Enhancing our understanding of the time course of acute exacerbations of COPD managed on an outpatient basis

International Journal of COPD Dovepress open access to scientific and medical research Original Research International Journal of Chronic Obstructive Pulmonary Disease downloaded from https://www.dovepress.com/ by 88.198.20.149 on 06-May-2021 For personal use only. Open Access Full Text Article Enhancing our understanding of the time course of acute exacerbations of COPD managed on an outpatient basis This article was published in the following Dove Press journal: International Journal of COPD Ana Oliveira 1–3 Vera Afreixo 3,4 Alda Marques 2,3 Faculty of Sports, University of Porto, Porto, Portugal; 2Respiratory Research and Rehabilitation Laboratory Lab3R, School of Health Sciences, University of Aveiro, Aveiro, Portugal; 3Institute for Biomedicine, iBiMED, University of Aveiro, Aveiro, Portugal; 4Center for Research and Development in Mathematics and Applications, CIDMA, University of Aveiro, Aveiro, Portugal 1 Introduction Correspondence: Alda Marques Respiratory Research and Rehabilitation Laboratory, Lab3R, School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, Agras do Crasto, Edifício 30, 3810-193 Aveiro, Portugal Tel +351 234 37 2462 Email COPD is frequently punctuated by acute exacerbations (acute exacerbations of COPD [AECOPD]), which account for more than half of the hospitalizations1 in COPD and are the main responsible for patients’ clinical deterioration and increased health care costs.2 Globally, more than 50% of COPD-related costs are due to AECOPD3 and in USA, costs are estimated in $7.100 per patient/exacerbation.4 Long-term consequences of AECOPD are known, such as clinical important physiological and functional deteriorations,2 resulting in significant declines in lung function, muscle strength, and quality of life and increased mortality.2,5 AECOPD are also responsible for significant patients’ clinical deterioration during its time course; however, most of the information available is on lung function and dyspnea6–8 in 3759 submit your manuscript | www.dovepress.com International Journal of COPD 2018:13 3759–3766 Dovepress © 2018 Oliveira et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://dx.doi.org/10.2147/COPD.S175890 Powered by TCPDF (www.tcpdf.org) Purpose: Acute exacerbations of COPD (AECOPD) are associated with pulmonary/systemic changes; however, quantification of those changes during AECOPD managed on an outpatient basis and factors influencing recovery are lacking. This study aimed to characterize patients’ changes during AECOPD and identify factors influencing their recovery. Methods: Body mass index, the modified British Medical Research Council questionnaire, number of exacerbations in the previous year, and the Charlson comorbidity index (independent variables) were collected within 24–48 hours of hospital presentation (T0). Peripheral oxygen saturation (SpO2), forced expiratory volume in one second, percentage predicted (FEV1% predicted), maximum inspiratory pressure, quadriceps muscle strength, 5 times sit-to-stand, and COPD assessment test (CAT) (dependent variables) were collected at T0 and approximately at days 8 (T1), 15 (T2), and 45 (T3) after T0. Results: A total of 44 outpatients with AECOPD (31♂; 68.2±9.1 years; 51.1±20.3 FEV1% predicted) were enrolled. All variables improved overtime (P,0.05); however, at day 8, only SpO2 and CAT (P#0.001) showed significant improvements. Changes in FEV1% predicted and SpO2 were not influenced by any independent measure, while changes in other outcome measures were influenced by at least one of the independent measures. Independently of the time of data collection, being underweight or overweight and having increased dyspnea, previous exacerbations, and severe comorbidities negatively affected patients’ outcomes. Conclusion: FEV1% predicted and SpO2 were not influenced by any independent measure and, thus, seem to be robust measures to follow-up outpatients with AECOPD. No single indicator was able to predict patients’ recovery for all measures; thus, a comprehensive assessment at the onset of the AECOPD is required to personalize interventions. Keywords: COPD exacerbations, management, outcome measures, outpatients Dovepress International Journal of Chronic Obstructive Pulmonary Disease downloaded from https://www.dovepress.com/ by 88.198.20.149 on 06-May-2021 For personal use only. Oliveira et al hospitalized patients.5,7,9–11 Little information is still available on more functional parameters, such as muscle strength, activities of daily living, and impact of the disease. Moreover, hospitalized patients differ from outpatients not only in their management but also in the disease severity,12 which may influence their pattern of recovery. Thus, understanding outpatients’ recovery seems crucial to timely manage and appropriately plan their follow-ups. Factors associated with the progression and prognosis of AECOPD during hospitalizations have already been studied and include patients’ anthropometrics, stage of the disease (according to dyspnea and number of AECOPD in the previous year), severity of comorbidities, and acute physiological derangements.13 Such information is essential to design management strategies and discharge plans during hospital stay. However, more than 80% of AECOPD are managed on an outpatient basis12 and knowledge on factors influencing the time course of AECOPD managed in this setting is scarce. This unawareness impairs the standardization, optimization, and personalization of the treatment and ultimately contributes to the existing high rate of AECOPD relapses.14 This study aimed to characterize patients’ lung function, oxygen saturation, muscles strength, impact of the disease, and functionality during the time course of AECOPD managed on an outpatient basis. Additionally, it was aimed to identify the factors influencing this recovery period. Methods Study design and participants A longitudinal observational study was conducted in nonhospitalized patients with AECOPD recruited from the urgent care of a Central Hospital. Inclusion criteria were the diagnosis of an AECOPD according to the GOLD criteria.12 Exclusion criteria were hospitalization (defined as the need to be admitted as an inpatient at the respiratory or intensive care unit for further assessment/treatment after consultation with the urgency clinician); patients requiring em (...truncated)