Adjusting the Level of Intervention in Patients with Chronic Obstructive Pulmonary Disease According to the Risk Stratification Proposed by the Spanish COPD Guidelines (GesEPOC) Version 2017

Śliwiński²,

Rhee

et al. 2020

Respirology

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 FEV 1 % = 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.

Section: Discussionmentioning

confidence: 99%

Predictive value of control of COPD for risk of exacerbations: An international, prospective study

Śliwiński²,

Rhee

et al. 2020

Respirology

“…In this context, the control evaluation can be a useful tool to reassess the clinical status of the patients and their future risks. A previous study using the same criteria of control demonstrated that the control tool is more sensitive to changes in the clinical status of the patient than changes in phenotype, the level of risk according to the Spanish COPD guidelines (22), or the GOLD A-D classification frequently used to guide therapy (7). In addition, changes in control status were clinically relevant because they resulted in changes in health status over a period of only 3 months (7).…”

Section: Discussionmentioning

confidence: 99%

Changes in Control Status of COPD Over Time and Their Consequences: A Prospective International Study

Archivos de Bronconeumología

Śliwiński²,

Rhee

et al. 2021

“…A new series of studies were conducted in order to further validate the use of control status in clinical practice. A Spanish multicentre, observational study in 354 COPD patients aimed to investigate the sensitivity of the control tool to changes in clinical status by comparing changes in control over a 3-month period with changes in GOLD A-D categories and in risk level and clinical phenotype (non-exacerbator, asthma-COPD overlap, exacerbator with emphysema or with chronic bronchitis) [35], according to the Spanish guidelines of COPD [3,5,36]. At 3 months, the proportion of controlled patients was 50.3% by clinical criteria and 47.8% by CAT [35].…”

Section: Prospective Validation Of the Definitive Control Criteriamentioning

confidence: 99%

“…In contrast, the risk level only changed in 26 (8.7%) patients (p < 0.001), 27 (9.1%) experienced changes in their clinical phenotype (p < 0.001) and 59 (19.8%) in the GOLD classification (p = 0.008) [35]. These results indicated that control status was more sensitive to changes in clinical status than the other usual severity markers used in guidelines [3,4,36]. Moreover, change in control status demonstrated to be clinically meaningful, because patients who showed an improvement in control status over 3 months had better CAT scores at the end of follow-up and, conversely, patients who changed control status from controlled at baseli-ne to uncontrolled at the end of follow-up experienced a significant impairment in CAT scores (p < 0.001 for both comparisons) [35].…”

Section: Prospective Validation Of the Definitive Control Criteriamentioning

confidence: 99%

See 1 more Smart Citation

The concept of control in chronic obstructive pulmonary disease: Development of the criteria and validation for use in clinical practice

Alcázar²,

Soler-Cataluña

2020

Pulʹmonologiâ (Mosk.)

Guidelines of treatment of chronic obstructive pulmonary disease (COPD) identify symptom reduction and prevention of exacerbations as the main goals of therapy. Initial pharmacological treatment must be guided by these parameters, and effectiveness must be assessed at each clinical visit. However, there is no clear guidance as to how this assessment must be performed. The concept of control has been well developed in asthma, but it has been elusive in COPD. Patients with COPD may not be completely free from symptoms or exacerbations even under optimized therapy; therefore, control in COPD does not mean cure or absence of symptoms, but rather reaching the best clinical status possible according to the level of disease severity. A control tool has been developed based on a cross sectional evaluation of the impact of the disease and a longitudinal evaluation of stability. Low impact is a disease status defined by at least 3 of the following: low levels of dyspnoea, absence of or white sputum, low use of rescue medication and self-declared walking time of more than 30 minutes a day, and stability is the absence of moderate or severe exacerbations in the previous 3 months. Control can also be defined by COPD Assessment Test (CAT) scores ≤ 10 units for patients with FEV1 ≥ 50% and 16 for patients with FEV1 < 50% and stability as a change in CAT ≤ 2 units. Control of COPD is then defined as a status of low impact and stability. The control tool has been validated prospectively in several studies and has demonstrated to be sensitive to clinical changes and to have a good predictive value for poor outcomes. Clinical criteria are more reliable than CAT scores for the evaluation of control. The control tool is a quick and inexpensive method to evaluate clinical status and future risk of exacerbations that can be used at all levels of healthcare.