Clinical control in COPD and therapeutic implications: The EPOCONSUL audit
Myriam Calle Rubio, Marc Miravitlles, Juan José Soler Cataluña, José Luis López-Campos, Bernardino Alcázar Navarrete, Manuel E. Fuentes Ferrer, Juan Luis Rodríguez Hermosa
Abstract
Objective
This study aimed to evaluate clinical control in chronic obstructive pulmonary disease (COPD), the consequences in terms of treatment decisions, and their potentially associated factors during follow-up of patients in real-life clinical practice.
Introduction
Clinical practice guidelines in COPD establish the reduction of symptoms and minimization of risk as the main therapeutic objectives [1, 2]. These objectives make it necessary to adapt actions to the changes experienced by patients throughout their evolution, considering therapeutic success to be the achievement of disease control. Thus, COPD clinical control is a measure proposed as a tool to help clinicians make decisions during the visit [1, 3]. Previous studies have shown that COPD control status is predictive of future exacerbations and time until the next exacerbation [4–6], as well as providing relevant information on health status [5] and survival prognosis [7], thus helping to identify patients that require clinician action.
Materials and method
The methodology of the EPOCONSUL audit has been previously reported [16]. Briefly, the EPOCONSUL audit promoted by the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) was designed to evaluate outpatient care provided to patients with COPD in respiratory clinics in Spain as an observational non-interventional cross-sectional study.
Results
Population of the study
A total of 4225 patients diagnosed with COPD at 45 centers were audited. Of these, 1804 (42.7%) patients who met all the GesEPOC criteria recorded at the visit were analyzed to define the level of clinical impact and stability in order to assess the level of clinical control of COPD. The sampling process is shown in Fig 1.
Discussion
This study provides novel information on actions taken during the visit in COPD patients undergoing follow-up in outpatient respiratory clinics as well as factors associated with clinical inertia and disagreement with control of COPD calculated and reported by physicians using real data generated in a clinical audit performed in Spain. This analysis describes requests for testing and changes made in treatment during the visit according to the level of clinical control of COPD and explores the determinants associated with a lack of action in uncontrolled patients.
Acknowledgments
The authors thank the centers that participated in EPOCONSUL study and participants investigators (S4 Appendix).
Citation: Calle Rubio M, Miravitlles M, Soler Cataluña JJ, López-Campos JL, Alcázar Navarrete B, Fuentes Ferrer ME, et al. (2025) Clinical control in COPD and therapeutic implications: The EPOCONSUL audit. PLoS ONE 20(1): e0314299. https://doi.org/10.1371/journal.pone.0314299
Editor: Stelios Loukides, National and Kapodistrian University of Athens, GREECE
Received: September 9, 2024; Accepted: November 7, 2024; Published: January 9, 2025
Copyright: © 2025 Calle Rubio et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are contained in the manuscript and its supplementary information files.
Funding: This study has been promoted and sponsored by the Spanish Society of Pneumology and Thoracic Surgery (SEPAR). We thank Chiesi for its financial support in carrying out the study. The financing entities did not participate in the design of the study, data collection, analysis, publication, or preparation of this manuscript.
Competing interests: I have read the journal policy and the authors of this manuscript have the following conflicts of interest: JLRH has received honoraria for lecturing and participation in clinical studies for: Bial, Boehringer Ingelheim, CSL Behring, Chiesi, GlaxoSmithKline, Zambon and Grifols, and consulting fees from Bial. MM has received speaker fees from AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Menarini, Kamada, Takeda, Zambon, CSL Behring, Specialty Therapeutics, Janssen, Grifols and Novartis, consulting fees from AstraZeneca, Atriva Therapeutics, Boehringer Ingelheim, Chiesi, Glax-oSmithKline, CSL Behring, Inhibrx, Ferrer, Menarini, Mereo Biopharma, Spin Therapeutics, Specialty Therapeutics, ONO Pharma, Palobiofarma SL, Takeda, Novartis, Novo Nordisk, Sanofi, Zambon and Grifols and research grants from Grifols. JLLC has received honoraria for lecturing, scientific advice, participation in clinical studies or writing for publications for: AstraZeneca, Bi-al, Boehringer Ingelheim, Chiesi, CSL Behring, Ferrer, Gebro, GlaxoSmithKline, Grifols, Menarini, Megalabs, Novartis and Rovi. JJSC has received speaker fees from AstraZeneca, Bial, Boehringer Ingelheim, Chiesi, FAES, GlaxoSmithKline, Menarini and Novartis, and consulting fees from Bi-al, Chiesi and GSK, and grants from GSK. BAN reports grants and personal fees from GSK, per-sonal fees and non-financial support from Boehringer Ingelheim, personal fees and non-financial support from Chiesi, non-financial support from Laboratorios Menarini, grants, personal fees and non-financial support from AstraZeneca, personal fees from Gilead, personal fees and non-financial support from MSD, personal fees from Laboratorios BIAL, personal fees from Zambon, outside the submitted work; in addition, Dr. Alcázar-Navarrete has a patent P201730724 issued. MCR has received speaker fees from AstraZeneca, Bial, Chiesi, CSL Behring, GlaxoSmithKline, Menarini, and Grifols, and consulting fees from GlaxoSmithKline and Bial. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
