Exploring Clinical Control of COPD: Insights From a Portuguese Outpatient Population.

Abstract

Purpose: Chronic obstructive pulmonary disease (COPD) remains a challenging condition to manage due to its variability in clinical presentation and progression. While disease control is a well-defined concept in asthma, its relevance in COPD is less clear. This study aimed to evaluate the clinical utility of a COPD control framework, developed in Spain, in Portuguese outpatients by analyzing exacerbation rates among controlled and uncontrolled patients.

Methods: This prospective, observational study enrolled 133 COPD outpatients, evaluated at baseline (V0), 6 months (V1), and one year (V2). Patients were classified as controlled or uncontrolled based on criteria assessing clinical stability and disease impact, incorporating dyspnea severity, rescue medication use, physical activity, sputum color, and recent exacerbation history. Patients classified as controlled and uncontrolled were compared regarding the occurrence of an exacerbation (hospitalization, emergency visit, or ambulatory exacerbation) during follow-up.

Results: At baseline, 33.1% of patients were classified as controlled. This proportion increased to 46.2% at V1 but decreased to 31.6% at V2. Notably, only 12% remained consistently controlled throughout follow-up. There was a consistent trend of higher exacerbation rates among those previously uncontrolled. Only the difference in emergency visits at 12 months reached statistical significance (27.1% versus 7.8% in controlled patients, p=0.023).

Conclusion: This study provides the first independent validation of COPD control criteria in a Portuguese cohort. Although the control framework proved feasible for clinical application, its predictive value for exacerbations was low in this severe-disease cohort. Future research should expand on these findings in diverse populations to optimize COPD management strategies.