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

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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 languageEnglish
Number of pages8
JournalRespirology
Early online date6 Apr 2020
DOIs
Publication statusPublished - 6 Apr 2020

Keywords

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

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  • 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. https://doi.org/10.1111/resp.13811