COPD Clinical Control: predictors and long-term follow-up of the CHAIN cohort
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 CHAI...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-02-01
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| Series: | Respiratory Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12931-021-01633-y |
| _version_ | 1818452783599190016 |
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| author | Myriam Calle Rubio Juan Luis Rodriguez Hermosa Juan P. de Torres José María Marín Cristina Martínez-González Antonia Fuster Borja G. Cosío Germán Peces-Barba Ingrid Solanes Nuria Feu-Collado Jose Luis Lopez-Campos Ciro Casanova the CHAIN Study Investigators |
| author_facet | Myriam Calle Rubio Juan Luis Rodriguez Hermosa Juan P. de Torres José María Marín Cristina Martínez-González Antonia Fuster Borja G. Cosío Germán Peces-Barba Ingrid Solanes Nuria Feu-Collado Jose Luis Lopez-Campos Ciro Casanova the CHAIN Study Investigators |
| author_sort | Myriam Calle Rubio |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-14T21:28:35Z |
| format | Article |
| id | doaj.art-c3a98340c2334d3fbfa91a6af5805015 |
| institution | Directory Open Access Journal |
| issn | 1465-993X |
| language | English |
| last_indexed | 2024-12-14T21:28:35Z |
| publishDate | 2021-02-01 |
| publisher | BMC |
| record_format | Article |
| series | Respiratory Research |
| spelling | doaj.art-c3a98340c2334d3fbfa91a6af58050152022-12-21T22:46:44ZengBMCRespiratory Research1465-993X2021-02-0122111210.1186/s12931-021-01633-yCOPD Clinical Control: predictors and long-term follow-up of the CHAIN cohortMyriam Calle Rubio0Juan Luis Rodriguez Hermosa1Juan P. de Torres2José María Marín3Cristina Martínez-González4Antonia Fuster5Borja G. Cosío6Germán Peces-Barba7Ingrid Solanes8Nuria Feu-Collado9Jose Luis Lopez-Campos10Ciro Casanova11the CHAIN Study InvestigatorsPulmonology Department, Hospital Clínico San Carlos, C/ Martin Lagos S/NPulmonology Department, Hospital Clínico San Carlos, C/ Martin Lagos S/NRespirology and Sleep Division, Queen’s UniversityRespiratory Department. Hospital, Universitario Miguel Servet and IISAragón, Ciber Enfermedades RespiratoriasPulmonology Department, Hospital Universitario Central de Asturias, Universidad de OviedoPulmonology Department, Hospital Universitario Son LlàtzerDepartment of Respiratory Medicine, Hospital Universitario Son Espases-IdISBa and CIBERESPulmonology Department, IIS-Fundación Jiménez Díaz-CIBERESPulmonology Department, Hospital de La Santa Creu Y San Pau, Universidad Autónoma de BarcelonaPulmonology Department, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de CórdobaUnidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen del Rocio, Universidad de Sevilla, CIBERESPulmonology Department, Hospital Universitario Nuestra Señora de Candelaria, Universidad de La LagunaAbstract 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.https://doi.org/10.1186/s12931-021-01633-yChronic obstructive pulmonary diseaseControlManagement |
| spellingShingle | Myriam Calle Rubio Juan Luis Rodriguez Hermosa Juan P. de Torres José María Marín Cristina Martínez-González Antonia Fuster Borja G. Cosío Germán Peces-Barba Ingrid Solanes Nuria Feu-Collado Jose Luis Lopez-Campos Ciro Casanova the CHAIN Study Investigators COPD Clinical Control: predictors and long-term follow-up of the CHAIN cohort Respiratory Research Chronic obstructive pulmonary disease Control Management |
| title | COPD Clinical Control: predictors and long-term follow-up of the CHAIN cohort |
| title_full | COPD Clinical Control: predictors and long-term follow-up of the CHAIN cohort |
| title_fullStr | COPD Clinical Control: predictors and long-term follow-up of the CHAIN cohort |
| title_full_unstemmed | COPD Clinical Control: predictors and long-term follow-up of the CHAIN cohort |
| title_short | COPD Clinical Control: predictors and long-term follow-up of the CHAIN cohort |
| title_sort | copd clinical control predictors and long term follow up of the chain cohort |
| topic | Chronic obstructive pulmonary disease Control Management |
| url | https://doi.org/10.1186/s12931-021-01633-y |
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