Clinical control in COPD and therapeutic implications: The EPOCONSUL audit

Abstract

Objective: The aim of the study was to evaluate the 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. Methods: EPOCONSUL 2021 is a cross-sectional audit that evaluated the outpatient care provided to patients with a diagnosis of COPD in respiratory clinics in Spain and multivariable logistic regression models was performed to assess the relationships between clinical control and clinical inertia. Results: 4225 patients from 45 hospitals in Spain were audited. In 1804 (42.7%) patients were analysed clinical control for having all the GesEPOC criteria. 49.1% of patients were classified as uncontrolled, and of them, in 42.2% there was a disagreement with the doctor's perception, which was reported in visit as good control. There was therapeutic inertia (TI), not taking any change or action in the treatment of COPD, in 68.4% of uncontrolled patients and in 9.1% uncontrolled patients not taking any action was made at the visit. Factors associated with TI in uncontrolled patients were there is disagreement in the degree of control reported by the doctor who performed the visit [Physician's perception is controlled versus uncontrolled, OR: 3.37 (2.33- 4.88), p<0.001] and having a lower burden of associated comorbidities [Charlson comorbidity index ≥3 versus <3, OR 0.8 (0.1–3.0), p=0.014]. The probability of a doctor having a disagreement in the perception in uncontrolled patients was lower in patients with severe exacerbations [OR 0.3 (0.17 – 0.78), p=0.009] or with more exacerbations in the last year [OR 0.6 (9.4 – 0.9), p=0.019]. Uncontrolled patients in whom their physician's perceived control was referred to as good are 2.7 less likely to receive a therapeutic action at the visit, and 4.7 more likely to be scheduled for a longer check-up. Conclusions: Therapeutic inertia exists in more than half of uncontrolled patients and is more likely when there was disagreement with the criteria of the physician responsible for the visit who reported that there was good control, this being more likely in the patient with less history of exacerbations.