Lack of Clinical Control in COPD Patients Depending on the Target and the Therapeutic Option

Figures & data

Figure 1 Distribution of controlled and uncontrolled patients considering the predominant treatable target and the therapeutic option (GOLD’s follow-up pharmacological treatment algorithm). Percentages in brackets represent the frequency of each treatment option in each respective pathway, whereas those in parentheses are the frequency of control and non-control for each treatment option. Approximately 1% and 2% of patients were not classified in the respective dyspnea and exacerbation pathways because having a different medication pattern.

Table 1 Sociodemographic and Clinical Characteristics of Controlled and Uncontrolled Patients Considering Their Therapeutic Option

	Total (N=4679)	LABA or LAMA		LABA + LAMA		LABA + ICS			LABA + LAMA+ ICS
		Controlled (N=45)	Uncontrolled (N=150)	Controlled (N=567)	Uncontrolled (N=1022)	Controlled (N=119)	Uncontrolled (N=374)		Controlled (N=578)	Uncontrolled (N=1824)
Age, mean years (SD)	69.5 (9.3)	67.6 (7.8)	71.0 (9.8)	68.8 (8.6)	69.3 (9.2)	67.5 (10.5)	69.7 (10.3)		68.7 (8.7)	70.2 (9.2)
Age groups, n (%)
< 70 years	2269 (48.5)	30 (66.7)	64 (42.7)	297 (52.4)	508 (49.7)	66 (55.5)	183 (48.9)		301 (52.1)	820 (45.0)
≥ 70 years	2410 (51.5)	15 (33.3)	86 (57.3)	270 (47.6)	514 (50.3)	53 (44.5)	191 (51.1)		277 (47.9)	1004 (55.0)
Post-bronchodilator FEV1 (% of pred.), mean (SD)	39.1 (8.3)	43.2 (7.1)	38.6 (8.2)	41.7 (6.9)	40.1 (8.0)	43.8 (6.0)	41.5 (7.1)		38.8 (8.3)	37.0 (8.6)
Dyspnea scale, n (%)
Grade 0	121 (2.6)	6 (13.3)	4 (2.7)	41 (7.2)	15 (1.5)	4 (3.4)	3 (0.8)		30 (5.2)	18 (1.0)
Grade 1	1175 (25.1)	24 (53.3)	39 (26.0)	243 (42.9)	225 (22.0)	56 (47.1)	79 (21.1)		216 (37.4)	293 (16.1)
Grade 2	1771 (37.8)	15 (33.3)	60 (40.0)	225 (39.7)	433 (42.4)	50 (42.0)	147 (39.3)		240 (41.5)	601 (32.9)
Grade 3	1218 (26.0)	0 (0.0)	33 (22.0)	56 (9.9)	284 (27.8)	8 (6.7)	117 (31.3)		82 (14.2)	638 (35.0)
Grade 4	394 (8.4)	0 (0.0)	14 (9.3)	2 (0.4)	65 (6.4)	1 (0.8)	28 (7.5)		10 (1.7)	274 (15.0)
Mean grade (SD)	2.1 (1.0)	1.2 (0.7)	2.1 (1.0)	1.5 (0.8)	2.2 (0.9)	1.6 (0.7)	2.2 (0.9)		1.7 (0.8)	2.5 (1.0)
Exacerbations in the last 3 months, n (%)
None	2126 (45.4)	45 (100.0)	23 (15.4)	567 (100.0)	265 (25.9)	119 (100.0)	84 (22.5)		578 (100.0)	445 (24.4)
≥ 1	2552 (54.6)	0 (0.0)	126 (84.6)	0 (0.0)	757 (74.1)	0 (0.0)	290 (77.5)		0 (0.0)	1379 (75.6)
Charlson comorbidity index, mean value (SD)	2.2 (1.5)	1.9 (1.0)	2.5 (1.6)	1.9 (1.3)	2.2 (1.6)	1.8 (1.5)	2.3 (1.6)		1.9 (1.4)	2.3 (1.6)

Abbreviations: LABA, long-acting beta₂-agonist; LAMA, long-acting antimuscarinic antagonist; ICS, inhaled corticosteroid; SD, standard deviation; FEV₁, forced expiratory volume in 1 second.

Table 2 Factors Independently Associated with Lack of Control of COPD Considering the Therapeutic Option

	LABA or LAMA		LABA + LAMA		LABA + ICS		LABA + LAMA + ICS
	Odds Ratio (95% CI)	P	Odds Ratio (95% CI)	P	Odds Ratio (95% CI)	P	Odds Ratio (95% CI)	P
Post-bronchodilator FEV1 (% of pred.): <30% versus ≥30%	10.3 (1.1–93.6)	0.039	1.9 (1.3–2.8)	0.002	N.A.	N.A.	1.5 (1.1–2.0)	0.003
Physical activity
Low/inactive versus high	8.1 (2.4–28.0)	<0.001	4.1 (3.0–5.8)	<0.001	1.8 (0.9–3.6)	0.004	3.7 (2.8–4.9)	<0.001
Moderate versus high	1.5 (0.5–4.6)	0.135	1.5 (1.1–2.0)	0.010	0.7 (0.4–1.4)	0.011	1.7 (1.3–2.2)	0.169
Adherence to inhalers
Poor versus good	6.6 (2.5–17.8)	<0.001	1.9 (1.4–2.7)	0.002	N.A.	N.A.	2.1 (1.4–3.1)	0.002
Intermediate versus good	0.9 (0.3–2.4)	0.028	1.3 (1.0–1.8)	0.781	N.A.	N.A.	1.3 (1.0–1.7)	0.404
Charlson comorbidity index: ≥2 versus 1	1.5 (1.0–2.1)	0.028	1.5 (1.2–1.9)	<0.001	2.2 (1.3–3.5)	0.002	1.2 (1.0–1.5)	0.038

Abbreviations: LABA, long-acting beta₂-agonist; LAMA, long-acting antimuscarinic antagonist; ICS, inhaled corticosteroid; SD, standard deviation; FEV₁, forced expiratory volume in 1 second; 95CI, 95% confidence interval; N.A., not associated (p≥0.05).