COPD Clinical Control : predictors and long-term follow-up of the CHAIN cohort
Calle Rubio, Myriam (Universidad Complutense de Madrid. Departamento de Medicina)
Rodriguez Hermosa, Juan Luis (Universidad Complutense de Madrid)
De Torres, Juan Pablo (Queen's University. Respirology and Sleep Division)
Marín, José María (Hospital Universitario Miguel Servet (Saragossa))
Martínez-González, Cristina (Hospital Universitario Central de Asturias)
Fuster, Antonia (Hospital Universitari Son Llàtzer (Palma de Mallorca, Balears))
Cosio, Borja G.. (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
Peces-Barba, Germán (Instituto de Investigación Sanitaria de la Fundación Jiménez Díaz)
Solanes García, Ingrid (Institut d'Investigació Biomèdica Sant Pau)
Feu-Collado, Nuria (Hospital Universitario Reina Sofía (Còrdova, Espanya))
López-Campos, José Luis (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Casanova, Ciro (Hospital Universitario Nuestra Señora de Candelaria (Santa Cruz de Tenerife))
Universitat Autònoma de Barcelona

Data:	2021
Resum:	Control in COPD is a dynamic concept that can reflect changes in patients' clinical status that may have prognostic implications, but there is no information about changes in control status and its long-term consequences. We classified 798 patients with COPD from the CHAIN cohort as controlled/uncontrolled at baseline and over 5 years. We describe the changes in control status in patients over long-term follow-up and analyze the factors that were associated with longitudinal control patterns and related survival using the Cox hazard analysis. 134 patients (16. 8%) were considered persistently controlled, 248 (31. 1%) persistently uncontrolled and 416 (52. 1%) changed control status during follow-up. The variables significantly associated with persistent control were not requiring triple therapy at baseline and having a better quality of life. Annual changes in outcomes (health status, psychological status, airflow limitation) did not differ in patients, regardless of clinical control status. All-cause mortality was lower in persistently controlled patients (5. 5% versus 19. 1%, p = 0. 001). The hazard ratio for all-cause mortality was 2. 274 (95% CI 1. 394-3. 708; p = 0. 001). Regarding pharmacological treatment, triple inhaled therapy was the most common option in persistently uncontrolled patients (72. 2%). Patients with persistent disease control more frequently used bronchodilators for monotherapy (53%) at recruitment, although by the end of the follow-up period, 20% had scaled up their treatment, with triple therapy being the most frequent therapeutic pattern. The evaluation of COPD control status provides relevant prognostic information on survival. There is important variability in clinical control status and only a small proportion of the patients had persistently good control. Changes in the treatment pattern may be relevant in the longitudinal pattern of COPD clinical control. Further studies in other populations should validate our results. Trial registration: Clinical Trials. gov: identifier NCT01122758.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Chronic obstructive pulmonary disease ; Control ; Management
Publicat a:	Respiratory Research, Vol. 22 (february 2021) , ISSN 1465-993X

DOI: 10.1186/s12931-021-01633-y
PMID: 33541356

12 p, 1.4 MB

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