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

Marc Miravitlles; Pawel Sliwinski; Chin Kook Rhee; Richard W Costello; Victoria Carter; Jessica H Y Tan; Therese S Lapperre; Bernardino Alcazar; Caroline Gouder; Cristina Esquinas; Juan Luis García-Rivero; Anu Kemppinen; Augustine Tee; Miguel Roman-Rodríguez; Juan José Soler-Cataluña; David B Price; Respiratory Effectiveness Group (REG)

doi:10.1111/resp.13811

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

Marc Miravitlles^* (Corresponding Author), Pawel Sliwinski, Chin Kook Rhee, Richard W Costello, Victoria Carter, Jessica H Y Tan, Therese S Lapperre, Bernardino Alcazar, Caroline Gouder, Cristina Esquinas, Juan Luis García-Rivero, Anu Kemppinen, Augustine Tee, Miguel Roman-Rodríguez, Juan José Soler-Cataluña, David B Price, Respiratory Effectiveness Group (REG)

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

19 Citations (Scopus)

3 Downloads (Pure)

Abstract

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.

Original language	English
Pages (from-to)	1136-1143
Number of pages	8
Journal	Respirology
Volume	25
Issue number	11
Early online date	6 Apr 2020
DOIs	https://doi.org/10.1111/resp.13811
Publication status	Published - 30 Nov 2020

Bibliographical note

Acknowledgements

Collaborators/REG Investigators: Spain: Marc Miravitlles, Cristina Esquinas, Miriam Barrecheguren, Alexa Nuñez, Hospital Universitari Vall d'Hebron, Barcelona. Bernardino Alcazar, Hospital de Alta Resolución de Loja. Juan Luis García‐Rivero, Karina Hueso, Hospital Comarcal de Laredo, Cantabria. Miguel Roman‐Rodríguez, Primary Health‐Care Center Son Pisà, IB‐Salut, Palma de Mallorca. Poland: Pawel Sliwinsk, Katarzyna Iwan, Jacek Kolakowski, Institute of Tuberculosis and Lung Diseases, Warsaw. Korea: Chin Kook Rhee, Esther Ahn, St Mary's Hospital, Seoul. Singapore: Jessica Tan, Therese Laperre, Karen Tan Li Leng, Nicole Chia, Ong Thun How, Syifa Binte Shamsuddin, Sherine Lim Shu Gim, Yap Chwee Bee, Soh Rui Ya, Singapore General Hospital. Augustine Tee, Jun Jie Yan, Samuel Hong, William Tan, Changi General Hospital. UK: Victoria Carter, Latife Hardaker, Andrew McLaughlin, Optimum Patient Care, Cambridge. Malta: Caroline Gouder, Mater Dei Hospital. Ireland: Richard W Costello, Royal College of Surgeons, Dublin.

The study was funded by an unrestricted grant from Novartis AG.

The study was designed and coordinated by the Respiratory Effectiveness Group (REG; www.effectivenessevaluation.org; Cambridge, UK) and delivered by Optimum Patient Care (OPC; www.optimumpatientcare.org).

Keywords

Chronic Obstructive Pulmonary Disease Assessment Test
clinical control status
dyspnoea
exacerbations
prevention
MANAGEMENT
COPD CONTROL
VALIDATION
CLINICAL CONTROL

Access to Document

10.1111/resp.13811Licence: Unspecified

Miravitlles_et_al_Res_PredictiveValueOf_AAMCombined
This is the peer reviewed version of the following article: [FULL CITE], which has been published in final form at https://doi.org/10.1111/resp.13811. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Accepted author manuscript, 505 KBLicence: Unspecified

Cite this

Miravitlles, M., Sliwinski, P., Rhee, C. K., Costello, R. W., Carter, V., Tan, J. H. Y., Lapperre, T. S., Alcazar, B., Gouder, C., Esquinas, C., García-Rivero, J. L., Kemppinen, A., Tee, A., Roman-Rodríguez, M., Soler-Cataluña, J. J., Price, D. B., & Respiratory Effectiveness Group (REG) (2020). Predictive value of control of COPD for risk of exacerbations: An international, prospective study. Respirology, 25(11), 1136-1143. https://doi.org/10.1111/resp.13811

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 & Respiratory Effectiveness Group (REG) 2020, 'Predictive value of control of COPD for risk of exacerbations: An international, prospective study', Respirology, vol. 25, no. 11, pp. 1136-1143. https://doi.org/10.1111/resp.13811

@article{04746436769e48e99d67a67ba0b92545,

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

abstract = "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.",

keywords = "Chronic Obstructive Pulmonary Disease Assessment Test, clinical control status, dyspnoea, exacerbations, prevention, MANAGEMENT, COPD CONTROL, VALIDATION, CLINICAL CONTROL",

author = "Marc Miravitlles and Pawel Sliwinski and Rhee, {Chin Kook} and Costello, {Richard W} and Victoria Carter and Tan, {Jessica H Y} and Lapperre, {Therese S} and Bernardino Alcazar and Caroline Gouder and Cristina Esquinas and Garc{\'i}a-Rivero, {Juan Luis} and Anu Kemppinen and Augustine Tee and Miguel Roman-Rodr{\'i}guez and Soler-Catalu{\~n}a, {Juan Jos{\'e}} and Price, {David B} and {Respiratory Effectiveness Group (REG)}",

note = "Acknowledgements Collaborators/REG Investigators: Spain: Marc Miravitlles, Cristina Esquinas, Miriam Barrecheguren, Alexa Nu{\~n}ez, Hospital Universitari Vall d'Hebron, Barcelona. Bernardino Alcazar, Hospital de Alta Resoluci{\'o}n de Loja. Juan Luis Garc{\'i}a‐Rivero, Karina Hueso, Hospital Comarcal de Laredo, Cantabria. Miguel Roman‐Rodr{\'i}guez, Primary Health‐Care Center Son Pis{\`a}, IB‐Salut, Palma de Mallorca. Poland: Pawel Sliwinsk, Katarzyna Iwan, Jacek Kolakowski, Institute of Tuberculosis and Lung Diseases, Warsaw. Korea: Chin Kook Rhee, Esther Ahn, St Mary's Hospital, Seoul. Singapore: Jessica Tan, Therese Laperre, Karen Tan Li Leng, Nicole Chia, Ong Thun How, Syifa Binte Shamsuddin, Sherine Lim Shu Gim, Yap Chwee Bee, Soh Rui Ya, Singapore General Hospital. Augustine Tee, Jun Jie Yan, Samuel Hong, William Tan, Changi General Hospital. UK: Victoria Carter, Latife Hardaker, Andrew McLaughlin, Optimum Patient Care, Cambridge. Malta: Caroline Gouder, Mater Dei Hospital. Ireland: Richard W Costello, Royal College of Surgeons, Dublin. The study was funded by an unrestricted grant from Novartis AG. The study was designed and coordinated by the Respiratory Effectiveness Group (REG; www.effectivenessevaluation.org; Cambridge, UK) and delivered by Optimum Patient Care (OPC; www.optimumpatientcare.org). ",

year = "2020",

month = nov,

day = "30",

doi = "10.1111/resp.13811",

language = "English",

volume = "25",

pages = "1136--1143",

journal = "Respirology",

issn = "1323-7799",

publisher = "Wiley",

number = "11",

}

TY - JOUR

T1 - Predictive value of control of COPD for risk of exacerbations

T2 - An international, prospective study

AU - Miravitlles, Marc

AU - Sliwinski, Pawel

AU - Rhee, Chin Kook

AU - Costello, Richard W

AU - Carter, Victoria

AU - Tan, Jessica H Y

AU - Lapperre, Therese S

AU - Alcazar, Bernardino

AU - Gouder, Caroline

AU - Esquinas, Cristina

AU - García-Rivero, Juan Luis

AU - Kemppinen, Anu

AU - Tee, Augustine

AU - Roman-Rodríguez, Miguel

AU - Soler-Cataluña, Juan José

AU - Price, David B

AU - Respiratory Effectiveness Group (REG)

N1 - Acknowledgements Collaborators/REG Investigators: Spain: Marc Miravitlles, Cristina Esquinas, Miriam Barrecheguren, Alexa Nuñez, Hospital Universitari Vall d'Hebron, Barcelona. Bernardino Alcazar, Hospital de Alta Resolución de Loja. Juan Luis García‐Rivero, Karina Hueso, Hospital Comarcal de Laredo, Cantabria. Miguel Roman‐Rodríguez, Primary Health‐Care Center Son Pisà, IB‐Salut, Palma de Mallorca. Poland: Pawel Sliwinsk, Katarzyna Iwan, Jacek Kolakowski, Institute of Tuberculosis and Lung Diseases, Warsaw. Korea: Chin Kook Rhee, Esther Ahn, St Mary's Hospital, Seoul. Singapore: Jessica Tan, Therese Laperre, Karen Tan Li Leng, Nicole Chia, Ong Thun How, Syifa Binte Shamsuddin, Sherine Lim Shu Gim, Yap Chwee Bee, Soh Rui Ya, Singapore General Hospital. Augustine Tee, Jun Jie Yan, Samuel Hong, William Tan, Changi General Hospital. UK: Victoria Carter, Latife Hardaker, Andrew McLaughlin, Optimum Patient Care, Cambridge. Malta: Caroline Gouder, Mater Dei Hospital. Ireland: Richard W Costello, Royal College of Surgeons, Dublin. The study was funded by an unrestricted grant from Novartis AG. The study was designed and coordinated by the Respiratory Effectiveness Group (REG; www.effectivenessevaluation.org; Cambridge, UK) and delivered by Optimum Patient Care (OPC; www.optimumpatientcare.org).

PY - 2020/11/30

Y1 - 2020/11/30

N2 - 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.

AB - 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.

KW - Chronic Obstructive Pulmonary Disease Assessment Test

KW - clinical control status

KW - dyspnoea

KW - exacerbations

KW - prevention

KW - MANAGEMENT

KW - COPD CONTROL

KW - VALIDATION

KW - CLINICAL CONTROL

UR - http://www.scopus.com/inward/record.url?scp=85082932627&partnerID=8YFLogxK

U2 - 10.1111/resp.13811

DO - 10.1111/resp.13811

M3 - Article

C2 - 32249487

SN - 1323-7799

VL - 25

SP - 1136

EP - 1143

JO - Respirology

JF - Respirology

IS - 11

ER -

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

Abstract

Bibliographical note

Keywords

Access to Document

Other files and links

Fingerprint

Cite this