Changes in Control Status of COPD Over Time and Their Consequences: A Prospective International Study

Miravitlles, Marc; Śliwiński, Paweł; Rhee, Chin Kook; Costello, Richard W.; Carter, Victoria; Tan, Jessica; Lapperre, Thérèse S.; Alcázar, Bernardino; Gouder, Caroline; Esquinas, Cristina; García-Rivero, Juan Luis; Kemppinen, Anu; Tee, Augustine; Román-Rodríguez, Miguel; Soler-Cataluña, Juan José; Price, David

doi:10.1016/j.arbres.2020.06.003

Cited by 20 publications

(18 citation statements)

References 24 publications

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“…While our present study involved 142 diverse departments (primary medicine, internal medicine, general pneumology, and specialized COPD units), the previously cited studies were mainly carried out in specialized COPD units. 6,7,16 Factors significantly associated with clinical control of COPD were in concordance with those implicated in the disease severity. Low levels of physical activity are correlated with higher decline in lung function, risk of allcause mortality, and incidence of comorbidities, such as diabetes, cardiovascular diseases or depression.…”

Section: Discussionmentioning

confidence: 64%

“…Moreover, the proportion of controlled patients among mild/moderate cases (FEV 1 >50) was 64.2%. Miravitlles et al, 16 in a prospective, international, multicenter study aimed at determining the 6-month prognostic value of control status in 267 patients with COPD, revealed a proportion of controlled patients of 59.3% among severe cases, and 68.5% among mild/moderate ones. Soler-Cataluña et al, 7 in a prospective, multicenter, observational study designed to compare changes in control over a 3-month period with changes in risk level, GOLD stage, and clinical phenotype in 354 patients with COPD, the proportion of controlled patients among severe cases was 44.7% versus 56.1% in mild/moderate ones.…”

Section: Discussionmentioning

confidence: 99%

“…While our present study involved diverse departments (primary medicine, internal medicine, general pneumology, and specialized COPD units), the previously cited studies were mainly carried out in specialized COPD units. 6 , 7 , 16 …”

Section: Discussionmentioning

confidence: 99%

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Clinical Control Criteria to Determine Disease Control in Patients with Severe COPD: The CLAVE Study

Soler-Cataluña¹,

Almagro²,

Huerta³

et al. 2021

COPD

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Background: Clinical control in chronic obstructive pulmonary disease (COPD) has not been completely characterized. A proposal of clinical control criteria (CCC) has been recently defined and validated as a tool for determining control, but there is scarce information on patients with severe COPD. Objective: To evaluate clinical control in severe COPD using the CCC. Patients and Methods: The study design was observational, multicenter, cross-sectional study involving 4801 patients with severe COPD in Spain. Clinical control was defined according to clinical impact (dyspnea grade, use of rescue treatment in last week, sputum color, and daily physical activity) and stability (exacerbations in last 3 months and patient's perception about health status). Clinical control of COPD was alternatively evaluated with the COPD assessment test (CAT) and the presence of exacerbations in the last 3 months. Results: According to CCC, 61.0% of patients had low clinical impact, and 41.4% showed clinical stability. Overall, 29.9% of patients had both low clinical impact and stability (controlled), whereas 70.1% showed high clinical impact and/or no clinical stability (non-controlled). COPD control was also assessed by using only the definition of CAT≤16 and no exacerbations in the last 3 months. Results obtained with this definition were similar to those obtained by CCC, and the concordance between both definitions was high (Kappa index = 0.698). Conclusion: By using the CCC, approximately only one third of patients with severe COPD were considered as controlled. Physical activity, adherence to inhalers, age, postbronchodilator FEV 1 , age-adjusted Charlson comorbidity index, and healthcare level were independent factors associated with COPD control.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 99%

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Clinical Control Criteria to Determine Disease Control in Patients with Severe COPD: The CLAVE Study

Soler-Cataluña¹,

Almagro²,

Huerta³

et al. 2021

COPD

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“…We found that persistently controlled patients were younger, had less frequent chronic bronchitis, a lower degree of airflow obstruction, lower involvement in the diffusion test, a better quality of life as evaluated by the CAT and a higher level of peripheral eosinophilia. In previous studies [9,10,20,21], the presence of chronic bronchitis, female sex, lower BMI and a history of prior exacerbations were identified as variables that were significantly associated with poor control. In addition, poor lung function and worse health status were demonstrated to be the best predictors of the risk of future exacerbations and were associated with a significant increase in the risk of mortality [22].…”

Section: Table 3 Baseline Characteristics Of Longitudinal Clinical Control Patternsmentioning

confidence: 95%

“…BMI body mass index, FEV1 forced expiratory volume in 1 s, FVC forced vital capacity, K CO carbon monoxide transfer coefficient, Triple therapy long-acting beta-2 agonist (LAMA) with corticosteroids (ICS) with long-acting antimuscarinic agent (LAMA), LTOT long-term oxygen therapy, CAT COPD Assessment Test, HDAS Hospital Anxiety and Depression Scale a p < 0.001 persistently controlled compared with intermittently controlled b p < 0.001 persistently controlled compared with persistently uncontrolled c P ≤ 0.05 persistently uncontrolled compared with intermittently controlled d P < 0.05 persistently controlled compared with persistently uncontrolled e P ≤ 0.001 persistently uncontrolled compared with intermittently controlled f p ≤ 0.05 persistently controlled compared with intermittently controlled [20]. These results are not comparable to our analysis, where follow-up is greater.…”

Section: Table 3 Baseline Characteristics Of Longitudinal Clinical Control Patternsmentioning

confidence: 99%

COPD Clinical Control: predictors and long-term follow-up of the CHAIN cohort

et al. 2021

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Background Control in COPD is a dynamic concept that can reflect changes in patients’ clinical status that may have prognostic implications, but there is no information about changes in control status and its long-term consequences. Methods We classified 798 patients with COPD from the CHAIN cohort as controlled/uncontrolled at baseline and over 5 years. We describe the changes in control status in patients over long-term follow-up and analyze the factors that were associated with longitudinal control patterns and related survival using the Cox hazard analysis. Results 134 patients (16.8%) were considered persistently controlled, 248 (31.1%) persistently uncontrolled and 416 (52.1%) changed control status during follow-up. The variables significantly associated with persistent control were not requiring triple therapy at baseline and having a better quality of life. Annual changes in outcomes (health status, psychological status, airflow limitation) did not differ in patients, regardless of clinical control status. All-cause mortality was lower in persistently controlled patients (5.5% versus 19.1%, p = 0.001). The hazard ratio for all-cause mortality was 2.274 (95% CI 1.394–3.708; p = 0.001). Regarding pharmacological treatment, triple inhaled therapy was the most common option in persistently uncontrolled patients (72.2%). Patients with persistent disease control more frequently used bronchodilators for monotherapy (53%) at recruitment, although by the end of the follow-up period, 20% had scaled up their treatment, with triple therapy being the most frequent therapeutic pattern. Conclusions The evaluation of COPD control status provides relevant prognostic information on survival. There is important variability in clinical control status and only a small proportion of the patients had persistently good control. Changes in the treatment pattern may be relevant in the longitudinal pattern of COPD clinical control. Further studies in other populations should validate our results. Trial registration: Clinical Trials.gov: identifier NCT01122758.

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Spanish COPD guidelines (GesEPOC) 2021: Updated pharmacological treatment of stable COPD

Miravitlles

Calle

Molina

et al. 2021

Archivos de Bronconeumología (English Edition)

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Changes in Control Status of COPD Over Time and Their Consequences: A Prospective International Study

Abstract: The study was designed and coordinated by the Respiratory Effectiveness Group (REG; www.effectivenessevaluation.org; Cambridge, UK) and delivered by Optimum Patient Care (OPC; www.optimumpatientcare.org). Funding: The study was funded by an unrestricted grant from Novartis AG.

Cited by 20 publications

References 24 publications

Clinical Control Criteria to Determine Disease Control in Patients with Severe COPD: The CLAVE Study

Clinical Control Criteria to Determine Disease Control in Patients with Severe COPD: The CLAVE Study

COPD Clinical Control: predictors and long-term follow-up of the CHAIN cohort

Spanish COPD guidelines (GesEPOC) 2021: Updated pharmacological treatment of stable COPD

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