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      Relationship Between Clinical Control, Respiratory Symptoms and Quality of Life for Patients with COPD

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          Abstract

          Background

          The concept of clinical control has been proposed as an instrument for evaluating patients with COPD. However, the possible association between clinical control, reduced symptom severity and HRQoL has yet to be confirmed.

          Methods

          This multicentre, prospective and observational study was carried out in 15 pulmonology clinics in Spain. The patients were followed up for six months, with a baseline visit (V0), followed by visits at three months (V1) and six months (V2). Clinical control was determined at V1, with the application of both clinical criteria and the COPD assessment test (CAT). All patients reported their symptoms by a validated symptom diary (E-RS) using a portable device, and their HRQoL was assessed using the EQ5D questionnaire. The relationship between clinical control and E-RS and HRQoL during follow-up was assessed with t-test.

          Results

          A total of 126 patients were screened. After application of the inclusion/exclusion criteria, 93 were finally included (mean age 66 ± 8 years, 84.9% male), with a mean FEV 1 predicted of 49.8% ± 16.5%. Of these patients, 44 (47.3%) achieved clinical control at V1, according to CAT criteria, and 50 (53.8%), according to clinical criteria. The E-RS scores differed between controlled and uncontrolled patients at all time points, both according to CAT (mean differences of −4.6, −5.6 and −6.2 units at V0, V1 and V2, respectively, p<0.005 for all comparisons) and to clinical criteria (mean differences of −3.3, −5-6 and −4.99 units, respectively, p<0.005 for all comparisons). The controlled patients also presented a significantly better HRQoL, measured by the EQ5D questionnaire (mean difference 0.13 and 0.10 at V2 by CAT or clinical criteria, respectively, p<0.05).

          Conclusion

          Clinical control in patients with COPD, whether measured by CAT or by clinical criteria, is associated with a lower symptom load and a better HRQoL.

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          Most cited references 28

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          Standardisation of spirometry.

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            Prevalence of COPD in Spain: impact of undiagnosed COPD on quality of life and daily life activities.

            This study aimed to determine the prevalence of chronic obstructive pulmonary disease (COPD) in Spain and identify the level of undiagnosed disease and its impact on health-related quality of life (HRQL) and activities of daily living (ADL). A population-based sample of 4274 adults aged 40-80 years was surveyed. They were invited to answer a questionnaire and undergo prebrochodilator and postbronchodilator spirometry. COPD was defined as a postbronchodilator FEV(1)/FVC (forced expiratory volume in 1 s/forced vital capacity) ratio of <0.70. For 3802 participants with good-quality postbronchodilator spirometry, the overall prevalence of COPD was 10.2% (95% CI 9.2% to 11.1%) and was higher in men (15.1%) than in women (5.6%). The prevalence of COPD stage II or higher was 4.4% (95%CI; 3.8%-5.1%). The prevalence of COPD increased with age and with cigarette smoking and was higher in those with a low educational level. A previous diagnosis of COPD was reported by only 27% of those with COPD. Diagnosed patients had more severe disease, higher cumulative tobacco consumption and more severely impaired HRQL compared with undiagnosed subjects. However, even patients with undiagnosed COPD stage I+ already showed impairment in HRQL and in some aspects of ADL compared with participants without COPD. The prevalence of COPD in individuals between 40 and 80 years of age in Spain is 10.2% and increases with age, tobacco consumption and lower educational levels. The rate of diagnosised COPD is very high and undiagnosed individuals with COPD already have a significant impairment in HRQL and ADL.
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              Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 Report: GOLD Executive Summary.

              This Executive Summary of the Global Strategy for the Diagnosis, Management, and Prevention of COPD (GOLD) 2017 Report focuses primarily on the revised and novel parts of the document. The most significant changes include: 1) the assessment of COPD has been refined to separate the spirometric assessment from symptom evaluation. ABCD groups are now proposed to be derived exclusively from patient symptoms and their history of exacerbations; 2) for each of the groups A to D, escalation strategies for pharmacological treatments are proposed; 3) the concept of de-escalation of therapy is introduced in the treatment assessment scheme; 4) nonpharmacologic therapies are comprehensively presented and; 5) the importance of comorbid conditions in managing COPD is reviewed.
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                Author and article information

                Journal
                Int J Chron Obstruct Pulmon Dis
                Int J Chron Obstruct Pulmon Dis
                copd
                copd
                International Journal of Chronic Obstructive Pulmonary Disease
                Dove
                1176-9106
                1178-2005
                28 October 2020
                2020
                : 15
                : 2683-2693
                Affiliations
                [1 ]AIG De Medicina. Hospital De Alta Resolución De Loja. Agencia Sanitaria Hospital De Poniente , Loja, Granada, Spain
                [2 ]CIBERES. Instituto De Salud Carlos III , Madrid, Spain
                [3 ]Servicio De Neumología. Hospital Universitario De Son Llatzer , Palma De Mallorca, Spain
                [4 ]Servicio De Neumología. Hospital De La Plana , Castellón, Spain
                [5 ]Servicio De Neumología. Hospital De Laredo , Laredo, Spain
                [6 ]Servicio De Neumología. Hospital Universitario Marqués De Valdecilla , Santander, Spain
                [7 ]Servicio De Neumología. Hospital Universitario Alvaro Cunqueiro , Vigo, Spain
                [8 ]Unidad Médico-Quirúrgica De Enfermedades Respiratorias. Hospital Virgen Del Rocío , Sevilla, Spain
                [9 ]UGC De Neumología. HU Virgen Macarena , Sevilla, Spain
                [10 ]Servicio De Neumología. Hospital Royo Villanova , Zaragoza, Spain
                [11 ]Servicio De Neumología. Complejo Hospitalario Universitario De Albacete , Albacete, Spain
                [12 ]Servicio De Neumología. Hospital De Sagunto , Sagunto, Spain
                [13 ]Servicio De Neumología. Hospital San Pedro De Alcántara , Cáceres, Spain
                [14 ]Servicio De Neumología. Hospital Universitario Lucus Augusti , Lugo, Spain
                [15 ]Servicio De Neumología. Hospital Arnau De Villanova- Lliria , Valencia, Spain
                [16 ]Servicio De Neumología. Hospital Universitari Vall De Hebron/Vall d’Hebron Institut De Recerca , Barcelona, Spain
                Author notes
                Correspondence: Bernardino Alcazar-Navarrete Hospital De Alta Resolución De Loja. Agencia Sanitaria Hospital De Poniente. Avda Tierno Galván s/n , Loja18300, Granada, Spain Email balcazar@telefonica.net
                Article
                265470
                10.2147/COPD.S265470
                7604255
                © 2020 Alcazar-Navarrete et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                Page count
                Figures: 4, Tables: 9, References: 29, Pages: 11
                Funding
                Funded by: Novartis Spain;
                This study was funded by an unrestricted grant from Novartis Spain. This company did not intervene in the development of the study, data collection, analysis of results or drafting of the manuscript.
                Categories
                Original Research

                Respiratory medicine

                copd, quality of life, symptoms, control, impact

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