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

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, CHAIN Study Investigators, 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, CHAIN Study Investigators

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.

Keywords: Chronic obstructive pulmonary disease; Control; Management.

Conflict of interest statement

MCR has received speaking fees from Boehringer Ingelheim, AstraZeneca, GlaxoSmithKline, Menarini and Novartis, and consulting fees from GlaxoSmith¬Kline, Gebro Pharma and Novartis. There is no real or perceived conflict of interest between these sources and the present paper. JLRH has received speaking fees from Boehringer Ingelheim and Gebro Pharma. There is no real or perceived conflict of interest between these sources and the present paper. JPT does not have a real or perceived conflict of interest. JMM does not have a real or perceived conflict of interest. CMG does not have a real or perceived conflict of interest. AF does not have a real or perceived conflict of interest. BC reports grants, personal fees and non-financial support from GSK; grants, personal fees and non-financial support from Chiesi; grants, personal fees and non-financial support from Astrazeneca; grants from Menarini and Boehringer-Ingheilm; non-financial support from Novartis; personal fees and non-financial support from Sanofi, outside the submitted work. GPB reports grants, personal fees and non-financial support from GSK, Boehringer Ingelheim, Chiesi and Orion Pharma. There is no real or perceived conflict of interest between these sources and the present paper. IS does not have a real or perceived conflict of interest. NFC does not have a real or perceived conflict of interest. JLLC reports personal fees and non-financial support from AstraZeneca; grants, personal fees and non-financial support from Boehringer Ingelheim; grants, personal fees and non-financial support from Chiesi; personal fees and non-financial support from CSL Behring; grants, personal fees and non-financial support from Esteve; personal fees and non-financial support from Ferrer; grants, personal fees and non-financial support from GebroPharma; grants, personal fees and non-financial support from GlaxoSmithKline; grants, personal fees and non-financial support from Grifols; grants, personal fees and non-financial support from Menarini; grants, personal fees and non-financial support from Novartis; grants, personal fees and non-financial support from Rovi; and grants, personal fees and non-financial support from Teva, outside the submitted work. CC has received speaker fees from Novartis, Menarini, Boehringer Ingelheim, AstraZeneca, GlaxoSmithKline and Teva, and consulting fees from AstraZeneca, Esteve, GlaxoSmithKline and Novartis.

Figures

Fig. 1
Fig. 1
The evolution of the clinical control pattern every year
Fig. 2
Fig. 2
Changes in treatment patterns for COPD at baseline and last visit in persistently controlled and uncontrolled patients
Fig. 3
Fig. 3
Kaplan–Meier analysis for all-cause mortality. Persistently controlled patients were associated with a longer survival time than persistently uncontrolled patients

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