk
factors
to
help
define
smoking
issues
at
the
populaXon
and
individual
levels.
Well
past
the
so-­‐called
cigareae
century
(4),
tobacco
is
sXll
causally
linked
to
an
increasing
number
of
diseases
(5).
Although
there
have
been
some
recent
successes
in
the
West,
there
are
more
smokers
nowadays
than
ever
before
in
human
history,
causing
far
too
many
premature
deaths
and
disabiliXes
(6).
We
strongly
believe
that
research
drives
all
health
advocacy
and
that
the
final
soluXon
to
the
tobacco
problem
will
be
through
legislaXon
(7).
Rephrasing
the
introductory
paragraphs
of
the
editorial,
“Imagine
a
world
with
no
tobacco,
and
later,
perhaps
only
one
generaXon
ajer,
a
no-­‐tobacco-­‐related-­‐disease
world.”
Wouldn’t
it
be
nice?
We
can
set
this
objecXve
within
our
lifeXme,
and
certainly
we
will
parXcipate
in
this
process
(8).
Volume
191,
Issue
1(June
15,
2015)
Soriano
and
Morera
What
if
.
.
.
the
NaEonal
Heart,
Lung,
and
Blood
InsEtute
Considers
Tobacco?
Joan
B.
Soriano
M.D.
and
Josep
Morera
M.D.
De
vueltas
con
el
futuro

13. 13
De
vueltas
con
el
futuro

14. 14
FluEcasone
furoate
and
vilanterol
and
survival
in
chronic
obstrucEve
pulmonary
disease
with
heightened
cardiovascular
risk
(SUMMIT):
a
double-­‐blind
randomised
controlled
trial
Jorgen
Vestbo,
Julie
A
Anderson,
Robert
D
Brook,Peter
M
A
Calverley,
B.Celli,
Courtney
Crim,
Fernando
MarXnez,
Julie
Yates,
David
E
Newby,
on
behalf
of
the
SUMMIT
InvesXgators.
The
lancet.
April
2016
De
vueltas
con
el
futuro

15. 15
Indacaterol-­‐Glycopyrronium
versus
Salmeterol-­‐FluEcasone
for
COPD.
Wedzicha
JA1,
Banerji
D1,
Chapman
KR1,
Vestbo
J1,
Roche
N1,
Ayers
RT1,
Thach
C1,
Fogel
R1,
Patalano
F1,
Vogelmeier
CF1;
FLAME
InvesXgators.
N
Engl
J
Med.
2016
May
15
De
vueltas
con
el
futuro

16. 16
De
vueltas
con
el
futuro
Vestbo
J
et
al.
N
Engl
J
Med
2016;375:1253-­‐1260.
Treatment
Effect
on
Moderate
or
Severe
Exacerba

17. 17
De
vueltas
con
el
futuro

18. 18
De
vueltas
con
el
futuro

19. 19
Chest.
2012
Nov;142(5):1300-­‐7.
De
vueltas
con
el
futuro

20.
Emerging
IndicaEons
for
Extracorporeal
Membrane
OxygenaEon
in
Adults
with
Respiratory
Failure
Darryl
Abrams1
and
Daniel
Brodie1Annals
of
the
American
Thoracic
Society,
Vol.
10,
No.
4
(2013),
pp.
371-­‐377.
De
vueltas
con
el
futuro

21. De
vueltas
con
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futuro

22. 22
Butler
JP
et
al.
N
Engl
J
Med
2012;367:244-­‐247.
De
vueltas
con
el
futuro

23. 23
De
vueltas
con
el
futuro

24. Nanotechnology in respiratory
medicine
Omlor et al. Respiratory Research (2015)
De
vueltas
con
el
futuro

25. 25
The
Asthma–COPD
Overlap
Syndrome
Postma
DS,
Rabe
KF.
N
Engl
J
Med
2015;373:1241-­‐1249.
De
vueltas
con
el
futuro

26. 26
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vueltas
con
el
futuro

27. 27
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vueltas
con
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futuro

28. 28
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vueltas
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29. 29
De
vueltas
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CONCLUSIONES
1.-­‐
La
mortalidad
por
tabaquismo
seguirá
aumentando
en
todo
el
siglo
XXI
2.-­‐
Se
priorizan
las
medidas
terapéuXcas
sobre
las
medidas
prevenXvas
3.-­‐
El
tabaquismo,
la
obesidad
y
el
asma,
y
sus
patologías
relacionadas,
serán
nuestros
máximos
retos
en
el
futuro
4.-­‐
Los
grandes
avances
en
bioingeniería,
biotecnología,
y
genéXca
prometen
grandes
espectaXvas
en
un
futuro
próximo

30. 30