The concept of control of COPD in clinical practice

Figures & data

Figure 1 Representation of the concept of impact, stability, and control in COPD.

Notes: The circles represent the transversal measurement of the clinical situation at different times (impact); the lines show the analysis of the changes (degree of stability) and the gray area marks the concept of control understood as the desirable situation in which a condition of low impact is maintained over a long period of time according to the severity of the disease. Copyright © 2014 European Respiratory Society. Reproduced with permission of the European Respiratory Society. Eur Respir J erj00644-2014; published ahead of print July 25, 2014, doi:10.1183/09031936.00064414.¹⁰
Abbreviation: COPD, chronic obstructive pulmonary disease.

Figure 2 Distribution of the degree of control for levels I and II of severity, using the COPD Assessment Test scores.

Abbreviation: COPD, chronic obstructive pulmonary disease.

Figure 3 Absence of exacerbation.

Notes: A patient is considered to enter a period free of exacerbation when at least 4 weeks have passed since the treatment for the previous exacerbation has been completed (or 6 weeks since the initiation of the same).

Table 1 Criteria necessary to establish the impact of patients with mild to moderate severity (BODE/Ex ≤4 points)

	Mild to moderate severity (BODE/BODEx ≤4 points)
	Low impact	High impact
Clinical evaluation
Dyspnea (mMRC)	0–1	≥2
Rescue medication	≤3 times in the last week	>3 times in the last week
Daily physical activity* (time walked per day)	≥60 minutes	<60 minutes
Sputum color	Absent or white	Dark
Questionnaires of clinical control
CAT	≤10	>10
CCQ	≤1	>1

Notes: High impact was considered when fulfilling one or more of the criteria established.

* Time walked per day: includes the total time the patient has walked whether at home or outside. BODE index: for Body mass index, Obstruction, Dyspnea and Exercise. BODEx index: for Body mass index, Obstruction, Dyspnea and Exacerbations.

Abbreviations: CAT, COPD Assessment Test; CCQ, Clinical COPD Questionnaire; COPD, chronic obstructive pulmonary disease; mMRC, modified scale of the Medical Research Council.

Table 2 Criteria necessary to establish the impact of patients with severe and very severe COPD (BODE/Ex >5 points)

	Severe/very severe COPD (BODE/BODEx >5 points)
	Low impact	High impact
Clinical evaluation
Dyspnea (mMRC)	0–2	≥3
Rescue medication	≤2 times a day	>2 times a day
Daily physical activity* (time walking per day)	≥30 minutes	<30 minutes
Sputum color	Absent or white	Dark
Questionnaires of clinical control
CAT	≤20	>20
CCQ	≤2	>2

Notes: High impact was considered when fulfilling one or more of the criteria established.

* Time walked per day: includes the total time the patient has walked whether at home or outside. BODE index: for Body mass index, Obstruction, Dyspnea and Exercise. BODEx index: for Body mass index, Obstruction, Dyspnea and Exacerbations.

Abbreviations: CAT, COPD Assessment Test; CCQ, Clinical COPD Questionnaire; COPD, chronic obstructive pulmonary disease; mMRC, modified scale of the Medical Research Council.

Table 3 Criteria necessary to establish the degree of control

	Control	No control
Current clinical situation
Impact (adjusted according to severity)	Low and all of the following	High or any of the following
Clinical changes in the last 3 months
Changes in the CAT	<2	≥2
Changes in the CCQ	<0.4	≥0.4
Exacerbations in the last 3 months	No	Yes

Notes: Control: requires low impact and also scarce clinical changes. The patient is considered not controlled whenever there is a high impact or when there is a significant worsening.

Abbreviations: CAT, COPD Assessment Test; CCQ, Clinical COPD Questionnaire; COPD, chronic obstructive pulmonary disease.

Figure 4 Evaluable dimensions of chronic obstructive pulmonary disease (COPD).

Notes: Evaluation of a patient with COPD should include the determination of: a) the clinical phenotype; b) the level of prognostic severity; and c) the degree of control. Control is achieved in COPD when the impact is low (adjusted to the corresponding level of severity) with scarce clinical changes or improvement or changes in the last 3 months. No control is observed when the patient presents significant worsening (instability) or has a moderate or high clinical impact. BODE index: for Body mass index, Obstruction, Dyspnea and Exercise. BODEx index: for Body mass index, Obstruction, Dyspnea and Exacerbations.

Soler-CataluñaJJAlcazar-NavarreteBMiravitllesMThe concept of control in COPD: a new proposal for optimising therapyEur Respir J20144441072107525063243

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