Evaluation of criteria for clinical control in a prospective, international, multicenter study of patients with COPD
Por:
Miravitlles M, Sliwinski P, Rhee CK, Costello RW, Carter V, Tan J, Lapperre TS, Alcazar B, Gouder C, Esquinas C, García-Rivero JL, Kemppinen A, Tee A, Roman-Rodríguez M, Soler-Cataluña JJ and Price DB
Publicada:
1 mar 2018
Ahead of Print:
31 ene 2018
Categoría:
Pulmonary and respiratory medicine
Resumen:
Background: The concept of clinical control in COPD has been developed to help in treatment decisions, but it requires validation in prospective studies.
Method: This international, multicenter, prospective study aimed to validate the concept of control in COPD [ control = stability ( no exacerbations or impairment in CAT scores) + low impact ( low level of symptoms)]. Data from the screening visit was used to: investigate the level of control, compare characteristics of patients according to the control status, and perform a sensitivity analysis of the levels of control using either clinical criteria or questionnaires ( COPD Assessment Test -CAT- or Clinical COPD Questionnaire -CCQ-).
Results: A total of 314 patients were analysed, mean age was 68.5 years and mean FEV1 was 52.6% of predicted. According to the prespecified criteria 21% of patients were classified as controlled, all of them with mild/moderate COPD ( Body mass index, Obstruction, Dyspnea and Exacerbations, -BODEx- index <5). A high level of dyspnea, a high CAT score or an exacerbation in the previous 3 months were found, using univariate analysis, to be the main reasons for patients not being classified as controlled. Multivariate analysis showed that female sex, chronic bronchitis and having exacerbations in the previous year were associated with uncontrolled COPD. Changing the severity cut off of BODEx from 5 to 3 did not change significantly the percentage of patients fulfilling the criteria of control.
Conclusions: The proposed criteria of control were only fulfilled by 21% of patients. The suggested cut offs and their predictive value for poor outcomes need to be refined in prospective studies.
Filiaciones:
Miravitlles M:
Pneumology Department, University Hospital Vall d'Hebron, Barcelona, Spain
CIBER de Enfermedades Respiratorias (CIBERES), Spain
Sliwinski P:
2nd Department of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
Rhee CK:
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
Costello RW:
Department of Respiratory Medicine, Royal College of Surgeons, Dublin, Ireland
Carter V:
Optimum Patient Care, Cambridge, UK
Tan J:
Singapore General Hospital, Singapore
Lapperre TS:
Singapore General Hospital, Singapore
Bispebjerg Hospital, Copenhagen, Denmark
Alcazar B:
Respiratory Department, Hospital de Alta Resolución de Loja, Spain
Gouder C:
Mater Dei Hospital, Malta
Esquinas C:
Pneumology Department, University Hospital Vall d'Hebron, Barcelona, Spain
Public Health, Mental, Maternal and Child Health Nursing Department, Faculty of Medicine and Health Sciences, University of Barcelona, Spain
García-Rivero JL:
Hospital Comarcal de Laredo, Cantabria, Spain
Kemppinen A:
Optimum Patient Care, Cambridge, UK
Tee A:
Respiratory and Critical Care Medicine, Changi General Hospital, Singapore
Roman-Rodríguez M:
Primary Health-care Center Son Pisà, IB-Salut, Palma, Baleares, Spain
:
CIBER de Enfermedades Respiratorias (CIBERES), Spain
Pneumology Department, Hospital Arnau de Vilanova, Valencia, Spain
Price DB:
Centre of Academic Primary Care, University of Aberdeen, UK
Observational and Pragmatic Research Institute, Singapore
Green Accepted, Green Submitted, hybrid
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