SESSION TITLE: Acute exacerbations of COPD
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Wednesday, October 30, 2013 at 02:45 PM - 04:15 PM
PURPOSE: Although physical activity is decreased during and following hospitalizations for COPD exacerbations, few longitudinal measurements of this important variable have been performed.
METHODS: Clinically-stable COPD patients with 2 or more exacerbations in the preceding 12 months were recruited. Physical activity was measured using a tri-axial accelerometer continuously worn on the wrist. Mean minutes per day of higher-level physical activity (>1.8 metabolic equivalents) in the 4 weeks before, during, and the 4 weeks following an exacerbation were compared. The exacerbation, including its onset and duration, was determined using the 14-item Exacerbations of Chronic Pulmonary Disease Tool (EXACT). This was completed daily. Each patient was followed out to 4 weeks following a clinically-reported exacerbation or (if no exacerbation was reported) for 6 consecutive months.
RESULTS: Seventeen patients (9 male; age 63 ±12 years; FEV1 52 ± 20 %) were studied for 135 ± 18 days. Fifteen patients had 27 EXACT-defined exacerbations; only 9 of these were clinically-reported. Patients spent fewer minutes per day at higher-level physical activity during exacerbation-days than non-exacerbation-days: 130 ± 18 vs.157 ± 18 minutes, p < 0.0001. The median duration of the exacerbation was 12 days. Linear regression showed a significant decline in higher-level physical activity from baseline (time zero) through the first 7 days of the exacerbation: intercept = 161 ± 18, Beta = - 5.8 ± 1.9 minutes per day (p = 0.003). There was no significant further decline over the subsequent 7 days. The pattern of physical activity was that of: 1) Stability during each of the 4 weeks preceding the exacerbation; 2) Significantly reduced activity during the exacerbation; 3) Decreased activity persisting over the 2 weeks following the exacerbation; 4) Activity approaching pre-exacerbation levels during weeks 3 and 4.
CONCLUSIONS: Physical activity was decreased during the COPD exacerbation, with much of this reduction taking place during the first week. Physical activity remained low for about two weeks after the EXACT-defined exacerbation had ended.
CLINICAL IMPLICATIONS: Clinicians should consider this reduction in physical activity when managing COPD exacerbations.
DISCLOSURE: R. ZuWallack: Consultant fee, speaker bureau, advisory committee, etc.: Richard ZuWallack has received speaking honoraria from Boehringer Ingelheim, Pfizer, and Glaxo Smith Kline and has served on advisory boards for Boehringer Ingelheim; all of these funds have gone to his institution. His institution has also received funds from Boehringer Ingelheim for investigator-initiated studies. Nancy Leidy: Other: Provide consulting and other research services to pharmaceutical, device, government, and nongovernment organizations. In her salaried position, she works with a variety of companies and organizations and are precluded from receiving payment or honoraria directly from these organizations for services rendered The following authors have nothing to disclose: Rana Khan, Mohsin Ehsan, Dorothy Wakefield, Asher Qureshi
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