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Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have a negative impact on patients' health status, including physical function and patient-reported outcomes. We aimed to explore the associations between physical tests and patient-reported outcome measures (PROMs) in hospitalised patients for an AECOPD. Patients were assessed on the day of discharge. Quadriceps force, handgrip strength, short physical performance battery (SPPB), five-repetition sit-to-stand test (5STS), four-meter gait speed test (4MGS), balance test, six-minute walk test (6MWT), COPD Assessment Test (CAT), London Chest Activity of Daily Living scale (LCADL), modified Medical Research Council (mMRC) dyspnea scale, Checklist of Individual Strength (CIS)-fatigue subscale, and Patient Health Questionnaire (PHQ-9) were collected. Sixty-nine patients with an AECOPD were included (54% female; age 69 ± 9 years; FEV1 39.2 (28.6-49.1%) predicted). Six-minute walk distance was strongly correlated with mMRC (ρ: -0.64, p < 0.0001) and moderately correlated with LCADL total score, subscales self-care and household activities (ρ ranging from -0.40 to -0.58, p < 0.01). Moreover, 4MGS was moderately correlated with mMRC (ρ: -0.49, p < 0.0001). Other correlations were weak or non-significant. During a severe AECOPD, physical tests are generally poorly related to PROMs. Therefore, a comprehensive assessment combining both physical tests and PROMs needs to be conducted in these patients to understand their health status. ispartof: JOURNAL OF CLINICAL MEDICINE vol:11 issue:1 ispartof: location:Switzerland status: published

Background: It is suggested that acute exacerbations of COPD (AECOPD) negatively impact on skeletal muscle function and exercise capacity, with limited recovery. We aim to describe muscle function and functional exercise capacity during and after a severe AECOPD, and to compare outcomes with patients with stable COPD (SCOPD). Methods: Hospitalised patients with AECOPD were assessed at day of discharge and 4 weeks after discharge. Stable patients were matched for lung function. Assessments included right quadriceps force (QF; Microfet), handgrip force (HF; Jamar) and a 6min-walk test (6MWT). This is an interim analysis of an ongoing trial. Results: We included 30 patients with AECOPD (14 male; age 68±9yrs; FEV1 42±12 %pred) and 30 patients with SCOPD (14 male; age 65±7yrs; FEV1 43±14 %pred). Data are provided in Table 1. 6MWT was lower in AECOPD compared to the assessment during SCOPD, but this difference was not significant at 4 weeks. No other significant differences were found for QF and HF. Conclusion: 6MWT, but not muscle strength, was lower at hospital discharge for AECOPD compared to patients with SCOPD patients with matched lung function. This difference was not sustained after 4 weeks of follow-up. No significant changes were observed during recovery from the AECOPD for any outcome.

Patienten mit chronisch-obstruktiver Lungenerkrankung (COPD), Asthma und interstitiellen Lungenerkrankungen (ILD) weisen häufig kardiovaskuläre Komorbiditäten (KVK) auf. Bewegungstraining ist eine tragende Säule bei der Behandlung dieser Erkrankungen, doch existieren kaum Empfehlungen zur maßgeschneiderten Anpassung von Programmen für Patienten mit Atemwegserkrankungen und KVK. Ziel der vorliegenden systematischen Übersichtsarbeit war es, die Eignungskriterien zu identifizieren, die für die Auswahl von Patienten mit COPD, Asthma oder ILD und KVK für Bewegungsprogramme herangezogen werden, und die Auswirkungen von Bewegung auf die kardiovaskulären Outcomes zu bewerten. Darüber hinaus sollte festgestellt werden, wie Bewegungsprogramme auf Patienten mit KVK zugeschnitten wurden. Es erfolgte eine Suche in den Datenbanken PubMed, Scopus, Web of Science und Cochrane. Drei Reviewer extrahierten die Daten, und zwei Reviewer bewerteten unabhängig voneinander die Qualität der Studien mithilfe des Quality Assessment Tool for Quantitative Studies. Bei der Berechnung der individuellen und gepoolten Effektstärken (ES) kam MetaXL 5.3 zur Anwendung. In den meisten Studien (58,9 %) waren Patienten mit stabiler und instabiler KVK ausgeschlossen. Insgesamt berichteten 26 von 42 Studien kardiovaskuläre Outcomes. Das am häufigsten berichtete Outcome-Maß war die Herzfrequenz in Ruhe (n = 13), und es zeigte sich ein geringer statistisch signifikanter Effekt (ES = -0,23) des Bewegungstrainings auf die Herzfrequenz in Ruhe bei COPD-Patienten. Es wurden keine speziellen Anpassungen für die verordneten Bewegungstrainings beschrieben. Wenige Studien schlossen Patienten mit KVK ein. Ein individueller Zuschnitt der Bewegungsprogramme fehlte und die beobachteten Effekte waren begrenzt. Zukünftige Studien sollten den Effekt maßgeschneiderter Bewegungsprogramme auf relevante Outcome-Maße bei Patienten mit Atemwegserkrankungen und KVK untersuchen.

Patients with chronic obstructive pulmonary disease (COPD), asthma and interstitial lung diseases (ILD) frequently suffer from cardiovascular comorbidities (CVC). Exercise training is a cornerstone intervention for the management of these conditions, however recommendations on tailoring programmes to patients suffering from respiratory diseases and CVC are scarce. This systematic review aimed to identify the eligibility criteria used to select patients with COPD, asthma or ILD and CVC to exercise programmes; assess the impact of exercise on cardiovascular outcomes; and identify how exercise programmes were tailored to CVC. PubMed, Scopus, Web of Science and Cochrane were searched. Three reviewers extracted the data and two reviewers independently assessed the quality of studies with the Quality Assessment Tool for Quantitative Studies. MetaXL 5.3 was used to calculate the individual and pooled effect sizes (ES). Most studies (58.9%) excluded patients with both stable and unstable CVC. In total, 26/42 studies reported cardiovascular outcomes. Resting heart rate was the most reported outcome measure (n = 13) and a small statistically significant effect (ES = −0.23) of exercise training on resting heart rate of patients with COPD was found. No specific adjustments to exercise prescription were described. Few studies have included patients with CVC. There was a lack of tailoring of exercise programmes and limited effects were found. Future studies should explore the effect of tailored exercise programmes on relevant outcome measures in respiratory patients with CVC.