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

Calle Rubio, Myriam ; Rodriguez Hermosa, Juan Luis ; de Torres, Juan P. ; Marín, José María (Universidad de Zaragoza) ; Martínez-González, Cristina ; Fuster, Antonia ; Cosío, Borja G. ; Peces-Barba, Germán ; Solanes, Ingrid ; Feu-Collado, Nuria ; Lopez-Campos, Jose Luis ; Casanova, Ciro

Resumen: 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.
Methods: 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
Results: 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.
Conclusions: 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.

Idioma: Inglés

DOI: 10.1186/s12931-021-01633-y

Año: 2021

Publicado en: Respiratory Research 22 (2021), 36 [12 pp.]
ISSN: 1465-9921

Factor impacto JCR: 7.162 (2021)

Categ. JCR: RESPIRATORY SYSTEM rank: 12 / 66 = 0.182 (2021) - Q1 - T1

Factor impacto CITESCORE: 8.9 - Medicine (Q1)

Factor impacto SCIMAGO: 1.813 - Pulmonary and Respiratory Medicine (Q1)

Tipo y forma: Artículo (Versión definitiva)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)