Table 2.

Clinical events or parameters that may indicate a requirement for modifying COPD treatment

Clinical event or parameter	Measure
Inadequate response to initial treatment	CAT score improvement <2 following intervention70,71 Insufficient symptomatic relief perceived by patient or physician1 • Changes in breathlessness • Changes in ability to carry out activities • Sleep quality • Are improvements worthwhile to patient?
Increased use of rescue medication	Sustained, increased requirement for short-acting bronchodilators • Eg, ≥6 inhalations/day of salbutamol72
Hospitalization	Any single hospitalization related to COPD or its complications
Worsening of symptoms	Worsening of COPD symptoms on clinical evaluation; deterioration in symptom or health-status assessment scores over time
Suboptimal symptom control across the whole day	Problematic nighttime, early morning, and/or daytime COPD symptoms
Suboptimal COPD control	Patient not achieving individualized treatment objectives in areas relating to COPD impact and stability: • CAT/CCQ scores • Degree of dyspnea • Use of rescue medication • Level of physical activity • Sputum color over time
Exacerbation events	Occurrence of an exacerbation (or hospitalization) after maintenance-treatment initiation
Reduction in lung function (in combination with other measures of clinical worsening)	Reduced FEV1 accompanied by an increase in disease severity, symptoms, or exacerbation rate, a decrease in exercise tolerance, or COPD comorbidities

Abbreviations: CAT, COPD Assessment Test; CCQ, Clinical COPD Questionnaire; FEV₁, forced expiratory volume in 1 second.