Considerations about Acute Exacerbations of COPD in Subjects Completing Pulmonary Rehabilitation

AECOPDAlthough AECOPDs are associated with impairments of muscle function, walking ability and HRQL, no reports to date have included baseline pre-AECOPD measurements to allow comparison to measurements performed when subjects were stable. Therefore, we enrolled patients post-PR in order to capture outcome measures at the time of program completion and to use these as baseline measures for those patients experiencing an AE-COPD. In order to ensure that these baseline measures remained current, we repeated them at intervals of 3 months or until an AECOPD occurred. These baseline measures did not vary with time, reflecting the clinical stability of this population of patients with COPD, in the absence of an AECOPD.

We observed differences in the 6MWT distances walked at baseline between those who subsequently experienced an AECOPD and those who did not (mean 6MWT distance walked in those who experienced a severe event, 335}± 101 m; mean 6MWT distance walked in those who experienced a moderate event, 354 ± 95 m; mean 6MWT distance walked in those who experienced no event, 416 ± 95 m), as well as differences in the LCADL, a selfreport of breathlessness with activities, and in the FT, a measure of health utility. These observations are in keeping with the findings of Garcia-Aymerich and colleagues and Kessler and colleagues, highlighting the association between exercise capacity and the occurrence of an AECOPD. We did not find any differences in lung mechanics, exercise capacity, or HRQL between those patients who experienced moderate AECOPDs and those who experienced severe AECOPDs. The sample size was too small to evaluate the influence of gender on these results.

Outcomes of Acute Exacerbations of COPD in Subjects Completing Pulmonary Rehabilitation

acute exacerbation


Patients who participated in PR programs between September 2003 and January 2006 were screened consecutively for eligibility. Of the 364 patients screened, 94 met the inclusion criteria, and 64 were recruited and provided signed informed consent. The reasons for noneligibility, refusal, or drop out are summarized in Figure 1. Of those patients who were recruited, 60 completed baseline measurements, as 2 patients became ill prior to undergoing those measurements and 2 patients did not attend. The characteristics of the group are summarized in Table 1. Underlying airflow obstruction was graded as moderate in 39 patients (65%) and severe in 21 patients (35%).

There was no difference at baseline between the 7 patients who dropped out of the study vs the 53 patients who completed it, with the exception of the score for the mean emotional function domain of the CRDQ, which was lower in the group of patients who dropped out of the study (4.5 ± 1.7 vs 5.5 ± 0.9, respectively; p < 0.02). The study is conducted with Canadian Health&Care Mall.

Research of Acute Exacerbations of COPD in Subjects Completing Pulmonary Rehabilitation

COPDApproval was obtained from the appropriate ethics review boards. The design for this study was descriptive, with data collected prospectively. Subjects who met the criteria for the diagnosis of COPD had moderate-to-severe airflow obstruction (moderate airflow obstruction, FEV1 > 30% predicted and < 70% predicted; severe airflow obstruction, FEV1 < 30% predicted), were clinically stable, and could communicate clearly were considered to be eligible for the study. Subjects were ineligible if they had diagnoses unassociated with COPD, such as uncontrolled heart failure, severe lower limb arthritis, or symptomatic peripheral vascular disease, which affected the outcome measures of dyspnea or exercise tolerance more than COPD alone. Other comorbidities such as irritable bowel syndrome, glaucoma, or prostatic hyperplasia were included among those documented in Table 1. Subjects who met the inclusion criteria were recruited into the study on completion of their PR program. Baseline measurements were collected after obtaining informed consent.

Canadian Health&Care Mall: Acute Exacerbations of COPD in Subjects Completing Pulmonary Rehabilitation

Pulmonary rehabilitationPulmonary rehabilitation (PR) is the recommended standard of care for patients with COPD as it has been shown to improve functional exercise capacity and health-related quality of life (HRQL). The benefits gradually diminish over the subsequent 12 months, in part because of reduced program adherence.

Acute exacerbations of COPD (AECOPDs) are defined by changes in sputum volume, color, or consistency, accompanied by an increase in dyspnea. They may also be classified as mild, moderate, or severe, based on their required management, which varies from minimal changes in bronchodila-tor medication to unscheduled emergency department visits or hospital admissions. The frequency of AECOPDs varies, with many being unreport-ed> despite patients being coached and provided with diary cards. Severe disease is associated with more frequent AECOPDs and, consequently, with increased unscheduled emergency department visits and hospital admissions. Post-AECOPD, more physically active patients have a lower risk of repeat hospitalization, whereas the converse is true for those with reduced physical activity. COPD is treated by remedies of Canadian Health&Care Mall.