Physical Activity as a Predictor of Thirty-Day Hospital Readmission after a Discharge for a Clinical Exacerbation of Chronic Obstructive Pulmonary Disease

Chawla, Harsh; Bulathsinghala, Chinthaka; Tejada, John Patrick; Wakefield, Dorothy; ZuWallack, Richard

doi:10.1513/annalsats.201405-198oc

Cited by 58 publications

(47 citation statements)

References 29 publications

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“…This suggests a direct association between physical activity and the use of health services and related costs. In patients discharged from hospital, those who were less active (objectively measured using an accelerometer) during the week following discharge were more likely to be readmitted within 30 days, independent of the exacerbation history in the preceding year, known Q13 ¶ to be the most important predictor of hospitalisation risk [58]. These results were confirmed in a large trial (>4500 patients) based on self-reported physical activity levels [59].…”

Section: Copd Patientsmentioning

confidence: 68%

The importance of physical activity

Langer¹,

Demeyer²,

Troosters³

et al. 2015

Controversies in COPD

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Section: Copd Patientsmentioning

confidence: 68%

The importance of physical activity

Langer¹,

Demeyer²,

Troosters³

et al. 2015

Controversies in COPD

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“…Physical inactivity and increased sedentary time are well recognized and described in COPD. Patients with reduced physical activity are at an increased risk of hospital admission, readmission to hospital following an index admission and death . These studies have corrected for factors, such as disease severity and symptom burden.…”

Section: The Impact Of Skeletal Muscle Dysfunction and Functional Impmentioning

confidence: 99%

Rehabilitation in chronic respiratory diseases: In‐hospital and post‐exacerbation pulmonary rehabilitation

2019

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Exacerbations of chronic obstructive pulmonary disease (COPD) that require hospitalization are important events for patients. Functional impairment and skeletal muscle dysfunction can increase the risk of hospitalization and readmission, independent of lung function. In addition, once a patient is admitted, multiple factors can lead to worsening outcome including immobility, systemic inflammation and nutritional depletion. These non-pulmonary factors are potentially amenable to exercise therapy, as part of pulmonary rehabilitation (PR). Peri-exacerbation PR has an important role in the management of exacerbations of COPD. In this review, we explore how functional limitation and skeletal muscle dysfunction affect patients having a severe exacerbation of COPD, the systemic impact of hospitalization on patients including potential aetiologies and the role of PR around the time of an exacerbation. This includes rehabilitation during the inpatient phase, postexacerbation rehabilitation and rehabilitation bridging hospital discharge. We also describe potential future developments in peri-exacerbation PR.Peri-exacerbation pulmonary rehabilitation 6MWT, 6-min walk test; ADL, activity of daily living; AECOPD, acute exacerbation of chronic obstructive pulmonary disease; CRQ, Chronic Respiratory Questionnaire; ISWT, incremental shuttle walk test; SGRQ, St George's Respiratory Questionnaire; VO 2max , oxygen consumption.Respirology (2019) 24, 889-898

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“…Encouraging patients to increase their levels of daily activity is also recommended, due to the general beneficial effects of physical exercise [2] and the reported links between lower levels of physical activity in patients with COPD and an increased risk of hospitalization [50, 51] and readmission [52]. …”

Section: Efficacy Of Bronchodilators In Prevention Of Exacerbationsmentioning

confidence: 99%

Optimizing bronchodilation in the prevention of COPD exacerbations

2017

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The natural disease course of chronic obstructive pulmonary disease (COPD) is often punctuated by exacerbations: acute events of symptom worsening associated with significant morbidity and healthcare resource utilization; reduced quality of life; and increased risk of hospitalization and death. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommend that patients at risk of exacerbations (GOLD Groups C and D) receive a long-acting muscarinic antagonist (LAMA) or a long-acting β2-agonist (LABA)/LAMA combination, respectively, as preferred initial treatments. The latter recommendation is based on recent trial evidence demonstrating the superior efficacy of a fixed-dose LABA/LAMA over an inhaled corticosteroid (ICS)/LABA in exacerbation prevention. ICS in combination with a LABA is also indicated for prevention of exacerbations, but the use of ICS is associated with an increased risk of adverse events such as pneumonia, and offers limited benefits beyond those provided by LABA or LAMA monotherapy. In this review, we examine evidence from a number of pivotal studies of LABAs and LAMAs, administered as monotherapy or as part of dual or triple combination therapy, with a specific focus on their effect on exacerbations. We also discuss a new proposed treatment paradigm for the management of COPD that takes into account this recent evidence and adopts a more cautious approach to the use of ICS. In alignment with GOLD 2017, we suggest that ICS should be reserved for patients with concomitant asthma or in whom exacerbations persist despite treatment with LABA/LAMA.

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Physical Activity as a Predictor of Thirty-Day Hospital Readmission after a Discharge for a Clinical Exacerbation of Chronic Obstructive Pulmonary Disease

Cited by 58 publications

References 29 publications

The importance of physical activity

The importance of physical activity

Rehabilitation in chronic respiratory diseases: In‐hospital and post‐exacerbation pulmonary rehabilitation

Optimizing bronchodilation in the prevention of COPD exacerbations

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