COPD Clinical Control: predictors and long-term follow-up of the CHAIN cohort

Respiratory Research

Borja G. Cosío¹  Juan Luis Rodriguez Hermosa²  Myriam Calle Rubio²  Cristina Martínez-González³  Ciro Casanova⁴  Nuria Feu-Collado⁵  Antonia Fuster⁶  Ingrid Solanes⁷  Germán Peces-Barba⁸  José María Marín⁹  Juan P. de Torres^1,10  Jose Luis Lopez-Campos^1,11 

[1] Department of Respiratory Medicine, Hospital Universitario Son Espases-IdISBa and CIBERES, Palma de Mallorca, Spain;Pulmonology Department, Hospital Clínico San Carlos, C/ Martin Lagos S/N, 28040, Madrid, Spain;Medical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain;Pulmonology Department, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain;Pulmonology Department, Hospital Universitario Nuestra Señora de Candelaria, Universidad de La Laguna, Tenerife, Spain;Pulmonology Department, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, Spain;Pulmonology Department, Hospital Universitario Son Llàtzer, Palma de Mallorca, Spain;Pulmonology Department, Hospital de La Santa Creu Y San Pau, Universidad Autónoma de Barcelona, Barcelona, Spain;Pulmonology Department, IIS-Fundación Jiménez Díaz-CIBERES, Madrid, Spain;Respiratory Department. Hospital, Universitario Miguel Servet and IISAragón, Ciber Enfermedades Respiratorias, Madrid, Spain;Respirology and Sleep Division, Queen’s University, Kingston, ON, Canada;Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocio, Universidad de Sevilla, CIBERES, Seville, Spain;

关键词: Chronic obstructive pulmonary disease;    Control;    Management;   

DOI  :  10.1186/s12931-021-01633-y

来源: Springer

【 摘 要 】

BackgroundControl 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.MethodsWe 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.Results134 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.ConclusionsThe 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.

【 授权许可】

CC BY