Medical Care According to Risk Level and Adaptation to Spanish COPD Guidelines (GesEPOC): The Epoconsul Study

Rubio, Myriam Calle; Hermosa, Juan Luis Rodríguez; Soler-Cataluña, Juan José; Lόpez-Campos, José Luís; Navarrete, Bernardino Alcázar; Soriano, Joan B.; González-Moro, José Miguel Rodríguez; Ferrer, Manuel Enrique Fuentes; Miravitlles, Marc

doi:10.1016/j.arbr.2017.11.019

Cited by 15 publications

(7 citation statements)

References 33 publications

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“…These results suggest that control status, especially when evaluated by clinical criteria, may be a valid tool to evaluate future risks and direct therapy in patients with COPD. After establishing initial therapy based on GOLD A–D classification or phenotypes and level of risk, the control status may be a dynamic tool to be easily incorporated at every clinical visit in order to make informed decisions about step‐up or ‐down therapy in COPD …”

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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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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“…The exacerbations make up a large part of health costs and have a significant impact on the patients and their environment up to being considered by the patients as the most important aspect of the disease. They are associated with a higher probability of new exacerbations, a more rapid functional deterioration and an increase in mortality . The increased cost of hospital admissions has led to new forms of treatment, such as a day hospital or home hospitalisation …”

Section: Introductionmentioning

confidence: 99%

Blood eosinophils could be useful as a biomarker in chronic obstructive pulmonary disease exacerbations

Barcala

San-Jose²,

Nieto‐Fontarigo

et al. 2019

Int J Clin Pract

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Summary IntroductionThe aim of analysing the usefulness of the blood eosinophil count (BEC) as a prognostic marker in exacerbations of patients with Chronic Obstructive Pulmonary Disease (COPD), evaluating its relationship with hospital mortality, the length of stay and the early and late re‐admissions. Materials and MethodsWe have carried out a retrospective study including all patients who required hospital admission from 1 January 2008 to 31 December 2009, with a diagnosis on hospital discharge of COPD exacerbation. These patients were classified using three cut‐off points of BEC: less than 200 vs ≥ 200/µL, less than 300 vs ≥ 300/µL and less than 400 vs ≥ 400/µL. ResultsThere were a total of 1626 hospital admissions during the study period with the diagnosis of exacerbation of COPD. In this study we have included 358 patients. The probability of any late re‐admission increased with a BEC ≥ 300/µL (odds ratio: 1.684) and for those with a BEC ≥ 400/µL (odds ratio: 2.068). The BEC does not appear to be related to hospital mortality or the probability of early re‐admission after an exacerbation of COPD. ConclusionsIn our study an elevated BEC is associated with a higher incidence of late hospital readmissions in COPD exacerbations.

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“…Recruitment was prospective, and the first ten patients with a diagnosis of COPD who consecutively came to the clinic for a checkup were included. The inclusion criteria were patients aged >40 years, smokers or ex-smokers (of at least 10 pack-years) with COPD diagnosed on the basis of spirometry tests (FEV1/FVC post-bronchodilation <0.7 or FEV1/FVC pre-bronchodilation <0.7 + FEV1 ≤80% if there was no bronchodilation reversibility testing available), and who were at high risk according to GesEPOC criteria [ 8 ]. The exclusion criteria were undergoing no previous follow-up in an outpatient clinic for at least 1 year or the inability to fill out the quality of life questionnaires or participate in a clinical study.…”

Section: Methodsmentioning

confidence: 99%

“…Patients with frequent exacerbations are specifically targeted with more aggressive therapy and an action plan in order to help prevent exacerbations [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Testing for Vitamin D in High-Risk COPD in Outpatient Clinics in Spain: A Cross-Sectional Analysis of the VITADEPOC Study

Rubio

Álvarez-Sala

Centanaro

et al. 2022

JCM

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Background: Vitamin D deficiency has been associated with an accelerated deterioration in lung function and increased exacerbations in chronic obstructive pulmonary disease (COPD). 25(OH) vitamin D levels have been indicated as a potentially useful marker for adverse results related to COPD. Methods: VITADEPOC is a cross-sectional clinical study recruiting consecutive patients with high-risk COPD. The objective of our study was to investigate vitamin D determination frequency in patients with high-risk COPD in clinical practice at outpatient clinics in Spain and to describe the factors associated with vitamin D testing. We also aimed to determine the frequency of vitamin D deficiency in these patients. Results: Only 51 (44%) patients underwent vitamin D determination and 33 (28.4%) had received vitamin D supplements in clinical practice. The patients who underwent testing for vitamin D in clinical practice were more often women (58.8% vs. 26.2%, p < 0.001) with comorbidities such as osteoporosis (19.6% vs. 6.2%, p < 0.001) or chronic renal failure (7.8% vs. 0%, p < 0.001) and with exacerbator phenotype (55% vs. 32.3%, p = 0.015). A total of 63 (54.3%) patients had serum vitamin D levels <20 ng/mL at the inclusion visit. Of these, 29 (46%) had serum vitamin D levels <12 ng/mL (severe deficiency). Having a history of inhaled corticosteroids (OR 3.210, p < 0.016), being treated with a cycle of systemic corticosteroids (OR 2.149, p < 0.002), and having a lower physical activity level (OR 3.840, p < 0.004) showed a statistically significant positive association with vitamin D deficiency. Conclusion: The testing of vitamin D levels in patients with high-risk COPD treated at outpatient respiratory clinics in Spain is infrequent. However, when tested, a severe deficiency is detected in one in four patients. Efforts to optimize case detection in COPD are needed.

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Medical Care According to Risk Level and Adaptation to Spanish COPD Guidelines (GesEPOC): The Epoconsul Study

Cited by 15 publications

References 33 publications

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

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

Blood eosinophils could be useful as a biomarker in chronic obstructive pulmonary disease exacerbations

Testing for Vitamin D in High-Risk COPD in Outpatient Clinics in Spain: A Cross-Sectional Analysis of the VITADEPOC Study

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