Patterns of Physical Activity Progression in Patients With COPD

Koreny, Maria; Demeyer, Heleen; Hopkinson, Nicholas; Louvaris, Zafeiris; Arbillaga-Etxarri, Ane; Benet, Marta; Delgado, A Retamero; Gimeno‐Santos, Elena; Torrent-Pallicer, Jaume; Vilaró, Jordi; Barberán-García, Anael; Rodríguez-Roisín, Robert; Balcells, Eva; Chiaradia, Diego Agustín Rodríguez; Marín, Alicia; Ortega, Pilar; Celorrio, Nuria; Monteagudo, Mónica; Montellà, Nuria; Muñoz, Laura; Simonet, Pere; Janèc), Carme; Martín-Cantera, Carlos; Borrell, Eulàlia; Vall-Casas, Pere; Ivanoff, Nathalie; Karlsson, Niklas; Corriol‐Rohou, Solange; Jarrod, Ian; Erzen, Damijen; Brindicci, Caterina; Higenbottam, Tim; Scuri, Mario; McBride, Paul; Kamel, Nadia Salah; Tabberer, Margaret; Troosters, Thierry; Dobbels, Fabienne; Garcia‐Aymerich, Judith; Boer, Willem I. de; Kulich, Károly; Glendenning, Alastair; Rüdell, Katja; Wilson, Frederick J. F.; Polkey, Michael I.; Hopkinson, Nicholas S; Vogiatzis, Ioannis; Nikaï, E.; Molen, Thys van der; Jong, Corina de; Rabinovich, Roberto; Macnee, Bill; Puhan, Milo; Frei, Anja

doi:10.1016/j.arbr.2020.08.014

Cited by 3 publications

(2 citation statements)

References 40 publications

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“…standardized, Tio Tiotropium, µm microgram COPD patients, that usually limits their ability to exercise [6,7,30]. Several studies on COPD patients have associated low levels of physical activity and sedentary time with an increased frequency of exacerbations, hospitalizations, worse quality of life, and also an increased risk of death as a result of progressive ventilatory limitation, cardiac impairment, peripheral muscle, and psychological factors [3,31,32]. Increasing physical activity and its intensity in those patients may improve quality of life and reduce the loss of pulmonary function [33,34].…”

Section: Sensitivity Analysismentioning

confidence: 99%

Exercise capacity and physical activity in COPD patients treated with a LAMA/LABA combination: a systematic review and meta-analysis

et al. 2022

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Background Persistent airflow limitation and dyspnoea may reduce chronic obstructive pulmonary disease (COPD) patients exercise capacity and physical activity, undermining their physical status and quality of life. Long-acting muscarinic antagonists and long-acting beta-2 agonists (LAMA/LABA) combinations are amongst moderate-to-severe COPD recommended treatments. This article analyses LAMA/LABA combinations effect on COPD patients exercise capacity and physical activity outcomes. Methods A systematic review and meta-analysis of double-blind randomized controlled trials comparing LAMA/LABA combinations against monotherapy or placebo was conducted. Results Seventeen articles were identified (N = 4041 patients). In endurance shuttle walk test and constant work rate cycle ergometry, LAMA/LABA combinations obtained better results than placebo, but not monotherapy, whereas in 6-min walking test, results favoured LAMA/LABA over monotherapy (four studies), but not over placebo (one study). Moreover, LAMA/LABA combinations obtained better results than placebo in number of steps per day, reduction in percentage of inactive patients and daily activity-related energy expenditure, and better than monotherapy when measuring time spent on ≥ 1.0–1.5, ≥ 2.0 and ≥ 3.0 metabolic equivalents of task activities. Conclusions LAMA/LABA combinations in COPD patients provided better results than monotherapy or placebo in most exercise capacity and physical activity outcomes.

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Section: Sensitivity Analysismentioning

confidence: 99%

Exercise capacity and physical activity in COPD patients treated with a LAMA/LABA combination: a systematic review and meta-analysis

et al. 2022

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“… 42 For example, continuous prospective evaluation is required in COPD patients since the impact on physical activity over time is heterogeneous and decliners cannot be predicted at baseline. 43 Meanwhile, the patient should keep in touch with the health center in case any adverse effects occur during these first weeks of treatment.…”

Section: Initial Stepping Up From Initial Treatmentmentioning

confidence: 99%

Step-Up and Step-Down Treatment Approaches for COPD: A Holistic View of Progressive Therapies

Lόpez-Campos¹,

Hernández²,

Ruiz-Duque³

et al. 2021

COPD

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Recent advances in inhaled drugs and a clearer definition of the disease have made the task of managing COPD more complex. Different proposals have been put forward which combine all the available treatments and the different clinical presentations in an effort to select the best therapeutic options for each clinical context. As COPD is a chronic progressive disease, the escalation of therapy has traditionally been considered the most natural way to tackle it. However, the notion of COPD as a constantly progressing disease has recently been challenged and, in specific areas, this points to the possibility of a deescalation in treatment. In this context, the clinician requires simple, specific recommendations to guide these changes in treatment in their daily clinical practice. To accomplish this, the first step must be a correct evaluation and an accurate initial preliminary diagnosis of the patient's condition. Thereafter, the first escalation in therapy must be introduced with caution as the disease progresses, since clinical trials are not designed with clinical decision-making in mind. During this escalation, three possibilities are open to change the current treatment for a different one within the same family, to increase non-pharmacological interventions or to increase the pharmacological therapies. Beyond that point, a patient with persistent symptoms represents a complex clinical scenario which requires a specialized approach, including the evaluation of different respiratory and non-respiratory comorbidities. Unfortunately, there are few de-escalation studies available, and these are mainly observational in nature. The debate on de-escalation in pharmacological treatment, therefore, involves two main discussion points: the withdrawal of bronchodilators and the withdrawal of inhaled steroids. Altogether, the scheme for modifying treatment must be more personalized than just adding molecules, and the therapeutic response and its conditioning factors should be evaluated at each step before proceeding further.

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COPD profiles and treatable traits using minimal resources: identification, decision tree and stability over time

et al. 2022

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Background and objective Profiles of people with chronic obstructive pulmonary disease (COPD) often do not describe treatable traits, lack validation and/or their stability over time is unknown. We aimed to identify COPD profiles and their treatable traits based on simple and meaningful measures; to develop and validate a decision tree and to explore profile stability over time. Methods An observational, prospective study was conducted. Clinical characteristics, lung function, symptoms, impact of the disease (COPD Assessment Test—CAT), health-related quality of life, physical activity, lower-limb muscle strength and functional status were collected cross-sectionally and a subsample was followed-up monthly over six months. A principal component analysis and a clustering procedure with k-medoids were applied to identify profiles. A decision tree was developed and validated cross-sectionally. Stability was explored over time with the ratio between the number of timepoints that a participant was classified in the same profile and the total number of timepoints (i.e., 6). Results 352 people with COPD (67.4 ± 9.9 years; 78.1% male; FEV1 = 56.2 ± 20.6% predicted) participated and 90 (67.6 ± 8.9 years; 85.6% male; FEV1 = 52.1 ± 19.9% predicted) were followed-up. Four profiles were identified with distinct treatable traits. The decision tree included CAT (< 18 or ≥ 18 points); age (< 65 or ≥ 65 years) and FEV1 (< 48 or ≥ 48% predicted) and had an agreement of 71.7% (Cohen’s Kappa = 0.62, p < 0.001) with the actual profiles. 48.9% of participants remained in the same profile whilst 51.1% moved between two (47.8%) or three (3.3%) profiles over time. Overall stability was 86.8 ± 15%. Conclusion Four profiles and treatable traits were identified with simple and meaningful measures possibly available in low-resource settings. A decision tree with three commonly used variables in the routine assessment of people with COPD is now available for quick allocation to the identified profiles in clinical practice. Profiles and treatable traits may change over time in people with COPD hence, regular assessments to deliver goal-targeted personalised treatments are needed.

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Patterns of Physical Activity Progression in Patients With COPD

Cited by 3 publications

References 40 publications

Exercise capacity and physical activity in COPD patients treated with a LAMA/LABA combination: a systematic review and meta-analysis

Exercise capacity and physical activity in COPD patients treated with a LAMA/LABA combination: a systematic review and meta-analysis

Step-Up and Step-Down Treatment Approaches for COPD: A Holistic View of Progressive Therapies

COPD profiles and treatable traits using minimal resources: identification, decision tree and stability over time

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