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Soler-Cataluña JJ, Huerta A, Almagro P, González-Segura D, Cosío BG. Lack of Clinical Control in COPD Patients Depending on the Target and the Therapeutic Option. Int J Chron Obstruct Pulmon Dis 2023; 18:1367-1376. [PMID: 37434953 PMCID: PMC10332360 DOI: 10.2147/copd.s414910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 06/28/2023] [Indexed: 07/13/2023] Open
Abstract
Introduction According to the Global Initiative for chronic obstructive lung disease (GOLD), when a treatment is not achieving an appropriate response it should be switched taking into account the predominant treatable trait to target (dyspnea or exacerbations). The objective of the present study was to investigate the lack of clinical control according to the target and medication groups. Materials and Methods This was a post-hoc analysis of the CLAVE study, an observational, cross-sectional, multicenter study which evaluated the clinical control, and related-factors, in a cohort of 4801 patients with severe chronic obstructive pulmonary disease (COPD). The primary endpoint was the percentage of uncontrolled patients defined as COPD Assessment Test (CAT) >16 or presence of exacerbations in the last 3 months despite receiving long-acting beta2-agonist (LABA) and/or long-acting antimuscarinic antagonist (LAMA) with or without inhaled corticosteroids (ICS). Secondary objectives included the description of sociodemographic and clinical characteristics of patients by therapeutic group and the identification of characteristics potentially associated with the lack of control of COPD including low adherence measured by the test to adherence to inhalers (TAI). Results In the dyspnea pathway, lack of clinical control was of 25.0% of patients receiving LABA or LAMA in monotherapy, 29.5% by those with LABA + LAMA, 38.3% with LABA + ICS and 37.0% with triple therapy (LABA + LAMA + ICS). In the exacerbation pathway, percentages were 87.1%, 76.7%, 83.3%, and 84.1%, respectively. Low physical activity and high Charlson comorbidity index were independent factor of non-control in all therapeutic groups. Additional factors were lower post-bronchodilator FEV1 and poor adherence to inhalers. Conclusion There are still room for improvement in COPD control. From the pharmacological perspective, every step in treatment have a pool of uncontrolled patients in which a step-up could be considered according to a trait to target strategy.
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Affiliation(s)
- Juan José Soler-Cataluña
- Department of Pneumology, Hospital Arnau de Vilanova-Lliria, Valencia, Spain
- Medicine Department, València University and CIBERES, Valencia, Spain
| | - Arturo Huerta
- Pulmonary and Critical Care Division, Clínica Sagrada Família, Barcelona, Spain
| | - Pere Almagro
- Internal Medicine Department, Mutua Terrassa University Hospital, Terrassa, Spain
| | | | - Borja G Cosío
- Department of Pneumology, H. Universitari Son Espases Hospital-IdISBa and CIBERES, Palma de Mallorca, Spain
| | - On behalf of the CLAVE Study Investigators
- Department of Pneumology, Hospital Arnau de Vilanova-Lliria, Valencia, Spain
- Medicine Department, València University and CIBERES, Valencia, Spain
- Pulmonary and Critical Care Division, Clínica Sagrada Família, Barcelona, Spain
- Internal Medicine Department, Mutua Terrassa University Hospital, Terrassa, Spain
- Medical Advisor, Chiesi SAU, Barcelona, Spain
- Department of Pneumology, H. Universitari Son Espases Hospital-IdISBa and CIBERES, Palma de Mallorca, Spain
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Calle Rubio M, Rodriguez Hermosa JL, de Torres JP, Marín JM, Martínez-González C, Fuster A, Cosío BG, Peces-Barba G, Solanes I, Feu-Collado N, Lopez-Campos JL, Casanova C. COPD Clinical Control: predictors and long-term follow-up of the CHAIN cohort. Respir Res 2021; 22:36. [PMID: 33541356 PMCID: PMC7863480 DOI: 10.1186/s12931-021-01633-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background 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.
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Affiliation(s)
- Myriam Calle Rubio
- 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
| | - Juan Luis Rodriguez Hermosa
- 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.
| | - Juan P de Torres
- Respirology and Sleep Division, Queen's University, Kingston, ON, Canada
| | - José María Marín
- Respiratory Department. Hospital, Universitario Miguel Servet and IISAragón, Ciber Enfermedades Respiratorias, Madrid, Spain
| | - Cristina Martínez-González
- Pulmonology Department, Hospital Universitario Central de Asturias, Universidad de Oviedo, Oviedo, Spain
| | - Antonia Fuster
- Pulmonology Department, Hospital Universitario Son Llàtzer, Palma de Mallorca, Spain
| | - Borja G Cosío
- Department of Respiratory Medicine, Hospital Universitario Son Espases-IdISBa and CIBERES, Palma de Mallorca, Spain
| | - Germán Peces-Barba
- Pulmonology Department, IIS-Fundación Jiménez Díaz-CIBERES, Madrid, Spain
| | - Ingrid Solanes
- Pulmonology Department, Hospital de La Santa Creu Y San Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Nuria Feu-Collado
- Pulmonology Department, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, Spain
| | - Jose Luis Lopez-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocio, Universidad de Sevilla, CIBERES, Seville, Spain
| | - Ciro Casanova
- Pulmonology Department, Hospital Universitario Nuestra Señora de Candelaria, Universidad de La Laguna, Tenerife, Spain
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