Marc Miravitlles1,2, Pawel Sliwinski3, Chin Kook Rhee4, Richard W Costello5, Victoria Carter6, Jessica H Y Tan7, Therese S Lapperre8,9, Bernardino Alcazar2,10, Caroline Gouder11, Cristina Esquinas1,12, Juan Luis García-Rivero13, Anu Kemppinen6, Augustine Tee14, Miguel Roman-Rodríguez15, Juan José Soler-Cataluña2,16, David B Price17,18. 1. Pneumology Department, University Hospital Vall d'Hebron/Vall d'Hebron Research Institute (VHIR), Barcelona, Spain. 2. CIBER de Enfermedades Respiratorias (CIBERES), Spain. 3. 2nd Department of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland. 4. Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. 5. Department of Respiratory Medicine, Royal College of Surgeons, Dublin, Ireland. 6. Optimum Patient Care, Cambridge, UK. 7. Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore. 8. Duke-National University of Singapore Medical School, Singapore. 9. Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark. 10. Respiratory Department, Hospital de Alta Resolución de Loja, Granada, Spain. 11. Department of Respiratory Medicine, Mater Dei Hospital, Msida, Malta. 12. Public Health, Mental, Maternal and Child Health Nursing Department, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain. 13. Department of Respiratory Medicine, Hospital Comarcal de Laredo, Laredo, Spain. 14. Respiratory and Critical Care Medicine, Changi General Hospital, Singapore. 15. Primary Health-Care Center Son Pisà, IB-Salut, Palma, Spain. 16. Pneumology Department, Hospital Arnau de Vilanova, Valencia, Spain. 17. Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK. 18. Observational and Pragmatic Research Institute, Singapore.
Abstract
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 FEV1 % = 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.
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 FEV1 % = 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.
Authors: Bernardino Alcazar-Navarrete; Antonia Fuster; Patricia García Sidro; Juan Luis García Rivero; Beatriz Abascal-Bolado; Abel Pallarés-Sanmartín; Eduardo Márquez; Agustin Valido-Morales; Ana Boldova Loscertales; Francisco Javier Callejas-Gonzalez; Marta Palop; Juan Antonio Riesco; Rafael Golpe; Juan Jose Soler-Cataluña; Marc Miravitlles Journal: Int J Chron Obstruct Pulmon Dis Date: 2020-10-28