Marc Miravitlles1, Pawel Sliwinski2, Chin Kook Rhee3, Richard W Costello4, Victoria Carter5, Jessica H Y Tan6, Therese Sophie Lapperre7, Bernardino Alcazar8, Caroline Gouder9, Cristina Esquinas10, Juan Luis García-Rivero11, Anu Kemppinen5, Augustine Tee12, Miguel Roman-Rodríguez13, Juan José Soler-Cataluña14, David B Price15. 1. Pneumology Department, Hospital Universitari Vall d'Hebron; Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; CIBER de Enfermedades Respiratorias (CIBERES), Spain. Electronic address: marcm@separ.es. 2. 2nd Department of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland. 3. 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. 4. Department of Respiratory Medicine, Royal College of Surgeons, Dublin, Ireland. 5. Optimum Patient Care, Cambridge, UK. 6. Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore. 7. Duke-National University of Singapore Medical School, Singapore; Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark. 8. CIBER de Enfermedades Respiratorias (CIBERES), Spain; Respiratory Department, Hospital de Alta Resolución de Loja, Spain. 9. Department of Respiratory Medicine, Mater Dei Hospital, Malta. 10. Pneumology Department, Hospital Universitari Vall d'Hebron; Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain; Public Health, Mental, Maternal and Child Health Nursing Department, Faculty of Medicine and Health Sciences, University of Barcelona, Spain. 11. Department of Respiratory Medicine, Hospital Comarcal de Laredo, Cantabria, Spain. 12. Respiratory and Critical Care Medicine, Changi General Hospital, Singapore. 13. Primary Health-care Center Son Pisà, IB-Salut, Palma, Baleares, Spain. 14. CIBER de Enfermedades Respiratorias (CIBERES), Spain; Pneumology Department, Hospital Arnau de Vilanova, Valencia, Spain. 15. Centre of Academic Primary Care, University of Aberdeen, UK; Observational and Pragmatic Research Institute, Singapore.
Abstract
INTRODUCTION: Control status may be a useful tool to assess response to treatment at each clinical visit in COPD. Control status has demonstrated to have long-term predictive value for exacerbations, but there is no information about the short-term predictive value of the lack of control and changes in control status over time. METHOD: Prospective, international, multicenter study aimed at describing the short-term (6 months) prognostic value of control status in patients with COPD. Patients with COPD were classified as controlled/uncontrolled at baseline and at 3,6-month follow-up visits using previously validated criteria of control. Moderate and severe exacerbation rates were compared between controlled and uncontrolled visits and between patients persistently controlled, uncontrolled and those changing control status over follow-up. RESULTS: A total of 267 patients were analyzed: 80 (29.8%) were persistently controlled, 43 (16%) persistently uncontrolled and 144 (53.7%) changed control status during follow-up. Persistently controlled patients were more frequently men, with lower (not increased) body mass index and higher FEV1(%). During the 6 months following an uncontrolled patient visit the odds ratio (OR) for presenting a moderate exacerbation was 3.41 (95% confidence interval (CI) 2.47-4.69) and OR=4.25 (95%CI 2.48-7.27) for hospitalization compared with a controlled patient visit. CONCLUSIONS: Evaluation of control status at each clinical visit provides relevant prognostic information about the risk of exacerbation in the next 6 months. Lack of control is a warning signal that should prompt investigation and action in order to achieve control status.
INTRODUCTION: Control status may be a useful tool to assess response to treatment at each clinical visit in COPD. Control status has demonstrated to have long-term predictive value for exacerbations, but there is no information about the short-term predictive value of the lack of control and changes in control status over time. METHOD: Prospective, international, multicenter study aimed at describing the short-term (6 months) prognostic value of control status in patients with COPD. Patients with COPD were classified as controlled/uncontrolled at baseline and at 3,6-month follow-up visits using previously validated criteria of control. Moderate and severe exacerbation rates were compared between controlled and uncontrolled visits and between patients persistently controlled, uncontrolled and those changing control status over follow-up. RESULTS: A total of 267 patients were analyzed: 80 (29.8%) were persistently controlled, 43 (16%) persistently uncontrolled and 144 (53.7%) changed control status during follow-up. Persistently controlled patients were more frequently men, with lower (not increased) body mass index and higher FEV1(%). During the 6 months following an uncontrolled patient visit the odds ratio (OR) for presenting a moderate exacerbation was 3.41 (95% confidence interval (CI) 2.47-4.69) and OR=4.25 (95%CI 2.48-7.27) for hospitalization compared with a controlled patient visit. CONCLUSIONS: Evaluation of control status at each clinical visit provides relevant prognostic information about the risk of exacerbation in the next 6 months. Lack of control is a warning signal that should prompt investigation and action in order to achieve control status.
Authors: Juan José Soler-Cataluña; Pere Almagro; Arturo Huerta; Diego González-Segura; Borja G Cosío Journal: Int J Chron Obstruct Pulmon Dis Date: 2021-01-25
Authors: Marc Miravitlles; Alexandra Solé; Helena Aguilar; Ana Ampudia; Jaume Costa-Samarra; Maria Mallén-Alberdi; Diana Nieves Journal: Int J Chron Obstruct Pulmon Dis Date: 2021-11-16