Predictive value of control ofCOPDfor risk of exacerbations: An international, prospective study
Por:
Miravitlles M, Sliwinski P, Rhee CK, Costello RW, Carter V, Tan JHY, Lapperre TS, Alcazar B, Gouder C, Esquinas C, García-Rivero JL, Kemppinen A, Tee A, Roman-Rodríguez M, Soler-Cataluña JJ, Price DB and Respiratory Effectiveness Group (REG)
Publicada:
1 nov 2020
Ahead of Print:
1 abr 2020
Categoría:
Pulmonary and respiratory medicine
Resumen:
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.
Filiaciones:
Miravitlles M:
Pneumology Department, University Hospital Vall d'Hebron/Vall d'Hebron Research Institute (VHIR), 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 JHY:
Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
Lapperre TS:
Duke-National University of Singapore Medical School, Singapore
Department of Respiratory Medicine, Bispebjerg Hospital, Copenhagen, Denmark
Alcazar B:
CIBER de Enfermedades Respiratorias (CIBERES), Spain
Respiratory Department, Hospital de Alta Resolución de Loja, Granada, Spain
Gouder C:
Department of Respiratory Medicine, Mater Dei Hospital, Msida, Malta
Esquinas C:
Pneumology Department, University Hospital Vall d'Hebron/Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
Public Health, Mental, Maternal and Child Health Nursing Department, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
García-Rivero JL:
Department of Respiratory Medicine, Hospital Comarcal de Laredo, Laredo, 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, 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, Aberdeen, UK
Observational and Pragmatic Research Institute, Singapore
Bronze, Green Published
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