Evaluation of Changes in Control Status in COPD

Soler-Cataluña, Juan José; Alcázar, Bernardino; Marzo, Maribel; Pérez, Joselín; Miravitlles, Marc

doi:10.1016/j.chest.2019.11.004

Cited by 25 publications

(15 citation statements)

References 22 publications

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“…While our present study involved 142 diverse departments (primary medicine, internal medicine, general pneumology, and specialized COPD units), the previously cited studies were mainly carried out in specialized COPD units. 6,7,16 Factors significantly associated with clinical control of COPD were in concordance with those implicated in the disease severity. Low levels of physical activity are correlated with higher decline in lung function, risk of allcause mortality, and incidence of comorbidities, such as diabetes, cardiovascular diseases or depression.…”

Section: Discussionmentioning

confidence: 63%

“…Miravitlles et al, 16 in a prospective, international, multicenter study aimed at determining the 6-month prognostic value of control status in 267 patients with COPD, revealed a proportion of controlled patients of 59.3% among severe cases, and 68.5% among mild/moderate ones. Soler-Cataluña et al, 7 in a prospective, multicenter, observational study designed to compare changes in control over a 3-month period with changes in risk level, GOLD stage, and clinical phenotype in 354 patients with COPD, the proportion of controlled patients among severe cases was 44.7% versus 56.1% in mild/moderate ones. Authors also showed the distribution of controlled patients at 3 months according to the GOLD A-D category.…”

Section: Discussionmentioning

confidence: 99%

“…Control status is a dynamic concept that can be used at every clinical visit and provides complementary information that may have therapeutic implications. 7 Available studies about the clinical control in patients with severe COPD (postbronchodilator forced expiratory volume in 1 second, FEV 1 , <50% of predicted) are limited. 3 The CLAVE (`Estudio observacional transversal para Caracterizar La EPOC grAVe en España´; Severe COPD categorization in Spain) study was designed to characterize severe COPD, and determine the level of clinical control in a large cohort of patients from Spain.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Clinical Control Criteria to Determine Disease Control in Patients with Severe COPD: The CLAVE Study

Soler-Cataluña¹,

Almagro²,

Huerta³

et al. 2021

COPD

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Background: Clinical control in chronic obstructive pulmonary disease (COPD) has not been completely characterized. A proposal of clinical control criteria (CCC) has been recently defined and validated as a tool for determining control, but there is scarce information on patients with severe COPD. Objective: To evaluate clinical control in severe COPD using the CCC. Patients and Methods: The study design was observational, multicenter, cross-sectional study involving 4801 patients with severe COPD in Spain. Clinical control was defined according to clinical impact (dyspnea grade, use of rescue treatment in last week, sputum color, and daily physical activity) and stability (exacerbations in last 3 months and patient's perception about health status). Clinical control of COPD was alternatively evaluated with the COPD assessment test (CAT) and the presence of exacerbations in the last 3 months. Results: According to CCC, 61.0% of patients had low clinical impact, and 41.4% showed clinical stability. Overall, 29.9% of patients had both low clinical impact and stability (controlled), whereas 70.1% showed high clinical impact and/or no clinical stability (non-controlled). COPD control was also assessed by using only the definition of CAT≤16 and no exacerbations in the last 3 months. Results obtained with this definition were similar to those obtained by CCC, and the concordance between both definitions was high (Kappa index = 0.698). Conclusion: By using the CCC, approximately only one third of patients with severe COPD were considered as controlled. Physical activity, adherence to inhalers, age, postbronchodilator FEV 1 , age-adjusted Charlson comorbidity index, and healthcare level were independent factors associated with COPD control.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Control Criteria to Determine Disease Control in Patients with Severe COPD: The CLAVE Study

Soler-Cataluña¹,

Almagro²,

Huerta³

et al. 2021

COPD

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“…dyspnoea degree, use of rescue medication, sputum colour, minutes walked a day and previous exacerbations) must be encouraged at each clinical visit of patients with COPD. 21 In COPD, as opposed to asthma, control does not mean absence of symptoms or return to normal lung function, but the achievement of the best health status possible according to the level of severity. 3,5,19 Due to these differences between COPD and asthma, the definition of control in COPD has been elusive to researchers and clinicians, 22 but the current definition is easy to apply and has demonstrated its predictive value, making it suitable for clinical practice both in primary and in secondary care.…”

Section: Discussionmentioning

confidence: 99%

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

Miravitlles

Śliwiński²,

Rhee

et al. 2020

Respirology

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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.

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“…In order to define the control status, diagnostic criteria have been proposed based on a combination of different clinical parameters (degree of dyspnoea, use of rescue medication, physical activity, sputum colour, presence of exacerbations and the patients' perception of their own health), or an alternative based on the use of validated clinical questionnaires such as the CAT 56 or Clinical COPD Questionnaires (CCQ) 57 ( Table 2). These diagnosis criteria have been recently validated, demonstrating that clinical control is an objective which is attainable in the short-term, dynamic over time, sensitive to change and associated with a better outcome in the short and long-term, with a lower risk of future exacerbations and better HRQoL 55,[58][59][60] . For all these reasons, clinical control has been proposed as a new comprehensive therapeutic objective with a key role in clinical decision making 61 .…”

Section: Relevance Of Symptom Variability For Clinical Controlmentioning

confidence: 99%

Relevance of Symptom Variability for Control and Management of COPD

Soler-Cataluña¹,

Lόpez-Campos²

2021

BRN

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Physiological and cellular functions operate in a 24-hour cyclical pattern orchestrated by an endogenous process known as the circadian rhythm. Airway calibre exhibits a circadian variation with maximum values occurring around noon and minimum values in the early morning. The mechanisms behind the daily variation are complex, but it has been speculated that autonomic input to airway tissues via the vagal nerve plays an essential role. In chronic obstructive pulmonary disease (COPD), there is important daily variation of respiratory symptoms, which are present in approximately half of the patients. This time-dependent variability has important consequences since it has an impact on daily life physical activity, sleep quality, severity of symptoms, exacerbations or health-related quality of life, which in turn represents a component of instability within a period previously considered as relatively calm. This article reviews the symptomatic variability in COPD, its pathophysiological basis, characteristics, determinants, potential consequences and therapeutic implications.

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Evaluation of Changes in Control Status in COPD

Cited by 25 publications

References 22 publications

Clinical Control Criteria to Determine Disease Control in Patients with Severe COPD: The CLAVE Study

Clinical Control Criteria to Determine Disease Control in Patients with Severe COPD: The CLAVE Study

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

Relevance of Symptom Variability for Control and Management of COPD

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