Hospital admissions and exercise capacity decline in patients with COPD

Abstract

Exercise capacity declines with time and is an important determinant of health status and prognosis in patients with chronic obstructive pulmonary disease (COPD). We hypothesised that hospital admissions are associated with exercise capacity decline in these patients.Clinical and functional variables were collected for 342 clinically stable COPD patients. The 6-min walk distance (6MWD) was determined at baseline and after a mean¡SD of 1.7¡0.3 years. Information on hospitalisations during follow-up was obtained from centralised administrative databases. Linear regression was used to model changes in exercise capacity.Patients were mostly male (92%), with mean¡SD age 67.9¡8.6 years, post-bronchodilator forced expiratory volume in 1 s 54¡17% predicted and baseline 6MWD 433¡93 m. During follow-up, 6MWD decreased by 21.9¡51.0 m?year -1 and 153 (45%) patients were hospitalised at least once. Among patients admitted only for COPD-related causes (50% of those ever admitted), the proportion presenting a clinically significant loss of 6MWD was higher than in patients admitted for only nonrespiratory conditions (53% versus 29%, p50.040). After adjusting for confounders, annual 6MWD decline was greater (26 m?year -1 , 95% CI 13-38 m?year -1 ; p,0.001) in patients with more than one all-cause hospitalisation per year, as compared with those with no hospitalisations.Hospitalisations are related to a greater decline in exercise capacity in COPD.@ERSpublications Hospitalisations are associated with higher decline in exercise capacity in COPD patients

Emphysema and DL CO predict a clinically important difference for 6MWD decline in COPD

“…Furthermore, a recent study [6] showed that when a subject's 6MWD decline is greater than 30 m he/she has an increased risk for mortality, a finding substantiated by prior investigation [5,34,35]. Although such studies used densitometric measures of emphysema on CT scans or DL CO to characterize their subjects [2,4,9], no information was reported on the association between these measures and the change in 6MWD. We built on this prior knowledge by demonstrating that both an anatomic surrogate (emphysema on CT scan) and a physiologic measure of lung gas-exchanging surface predict the MCID for this functional outcome.…”

“…The Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) Study has identified age, body mass index, and lung function as factors associated with the decline in 6MWD [2]. Additional investigation in COPD subjects has shown that low physical activity [8] at baseline and all-cause hospitalizations [9] are also associated with 6MWD decline. We and others have also found that greater burden of emphysema on CT scans is associated with decreased exercise capacity following lung volume reduction surgery [10] and lower 6MWD in cross sectional studies [4,11].…”

“…In longitudinal studies in subjects with COPD a number of determinants are associated with a decline in exercise capacity including lung function [2,7], physical activity [8], and hospitalizations [9]. Greater burden of emphysema on computed tomography (CT) scans is also associated with lower exercise response following lung volume reduction surgery [10] and reduced 6MWD in cross sectional studies [4,11].…”

Vitamin D Deficiency Is Associated with Rapid Decline in Exercise Capacity in Male Patients with Chronic Obstructive Pulmonary Disease

“…As we mentioned above, the severity of airflow limitation and the level of physical activity may be associated with the annual decline in exercise capacity [25,26]. Another recent report suggested that hospital admissions were related to a greater decline in exercise capacity in COPD [29]. It is well known that a number of factors contribute to hospitalizations of COPD patients.…”

Paradas durante la caminata de 6 minutos y su correlación con nuevas mediciones de la prueba en pacientes con enfermedad pulmonar obstructiva crónica

“…la incapacidad de ejercicio en los pacientes con ePoC, que puede presentarse desde las fases iniciales de la enfermedad, es un acontecimiento definitivo en la historia natural de la entidad al tener influencia en la presencia de síntomas, el deterioro de la calidad de vida relacionada con la salud, la frecuencia de exacerbaciones severas (hospitalizaciones) y la supervivencia (8,9).…”