Portal de Periódicos da CAPES

The concept of control in COPD: a new proposal for optimising therapy

2014; European Respiratory Society; Volume: 44; Issue: 4 Linguagem: Inglês

10.1183/09031936.00064414

1399-3003

Juan José Soler‐Cataluña, Bernardino Alcázar Navarrete, Marc Miravitlles,

Asthma and respiratory diseases

To the Editor: Chronic obstructive pulmonary disease (COPD) is a very heterogeneous disease and therefore treatment should be individualised considering the different clinical characteristics and severity of each patient [1–3]. In an attempt to identify individuals with similar characteristics and response to treatment, a group of experts has defined the “clinical phenotypes” of COPD as those attributes of the disease alone or in combination that “describe differences between individuals with COPD in relation to parameters that have clinical significance (symptoms, exacerbations, response to treatment, rate of progression disease, or death)” [4]. Therefore, the clinical phenotype should be able to classify patients into subgroups with prognostic value and to determine the most appropriate therapy to achieve better results from a clinical standpoint. However, even patients with similar clinical characteristics and degree of airflow obstruction may have a different expression of their disease or present with short-term changes in their state that may require changes in treatment. Therefore, the new concept of disease control, similar to the “control of asthma” concept should be added in the assessment of patients with COPD. But, what is control in COPD? Control is a new dimension in the evaluation of patients with COPD, after the evaluation of symptoms, comorbidities and the degree of severity based either on the impairment in lung function or on any multidimensional prognostic indices. Control is a dynamic concept; as an example, two patients who are the same age, have the same level of symptoms and same level of airflow obstruction, with two exacerbations in the current year, may have different degrees of clinical control. One of the patients may have had four exacerbations in the previous year and so comparatively control has improved, whereas the second patient may have had no exacerbations the …