Juan José Soler-Cataluña

Hospital Arnau de Vilanova, Valenza, Valencia, Spain

Are you Juan José Soler-Cataluña?

Claim your profile

Publications (74)208.73 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: There is no universal consensus on the best staging system for chronic obstructive pulmonary disease (COPD). Although documents (eg, the Global Initiative for Chronic Obstructive Lung Disease [GOLD] 2007) have traditionally used forced expiratory volume in 1 s (FEV1) for staging, clinical parameters have been added to some guidelines (eg, GOLD 2011) to improve patient management. As part of the COPD Cohorts Collaborative International Assessment (3CIA) initiative, we aimed to investigate how individual patients were categorised by GOLD 2007 and 2011, and compare the prognostic accuracy of the staging documents for mortality. We searched reports published from Jan 1, 2008, to Dec 31, 2014. Using data from cohorts that agreed to participate and had a minimum amount of information needed for GOLD 2007 and 2011, we did a patient-based pooled analysis of existing data. With use of raw data, we recalculated all participant assignments to GOLD 2007 I-IV classes, and GOLD 2011 A-D stages. We used survival analysis, C statistics, and non-parametric regression to model time-to-death data and compare GOLD 2007 and GOLD 2011 staging systems to predict mortality. We collected individual data for 15 632 patients from 22 COPD cohorts from seven countries, totalling 70 184 person-years. Mean age of the patients was 63·9 years (SD 10·1); 10 751 (69%) were men. Based on FEV1 alone (GOLD 2007), 2424 (16%) patients had mild (I), 7142 (46%) moderate (II), 4346 (28%) severe (III), and 1670 (11%) very severe (IV) disease. We compared staging with the GOLD 2007 document with that of the new GOLD 2011 system in 14 660 patients: 5548 (38%) were grade A, 2733 (19%) were grade B, 1835 (13%) were grade C, and 4544 (31%) were grade D. GOLD 2011 shifted the overall COPD severity distribution to more severe categories. There were nearly three times more COPD patients in stage D than in former stage IV (p<0·05). The predictive capacity for survival up to 10 years was significant for both systems (p<0·01) but area under the curves were only 0·623 (GOLD 2007) and 0·634 (GOLD 2011), and GOLD 2007 and 2011 did not differ significantly. We identified the percent predicted FEV1 thresholds of 85%, 55% and 35% as better to stage COPD severity for mortality, which are similar to the ones used previously. Neither GOLD COPD classification schemes have sufficient discriminatory power to be used clinically for risk classification at the individual level to predict total mortality for 3 years of follow-up and onwards. Increasing intensity of treatment of patients with COPD due to their GOLD 2011 reclassification is not known to improve health outcomes. Evidence-based thresholds should be searched when exploring the prognostic ability of current and new COPD multicomponent indices. None. Copyright © 2015 Elsevier Ltd. All rights reserved.
    The Lancet Respiratory Medicine 05/2015; 3(6). DOI:10.1016/S2213-2600(15)00157-5
  • [Show abstract] [Hide abstract]
    ABSTRACT: The COPD assessment test (CAT) is a questionnaire that assesses the impact of chronic obstructive pulmonary disease (COPD) on health status, but some patients have difficulties filling it up by themselves. We examined whether the mode of administration of the Spanish version of CAT (self vs. interviewer) influences its scores and/or psychometric properties. Observational, prospective study in 49 Spanish centers that includes clinically stable COPD patients (n = 153) and patients hospitalized because of an exacerbation (ECOPD; n = 224). The CAT was self-administered (CAT-SA) or administered by an interviewer (CAT-IA) based on the investigator judgment of the patient's capacity. To assess convergent validity, the Saint George's Respiratory Disease Questionnaire (SGRQ) and the London Chest Activity of Daily Living (LCADL) instrument were also administered. Psychometric properties were compared across modes of administration. A total of 118 patients (31 %) completed the CAT-SA and 259 (69 %) CAT-IA. Multiple regression analysis showed that mode of administration did not affect CAT scores. The CAT showed excellent psychometric properties in both modes of administration. Internal consistency coefficients (Cronbach's alpha) were high (0.86 for CAT-SA and 0.85 for CAT-IA) as was test-retest reliability (intraclass correlation coefficients of 0.83 for CAT-SA and CAT-IA). Correlations with SGRQ and LCADL were moderate to strong both in CAT-SA and CAT-IA, indicating good convergent validity. Similar results were observed when testing longitudinal validity. The mode of administration does not influence CAT scores or its psychometric properties. Hence, both modes of administration can be used in clinical practice depending on the physician judgment of patient's capacity.
    Quality of Life Research 04/2015; DOI:10.1007/s11136-015-0983-x · 2.86 Impact Factor
  • Source
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The modified Medical Research Council (mMRC) dyspnea, the Chronic obstructive pulmonary disease (COPD) Assessment Test (CAT), and the Clinical COPD Questionnaire (CCQ) have been interchangeably proposed by the GOLD initiative for assessing symptoms in COPD patients. However, there are no data on the prognostic value of these tools in terms of mortality. To evaluate the prognostic value of the CAT and CCQ scores and compare with modified Medical Research Council (mMRC) dyspnea. We analyzed the ability of these tests to predict mortality in an observational cohort of 768 COPD patients (82% males; FEV1 60%) from the CHAIN study, a multicenter observational Spanish cohort who were monitored annually for a mean follow-up time of 38 months. Subjects who died (n=73; 9.5%) had higher CAT (14 vs. 11, p=0.022), CCQ (1.6 vs. 1.3, p=0.033), and mMRC dyspnea scores (2 vs. 1, p<0.001) than survivors. Receiver operating characteristic analysis showed that higher CAT, CCQ, and dyspnea scores were associated with higher mortality (area under the curve: 0.589, 0.588, and 0.649, respectively). CAT scores ≥17 and CCQ scores >2.5 provided a similar sensitivity than mMRC dyspnea scores ≥2 to predict all-cause mortality. The CAT and the CCQ have similar ability for predicting all-cause mortality in patients with chronic obstructive pulmonary disease, but were inferior to mMRC dyspnea scores. We suggest new thresholds for CAT and CCQ scores based on mortality risk that could be useful for the new GOLD grading classification. ClinicalTrials.gov Identifier: NCT01122758.
    Chest 01/2015; DOI:10.1378/chest.14-2449 · 7.13 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The COPD Assessment Test (CAT) has been recently developed to quantify COPD impact in routine practice. However, no relationship with other measures in the Global Initiative for Obstructive Lung Disease (GOLD) strategy has been evaluated. The present study aimed to evaluate the relationship of the CAT with other GOLD multidimensional axes, patient types, and the number of comorbidities. This was a cross-sectional analysis of the Clinical presentation, diagnosis, and course of chronic obstructive pulmonary disease (On-Sint) study. The CAT score was administered to all participants at the inclusion visit. A GOLD 2011 strategy consisting of modified Medical Research Council scale (MRC) scores was devised to study the relationship between the CAT, and GOLD 2011 axes and patient types. The relationship with comorbidities was assessed using the Charlson comorbidity index, grouped as zero, one to two, and three or more. The CAT questionnaire was completed by 1,212 patients with COPD. The CAT maintained a relationship with all the three axes, with a ceiling effect for dyspnea and no distinction between mild and moderate functional impairment. The CAT score increased across GOLD 2011 patient types A-D, with similar scores for types B and C. Within each GOLD 2011 patient type, there was a considerably wide distribution of CAT values. Our study indicates a correlation between CAT and the GOLD 2011 classification axes as well as the number of comorbidities. The CAT score can help clinicians, as a complementary tool to evaluate patients with COPD within the different GOLD patient types.
    International Journal of COPD 01/2015; 10:975. DOI:10.2147/COPD.S82781
  • Juan José Soler-Cataluña, Fernando Sánchez Toril, M. Carmen Aguar Benito
    [Show abstract] [Hide abstract]
    ABSTRACT: Longer life expectancy and the progressive aging of the population is changing the epidemiological pattern of healthcare, with a reduction in the incidence of acute diseases and a marked increase in chronic diseases. This change brings important social, healthcare and economic consequences that call for a reorganization of patient care. In this respect, the Spanish National Health System has developed a Chronicity strategy that proposes a substantial change in focus from traditional rescue medicine to patient- and environment-centered care, with a planned, proactive, participative and multidisciplinary approach. Some of the more common chronic diseases are respiratory. In COPD, this integrated approach has been effective in reducing exacerbations, improving quality of life, and even reducing costs. However, the wide variety of management strategies, not only in COPD but also in asthma and other respiratory diseases, makes it difficult to draw definitive conclusions. Pulmonologists can and must participate in the new chronicity models and contribute their knowledge, experience, innovation, research, and special expertise to the development of these new paradigms.
    Archivos de Bronconeumología 12/2014; DOI:10.1016/j.arbres.2014.10.007 · 1.82 Impact Factor
  • Juan José Soler-Cataluña, Fernando Sánchez Toril, M Carmen Aguar Benito
    [Show abstract] [Hide abstract]
    ABSTRACT: Longer life expectancy and the progressive aging of the population is changing the epidemiological pattern of healthcare, with a reduction in the incidence of acute diseases and a marked increase in chronic diseases. This change brings important social, healthcare and economic consequences that call for a reorganization of patient care. In this respect, the Spanish National Health System has developed a Chronicity strategy that proposes a substantial change in focus from traditional rescue medicine to patient- and environment-centered care, with a planned, proactive, participative and multidisciplinary approach. Some of the more common chronic diseases are respiratory. In COPD, this integrated approach has been effective in reducing exacerbations, improving quality of life, and even reducing costs. However, the wide variety of management strategies, not only in COPD but also in asthma and other respiratory diseases, makes it difficult to draw definitive conclusions. Pulmonologists can and must participate in the new chronicity models and contribute their knowledge, experience, innovation, research, and special expertise to the development of these new paradigms. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.
    Archivos de Bronconeumología 12/2014; DOI:10.1016/j.arbr.2015.04.014 · 2.17 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2011 introduced a new multidimensional system (symptom/risk) for assessment chronic obstructive pulmonary disease (COPD). The aim of this study was to explore the construct validity of the GOLD 2011 classification strategy; specifically, we evaluated its internal structure in terms of reliability and exploratory factor analysis (EFA). Reliability (Cronbach alpha coefficient), correlations between variables and two successive EFA were performed to assess the internal structure of GOLD 2011. Symptoms (mMRC dyspnea score) and risk (number of previous year exacerbations and forced expiratory volume in the first second % of predicted) were selected as variables. The analysis included 679 COPD patients from two Spanish cohorts (71.4 ± 11.7 years). Alpha coefficient of the 3 items was 0.52 for the whole sample. Variables presented statistically significant correlations, but of low to moderate magnitude. A first EFA extracted only one factor accounting 52% of the total variance. A second EFA including four items (the three GOLD 2011 variables plus comorbidities as Charlson index score), extracted two-factors accounting for 65% of the total variance. The first factor included the three items of GOLD 2011, and the second contained only one variable (comorbidities). This solution was stable in patients with different levels of COPD severity. The available evidence suggests that GOLD 2011 strategy presented a low reliability, and its theorized multidimensionality was not confirm by EFA. Comorbidities appears as a separate and independent domain. Copyright © 2014. Published by Elsevier Ltd.
    Pulmonary Pharmacology &amp Therapeutics 12/2014; 30. DOI:10.1016/j.pupt.2014.12.002 · 2.57 Impact Factor
  • Source
    Juan José Soler-Cataluña, Bernardino Alcázar-Navarrete, Marc Miravitlles
    [Show abstract] [Hide abstract]
    ABSTRACT: Treatment of chronic obstructive pulmonary disease (COPD) requires a personalized approach according to the clinical characteristics of the patients, the level of severity, and the response to the different therapies. Furthermore, patients with the same level of severity measured by the degree of airflow obstruction or even with multidimensional indices may have very different symptoms and limitations for daily activities. The concept of control has been extensively developed in asthma but has not been defined in COPD. Here, we propose a definition of COPD control based on the concepts of impact and stability. Impact is a cross-sectional concept that can be measured by questionnaires such as the COPD Assessment Test or the Clinical COPD Questionnaire. Alternatively, impact can be assessed by the degree of dyspnea, the use of rescue medication, the level of physical activity, and sputum color. Stability is a longitudinal concept that requires the absence of exacerbations and deterioration in the aforementioned variables or in the COPD Assessment Test or Clinical COPD Questionnaire scores. Control is defined by low impact (adjusted for severity) and stability. The concept of control in COPD can be useful in the decision making regarding an increase or decrease in medication in the stable state.
    International Journal of COPD 12/2014; 9:1397-405. DOI:10.2147/COPD.S71370
  • [Show abstract] [Hide abstract]
    ABSTRACT: Several diseases commonly co-exist with chronic obstructive pulmonary disease (COPD), especially in elderly patients. This study aimed to investigate whether there is an association between COPD severity and the frequency of comorbidities in stable COPD patients. In this multicenter, cross-sectional study, patients with spirometric diagnosis of COPD attended to by internal medicine departments throughout Spain were consecutively recruited by 225 internal medicine specialists. The severity of airflow obstruction was graded using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and data on demographics, smoking history, comorbidities, and dyspnea were collected. The Charlson comorbidity score was calculated. Eight hundred and sixty-six patients were analyzed: male 93%, mean age 69.8 (standard deviation [SD] 9.7) years and forced vital capacity in 1 second 42.1 (SD 17.7)%. Even, the mean (SD) Charlson score was 2.2 (2.2) for stage I, 2.3 (1.5) for stage II, 2.5 (1.6) for stage III, and 2.7 (1.8) for stage IV (P=0.013 between stage I and IV groups), independent predictors of Charlson score in the multivariate analysis were age, smoking history (pack-years), the hemoglobin level, and dyspnea, but not GOLD stage. COPD patients attended to in internal medicine departments show high scores of comorbidity. However, GOLD stage was not an independent predictor of comorbidity.
    International Journal of COPD 11/2014; 9:1307-14. DOI:10.2147/COPD.S71849
  • Juan Jose Soler-Cataluna, Bernardino Alcázar-Navarrete, Marc Miravitlles
    European Respiratory Journal 07/2014; 44(4). DOI:10.1183/09031936.00064414 · 7.13 Impact Factor
  • Chest 07/2014; 146(1):111. DOI:10.1378/chest.13-2246 · 7.13 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: FEV1 is universally used as a measure of severity in COPD. Current thresholds are based on expert opinion and not on evidence. We aimed to identify the best FEV1 (% predicted) and dyspnea (mMRC) thresholds to predict 5-yr survival in COPD patients. We conducted a patient-based pooled analysis of eleven COPD Spanish cohorts (COCOMICS). Survival analysis, ROC curves, and C-statistics were used to identify and compare the best FEV1 (%) and mMRC scale thresholds that predict 5-yr survival. A total of 3,633 patients (93% men), totaling 15,878 person-yrs. were included, with a mean age 66.4±9.7, and predicted FEV1 of 53.8% (±19.4%). Overall 975 (28.1%) patients died at 5 years. The best thresholds that spirometrically split the COPD population were: mild ≥70%, moderate 56-69%, severe 36-55%, and very severe ≤35%. Survival at 5 years was 0.89 for patients with FEV1≥70 vs. 0.46 in patients with FEV1 ≤35% (H.R: 6; 95% C.I.: 4.69-7.74). The new classification predicts mortality significantly better than dyspnea (mMRC) or FEV1 GOLD and BODE cutoffs (all p<0.001). Prognostic reliability is maintained at 1, 3, 5, and 10 years. In younger patients, survival was similar for FEV1 (%) values between 70% and 100%, whereas in the elderly the relationship between FEV1 (%) and mortality was inversely linear. The best thresholds for 5-yr survival were obtained stratifying FEV1 (%) by ≥70%, 56-69%, 36-55%, and ≤35%. These cutoffs significantly better predict mortality than mMRC or FEV1 (%) GOLD and BODE cutoffs.
    PLoS ONE 02/2014; 9(2):e89866. DOI:10.1371/journal.pone.0089866 · 3.53 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: ABSTRACT RATIONALE: The Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT) was proposed for assessing health status in COPD, but little is known about its longitudinal changes. OBJECTIVE: To evaluate one-year CAT variability in stable COPD patients and relate its variations to changes in other disease markers. METHODS: We evaluated the following variables in smokers with and without COPD at baseline and after one year: CAT score, age, gender, smoking status, pack-years history, BMI, modified Medical Research Council (MMRC) scale, 6MWD, lung function, BODE index, hospital admissions, Hospital and Depression Questionnaire, and the Charlson comorbidity score. In COPD patients we explored the association of CAT scores and its one-year changes with the studied parameters. RESULTS: 824 smokers with COPD and 126 without were evaluated at baseline, and 441 smokers with COPD and 66 without one year later. At 1 year, CAT scores for COPD patients were similar (±4 points) in 56%, higher in 27%, and lower in 17%. Interestingly, MMRC scores were similar (± 1 point) in 46% of patients, worse in 36% and better in 18% at 1 year. One-year CAT changes were best predicted by changes in MMRC scores (β coefficient 0.47, p<0.001). A similar behavior was found for CAT and MMRC in smokers without COPD. CONCLUSIONS: One-year longitudinal data shows variability in CAT scores among stable COPD patients, similar to what happened to MMRC that was the best predictor of one-year CAT changes. Further longitudinal studies should confirm the long-term CAT variability and it clinical applicability.
    Chest 02/2014; DOI:10.1378/chest.13-2246. · 7.13 Impact Factor
  • Source
    Archivos de Bronconeumología 01/2014; 50 Suppl 1:1-16. DOI:10.1016/S0300-2896(14)70070-5 · 2.17 Impact Factor
  • Thorax 11/2013; 68(Suppl 3):A127-A127. DOI:10.1136/thoraxjnl-2013-204457.266 · 8.56 Impact Factor
  • Source
  • [Show abstract] [Hide abstract]
    ABSTRACT: After the development of the COPD Strategy of the National Health Service in Spain, all scientific societies, patient organisations, and central and regional governments formed a partnership to enhance care and research in COPD. At the same time, the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) took the initiative to convene the various scientific societies involved in the National COPD Strategy and invited them to participate in the development of the new Spanish guidelines for COPD (Guía Española de la EPOC; GesEPOC). Probably the more innovative approach of GesEPOC is to base treatment of stable COPD on clinical phenotypes, a term which has become increasingly used in recent years to refer to the different clinical forms of COPD with different prognostic implications. The proposed phenotypes are: (A) infrequent exacerbators with either chronic bronchitis or emphysema; (B) overlap COPD-asthma; (C) frequent exacerbators with emphysema predominant; and (D) frequent exacerbators with chronic bronchitis predominant. The assessment of severity has also been updated with the incorporation of multidimensional indices. The severity of the obstruction, as measured by forced expiratory volume in 1 second, is essential but not sufficient. Multidimensional indices such as the BODE index have shown excellent prognostic value. If the 6-minute walking test is not performed routinely, its substitution by the frequency of exacerbations (BODEx index) provides similar prognostic properties. This proposal aims to achieve a more personalised management of COPD according to the clinical characteristics and multidimensional assessment of severity.
    Primary care respiratory journal: journal of the General Practice Airways Group 03/2013; 22(1):117-21. DOI:10.4104/pcrj.2013.00016
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Guidelines recommend to define COPD by airflow obstruction and other factors, but no studies evaluated the ability of existing multicomponent indices to predict mortality up to 10 years.We conducted a patient-based pooled analysis. Survival analysis and C-statistics were used to determine the best COPD index/indices according to several construct variables and by varying time points. Individual data of 3,633 patients from eleven COPD cohorts were collected, totalling the experience of 15,878 person-years.Overall, there were 1,245 death events within our cohorts, with a K-M survival of 0.963 at 6-months, down to 0.432 at 10 years. In all patients, ADO, BODE and e-BODE were the best indices to predict 6-months mortality. The ADO index was the best to predict 12-month mortality (C-statistic 0.702), 5-yr mortality (C-statistic 0.695), and 10-yr mortality (C-statistic 0.698), significantly better than BODE (all p<0.05). The best indices to predict death by C-statistics when adjusting by age were eBODE, BODEx, and BODE.No index predicts well short-term survival. All BODE modifications score better than ADO after age adjustment.. The ADO and BODE indices are overall the most valid multicomponent indices to predict time to death in all COPD patients.
    European Respiratory Journal 12/2012; 42(2). DOI:10.1183/09031936.00121012 · 7.13 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: IntroductionThis present paper describes the method and the organization of the study known as the COPD History Assessment In SpaiN (CHAIN), whose main objective is to evaluate the long-term natural history of a chronic obstructive pulmonary disease (COPD) patient cohort from a multidimensional standpoint and to identify clinical phenotypes, in comparison with another non-COPD control cohort.Patients and methodsCHAIN is a multicenter, observational study of prospective cohorts carried out at 36 Spanish hospitals. Both cohorts will be followed-up during a 5-year study period with complete office visits every 12 months and telephone interviews every 6 months in order to evaluate exacerbations and the vital state of the subjects. The recruitment period for cases was between 15 January 2010 and 31 March 2012. At each annual visit, information will be collected on: (i) clinical aspects (socio-economic situation, anthropometric data, comorbidities, smoking, respiratory symptoms, exacerbations, quality of life, anxiety-depression scale, daily life activities, treatments); (ii) respiratory function (spirometry, blood gases, hyperinflation, diffusion, respiratory pressures); (iii) BODE index (main study variable); (iv) peripheral muscle function, and (v) blood work-up (including IgE and cardiovascular risk factors). In addition, a serum bank will be created for the future determination of biomarkers. The data of the patients are anonymized in a database with a hierarchical access control in order to guarantee secure information access. The CHAIN study will provide information about the progression of COPD and it will establish a network of researchers for future projects related with COPD.
    Archivos de Bronconeumología 12/2012; 48(12):453–459. DOI:10.1016/j.arbres.2012.05.006 · 2.17 Impact Factor

Publication Stats

2k Citations
208.73 Total Impact Points

Institutions

  • 2014–2015
    • Hospital Arnau de Vilanova
      Valenza, Valencia, Spain
  • 2003–2013
    • Requena General Hospital
      Valenza, Valencia, Spain
  • 2010
    • Fundación Caubet-Cimera Centro Internacional de Medicina Respiratoria Avanzada
      Bunyola, Balearic Islands, Spain