Development and Validation of a Quantitative Score for the Criteria Clinical Control in Stable COPD Proposed in the Spanish COPD Guidelines (GesEPOC): Results of the EPOCONSUL Audit

Abstract

Introduction/Objective: the concept of clinical control of COPD is a measure proposed in the Spanish COPD Guidelines (GesEPOC), which aims to help clinicians assess the clinical status in order to adapt the treatment plan at follow-up. However, studies that have evaluated clinical practice reveal that the degree of control of COPD is not always assessed, which underlines the need to promote its assessment through a scoring system. To develop a scoring system that quantitatively assesses the validated criteria defining the degree of COPD control. Methods: this study used data from the EPOCONSUL audit in respiratory clinics across Spain. We included in this analysis all patients with a COPD clinical control grade estimated and reported by the physician at the visit, who had registered the criteria necessary to define the degree of clinical control validated and established in GesEPOC. Patients were randomly assigned to either the development or validation cohorts. The development cohort included 485 patients and the validation cohort included 341 patients. Score modelling was conducted using a multivariate logistic regression model, and calibration of the model and score was assessed using the Hosmer-Lemeshow goodness-of-fit test and GiViTi Calibration belts. The model and generated score's discrimination capacity were analyzed by calculating the Area Under the Curve (AUC). Results: the scoring system was developed using four criteria as predictors of poor clinical control of COPD reported by the treating physician:adjusted dyspnoea severity, use of rescue inhaler more than three times per week, walking less than 30 min per day, and COPD exacerbations in the last three months. The scoring system attributed scores from 0 to 8. Calibration was satisfactory in both development and validation cohorts, and the score's discrimination power, as indicated by the AUC, was 0.892. Conclusions: this scoring system provides an easy-to-use quantitative assessment of clinical control of COPD that we believe will help to measure COPD control and its evolution during patient follow-up. Future research will be needed to prospectively evaluate this score as a predictor of outcome.

Keywords: chronic obstructive pulmonary disease; degree clinical control; predicted probability; score.

Figure 1

Flow chart of the sampling process.

Figure 2

(A): Number of participating centres (C) and patients (P) evaluated by regions in development cohort. Data are presented as numbers. (B): Number of participating centres and patients evaluated by regions in validation cohort. Data are presented as numbers.

Figure 3

(A) Area Under the Receiver Operating Characteristic Curve Modelo Develop. (B) Area Under the Receiver Operating Characteristic Curve Score Develop. (C) Area Under the Receiver Operating Characteristic Curve Score Validation.

Figure 4

(A) Calibraton Belt Modelo Develop. (B) Calibraton Belt Score Develop. (C) Calibraton Belt Score Validation.