Spanish COPD Guidelines (GesEPOC) 2017. Pharmacological Treatment of Stable Chronic Obstructive Pulmonary Disease

Miravitlles, Marc; Soler-Cataluña, Juan José; Calle, Myriam; Molina, Jesús; Almagro, Pere; Quintano, José Antonio; Trigueros, Juan Antonio; Cosío, Borja G.; Casanova, Ciro; Riesco, Juan Antonio; Simonet, Pere; Rigau, David; Soriano, Joan B.; Ancochea, Julio

doi:10.1016/j.arbr.2017.03.017

Cited by 103 publications

(151 citation statements)

References 87 publications

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“…As expected for a symptoms questionnaire, the E-RS scores correlated strongly with the mMRC and CAT scores; however, although severely symptomatic patients had worse FEV 1 (% predicted) compared with those who were less symptomatic, the correlation of E-RS scores with FEV 1 was poor, as has been observed with the correlations between lung function and other symptom questionnaires. This poor correlation indicates that lung function and symptoms are two dimensions of the disease relatively independent and justifies the evaluation of symptoms in the therapeutic decision-making for patients with COPD, as suggested by GOLD [20] and COPD guidelines [21,22]. Older age, more impaired FEV1, low level of Fig.…”

Section: Discussionmentioning

confidence: 98%

Prevalence and impact of respiratory symptoms in a population of patients with COPD in Latin America: The LASSYC observational study

Miravitlles

Menezes

Varela

et al. 2018

Respiratory Medicine

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Section: Discussionmentioning

confidence: 98%

Prevalence and impact of respiratory symptoms in a population of patients with COPD in Latin America: The LASSYC observational study

Miravitlles

Menezes

Varela

et al. 2018

Respiratory Medicine

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“…When the episode required treatment in a hospital setting or assistance in the emergency room for at least 24 hrs it was considered severe. 6 Firstly patients were divided into clinical phenotypes according to the GesEPOC criteria: 16 1) non-exacerbator (NE): patients with 0 or 1 ECOPD in the previous year; 2) exacerbator with emphysema (EE): patients presenting at least two ECOPD in the previous year and clinical/radiological or functional evidence of emphysema; 3) exacerbator with chronic bronchitis (ECB): exacerbators with cough and expectoration for at least 3 months of the year over two consecutive years; and 4) asthma-COPD overlap: patients with a concomitant diagnosis of asthma and/ or blood eosinophilia ≥ 300 cells/µL. 17 Secondly, they were classified into 2 groups: exacerbators, defined as patients with ≥ 2 ambulatory exacerbations or 1 hospitalisation, or non-exacerbators defined as patients presenting ≤ 1 ambulatory exacerbation in the previous year.…”

Section: Variablesmentioning

confidence: 99%

<p>Association Between Routine Blood Biomarkers and Clinical Phenotypes and Exacerbations in Chronic Obstructive Pulmonary Disease</p>

Núñez¹,

Marras²,

Harlander³

et al. 2020

COPD

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Introduction: Chronic obstructive pulmonary disease (COPD) is associated with increased lung and systemic inflammation. We aimed to identify associations between easy-to-obtain blood biomarkers and the frequency and severity of exacerbations. Methods: Cross-sectional, multicentre study performed in four centres in Spain, Italy, Bulgaria, and Slovenia. Blood samples were obtained for blood cell count, C-reactive protein (CRP), alpha-1 antitrypsin (AAT) and fibrinogen analysis. The neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and eosinophil/basophil ratio (EBR) were calculated. Firstly, patients were divided into clinical phenotypes according to the Spanish guidelines of COPD, and secondly, patients were classified into 2 groups: non-exacerbators (≤1 ambulatory exacerbation in the previous year) and exacerbators (≥2 ambulatory exacerbations or 1 hospitalisation in the previous year). A multivariate stepwise logistic regression model was performed to identify laboratory parameters associated with exacerbators. Results: A total of 355 patients with a mean age 66 years (SD=8.9) were included, and 64% were male. The mean FEV1% (forced expiratory volume in the first second) was 55% (SD=20%), and the mean COPD Assessment Test (CAT) score was 15.6 (SD=7.9). One hundred ninety-six (55.2%) patients were classified in the non-exacerbator group, and 159 (44.8%) were exacerbators. Patients in the exacerbators group presented lower haemoglobin levels (p=0.019) and ERB (p= 0.023) but higher CRP levels (p=0.001). In the multivariate analysis, females, higher levels of CRP, lower FEV1% and low EBR were independently related to exacerbators. Conclusion: Female sex, having a more severe impairment of lung function, higher CRP levels and a lower EBR are associated with an exacerbator phenotype in COPD.

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“…The main objectives of treatment of chronic obstructive pulmonary disease (COPD) are the control of symptoms and the prevention of exacerbations. 1,2 However, the definition of control of symptoms is not yet established. 3 The Global Initiative for Obstructive Lung Disease (GOLD) strategy recommends more intensified treatment in patients with a COPD Assessment Test (CAT) score 10 or higher or a modified Medical Research Council (mMRC) dyspnoea degree 2 or higher, but it does not mention which the goal of therapy should be.…”

Section: Introductionmentioning

confidence: 99%

Predictive value of control of COPD for risk of exacerbations: An international, prospective study

Miravitlles

Śliwiński²,

Rhee

et al. 2020

Respirology

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Background and objective: The concept of clinical control in COPD has been developed to help in treatment decisions, but it requires validation in prospective studies. Methods: This international, multicentre, prospective study aimed to validate the concept of control in COPD. Patients with COPD were classified as controlled/uncontrolled by clinical criteria or CAT scores at baseline and followed up for 18 months. The main outcome was the difference in rate of a composite endpoint of moderate and severe exacerbations or death over the 18-month follow-up period. Results: A total of 307 patients were analysed (mean age = 68.6 years and mean FEV 1 % = 52.5%). Up to 65% and 37.9% of patients were classified as controlled by clinical criteria or CAT, respectively. Controlled patients had significantly less exacerbations during follow-up (by clinical criteria: 1.1 vs 2.6, P < 0.001; by CAT: 1.1 vs 1.9, P = 0.014). Time to first exacerbation was significantly prolonged for patients controlled by clinical criteria only (median: 93 days, IQR: 63; 242 vs 274 days, IQR: 221; 497 days; P < 0.001). Control status by clinical criteria was a better predictor of exacerbations compared to CAT criteria (AUC: 0.67 vs 0.57). Conclusion: Control status, defined by easy-to-obtain clinical criteria, is predictive of future exacerbation risk and time to the next exacerbation. The concept of control can be used in clinical practice at each clinical visit as a complement to the current recommendations of initial treatment proposed by guidelines.

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Spanish COPD Guidelines (GesEPOC) 2017. Pharmacological Treatment of Stable Chronic Obstructive Pulmonary Disease

Cited by 103 publications

References 87 publications

Prevalence and impact of respiratory symptoms in a population of patients with COPD in Latin America: The LASSYC observational study

Prevalence and impact of respiratory symptoms in a population of patients with COPD in Latin America: The LASSYC observational study

<p>Association Between Routine Blood Biomarkers and Clinical Phenotypes and Exacerbations in Chronic Obstructive Pulmonary Disease</p>

Predictive value of control of COPD for risk of exacerbations: An international, prospective study

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