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Vol. 57. Issue 2.
Pages 122-129 (February 2021)
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Vol. 57. Issue 2.
Pages 122-129 (February 2021)
Original Article
Changes in Control Status of COPD Over Time and Their Consequences: A Prospective International Study
Cambios en el estado de control de la EPOC a lo largo del tiempo y sus consecuencias: un estudio internacional prospectivo
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Marc Miravitllesa,b,
Corresponding author
marcm@separ.es

Corresponding author.
, Pawel Sliwinskic, Chin Kook Rheed, Richard W. Costelloe, Victoria Carterf, Jessica H.Y. Tang, Therese Sophie Lapperreh,i, Bernardino Alcazarb,j, Caroline Gouderk, Cristina Esquinasa,l, Juan Luis García-Riverom, Anu Kemppinenf, Augustine Teen, Miguel Roman-Rodríguezo, Juan José Soler-Cataluñab,p, David B. Priceq,r, on Behalf of the Respiratory Effectiveness Group (REG)
a Pneumology Department, Hospital Universitari Vall d’Hebron; Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
b CIBER de Enfermedades Respiratorias (CIBERES), Spain
c 2nd Department of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
d 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
e Department of Respiratory Medicine, Royal College of Surgeons, Dublin, Ireland
f Optimum Patient Care, Cambridge, UK
g Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
h Duke-National University of Singapore Medical School, Singapore
i Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark
j Respiratory Department, Hospital de Alta Resolución de Loja, Spain
k Department of Respiratory Medicine, Mater Dei Hospital, Malta
l Public Health, Mental, Maternal and Child Health Nursing Department, Faculty of Medicine and Health Sciences, University of Barcelona, Spain
m Department of Respiratory Medicine, Hospital Comarcal de Laredo, Cantabria, Spain
n Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
o Primary Health-care Center Son Pisà, IB-Salut, Palma, Baleares, Spain
p Pneumology Department, Hospital Arnau de Vilanova, Valencia, Spain
q Centre of Academic Primary Care, University of Aberdeen, UK
r Observational and Pragmatic Research Institute, Singapore
The following investigators participated in the study
Article information
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Tables (5)
Table 1. Control criteria with adjustment of severity according to FEV1%.
Table 2. Demographic and clinical characteristics of patients according to control status at the different follow-up visits.
Table 3. Outcomes over the 18-month follow-up of COPD patients according to control status at the different follow-up visits. Exacerbations, emergency visits and hospitalisations are caused by COPD.
Table 4. Univariate and multivariate logistic regression analyses for controlled patients during follow-up (I).
Table 5. Short-term outcomes at 6 months after each clinical visit according to control status at that visit. Exacerbations, emergency visits and hospitalisations are caused by COPD.
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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.

Keywords:
COPD
Control
CAT
Exacerbations
Outcomes
Resumen
Introducción

El estado de control de la enfermedad puede ser una herramienta útil para evaluar la respuesta al tratamiento de la EPOC en cada asistencia a consulta. El estado de control de la enfermedad ha demostrado tener valor predictivo a largo plazo para las exacerbaciones, pero no existe información sobre el valor predictivo a corto plazo de la falta de control de la EPOC y los cambios en dicho control a lo largo del tiempo.

Método

Estudio prospectivo, internacional, multicéntrico enfocado en describir el valor pronóstico a corto plazo (6 meses) del estado de control de la enfermedad en pacientes con EPOC. Los pacientes con EPOC se clasificaron como con enfermedad controlada/sin controlar al inicio del estudio y en las 3 visitas de seguimiento separadas 6 meses, utilizando criterios de control previamente validados. Se compararon las tasas de exacerbación moderada y grave entre visitas en las que la enfermedad estaba controlada y aquellas en las que no y entre pacientes con control persistente de la enfermedad, pacientes sin control de la enfermedad y aquellos cuyo estado de control cambió durante el seguimiento.

Resultados

Se analizó a un total de 267 pacientes: 80 (29,8%) presentaron control persistente de la enfermedad, 43 (16%) permanecieron con enfermedad no controlada de manera persistente y 144 (53,7%) presentaron un cambio en el estado de control de su EPOC durante el seguimiento. Los pacientes con control persistente de su enfermedad fueron con mayor frecuencia hombres, con un índice de masa corporal más bajo (no elevado) y un FEV1 (%) más alto. Durante los 6 meses posteriores a una visita en la que la enfermedad del paciente no estaba controlada, la odds ratio (OR) para presentar una exacerbación moderada fue de 3,41 (intervalo de confianza [IC] del 95%: 2,47 a 4,69) y la OR=4,25 (IC del 95%: 2,48 a 7,27) para la hospitalización, en comparación con una visita en la que la EPOC estaba controlada.

Conclusiones

La evaluación del estado de control de la EPOC en cada asistencia a consulta proporciona información pronóstica relevante sobre el riesgo de exacerbación en los próximos 6 meses. La falta de control es una señal de alarma que debe motivar la investigación y la acción para lograr el control de la enfermedad.

Palabras clave:
EPOC
Control
TAC
Exacerbaciones
Resultados

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