Introducción: La enfermedad pulmonar obstructiva crónica (EPOC) es una enfermedad heterogénea, compleja y multicomponente, caracterizada por la presencia de limitación del flujo aéreo pobremente reversible, cuya clínica, presentación funcional y radiológica varía de un paciente a otro, a pesar de existir un grado similar de obstrucción. En la actualidad se usa el concepto de los fenotipos clínicos en la EPOC para su diferenciación, lo que se relaciona con consecuencias clínicas relevantes, tales como síntomas, exacerbaciones, respuesta al tratamiento, progresión de la enfermedad o muerte. Objetivos: Determinar los fenotipos clínicos de EPOC en los pacientes que acudieron a consulta externa del Servicio de Neumología del Hospital Daniel Alcides Carrión durante el mes de enero del 2016. Diseño: Estudio descriptivo transversal. Lugar: Consultorio externo del Servicio de Neumología, Hospital Nacional Daniel Alcides Carrión. Participantes: 58 pacientes diagnosticados con EPOC, con una muestra de 51 pacientes. Intervenciones: Toda la información fue obtenida de historias clínicas. Para la clasificación en fenotipos se usó las guías GesEPOC .Principales medidas de resultados: Fenotipos clínicos en la EPOC. Resultados: De 51 pacientes se registraron 10 en el fenotipo agudizador (20%), 13 pacientes (25.5%) en el fenotipo mixto EPOC-asma, 12 pacientes (24%) en el fenotipo enfisema-hiperinsuflado y 16 pacientes (31%) en el fenotipo bronquitis crónica. Conclusiones: En los pacientes se observaron cuatro tipos de fenotipos, siendo el de mayor frecuencia el de bronquitis crónica, Se evidenció un aumento de la población masculina en el fenotipo agudizador y de la población femenina en el fenotipo bronquitis crónica. Palabras clave: EPOC, fenotipo, HNDAC. / --- Introduction: Chronic obstructive pulmonary disease (COPD) is a complex multicomponent heterogeneous disease characterized by the presence of poorly reversible limitation of airflow, whose clinical, functional and radiological presentation varies greatly from one patient to another. Nowadays we use the concept of clinical phenotypes in COPD to differentiate individuals with this disease, it is related to relevant issues, such as symptoms, exacerbations, response to treatment, disease progression or death. Objectives: Objectives: To determine the dominant clinical phenotype in patients with COPD of Daniel Alcides Carrión Hospital during the month of January 2016. Design: A crosssectional descriptive study. Setting: The pulmonology medical office of Daniel Alcides Carrion Hospital. Participants: 58 patients diagnosed with COPD, with a sample of 51 patients. Interventions: All information was obtained from medical records. To classify phenotypes were used GesEPOC guidelines. Main outcome measures: clinical phenotypes in COPD. Results: Of 51 patients, 10 are distributed in the exacerbator phenotype (20%), 13 patients (25.5%) in mixed phenotype COPD-asthma, in the phenotype emphysemahyperinflation a total of 12 patients were enrolled (24% ) and chronic bronchitis phenotype in 16 patients (31%) with main symptom cough associated with expectoration. Conclusions: Four types of phenotype were observed in patients registered; being the dominant type chronic bronchitis phenotype. There was an increase in the male population in the exacerbator phenotype and female population in chronic bronchitis phenotype Keywords: COPD, phenotype, HNDAC / Tesis

[pt] A noradrenalina desempenha um papel central em diversos transtornos relacionados ao medo, como o transtorno de ansiedade generalizada (TAG). Estudos farmacológicos em humanos e animais mostraram que os comportamentos relacionados ao medo podem ser regulados pela aplicação sistêmica de drogas noradrenérgicas. No entanto, as diferenças individuais na ansiedade-traço são frequentemente negligenciadas ao estudar os efeitos não apenas de drogas noradrenérgicas, mas de outros compostos. No presente estudo, examinamos os efeitos da ioimbina, um antagonista do receptor alfa2-adrenérgico, em duas linhagens de ratos criados para respostas de alto e baixo congelamento à pistas contextuais previamente associadas a choques nos pés (ratos Carioca de Alto e Baixo Congelamento - CAC e CBC, respectivamente). Descobrimos que a administração sistêmica de ioimbina no segundo dia de condicionamento do medo contextual (sessão de teste) diminuiu significativamente as respostas de congelamento de fêmeas CAC, mas não de machos. No entanto, o tratamento com ioimbina induziu um aumento significativo no comportamento de congelamento de ratos CBC machos e fêmeas. Resultados semelhantes foram observados quando os grupos foram novamente expostos à mesma câmara de condicionamento 6 dias depois. Nossos resultados indicam que, embora a ioimbina leve a efeitos ansiolíticos em ratos CAC, ela tem um efeito ansiogênico nos ratos CBC. Entretanto, esse efeito foi mais evidente nas fêmeas do que nos machos. Nossas descobertas apontam para o papel da noradrenalina na regulação e mediação das respostas de medo em diferentes traços de ansiedade. Além disso, nossos resultados também ressaltam a relevância do uso de ambos os sexos em estudos comportamentais e farmacológicos usando modelos animais de transtornos de ansiedade. / [en] Norepinephrine plays a central role in several fear-related disorders, such as generalized anxiety disorder (GAD). Pharmacological studies in humans and animals have shown that fear-related behaviors can be regulated by the systemic application of noradrenergic drugs. However, individual differences in trait anxiety are often overlooked when studying the effects of not only noradrenergic drugs, but other compounds. In the present study we examined the effects of yohimbine, an alpha2-adrenergic receptor antagonist, in two lines of rats bred for high and low freezing responses to contextual cues previously associated with footshocks (Carioca high- and low-conditioned freezing rats - CHF and CLF, respectively). We found that systemic administration of yohimbine on the second day of contextual fear conditioning (test session) significantly decreased the freezing responses of CHF females, but not CHF males. Yet, yohimbine treatment induced a significant increase in freezing behavior of both male and female CLF rats. Similar results were observed when groups were re-exposed to the same conditioning chamber 6 days later. Our findings indicate that while yohimbine leads to anxiolytic effects on CHF rats, it has an anxiogenic effect on CLF ones. However, such effect was more evident in females than in males. Our findings point to the role of norepinephrine in regulating and mediating fear responses in different anxiety traits. Furthermore, our findings also underscore the relevance of using both sexes in behavioral and pharmacological studies using animal models of anxiety disorders.