COPD exacerbations are frequent events that have a negative impact on the lives of patients. The aims of this study were to analyze physical and functional impairment during hospital stay in subjects hospitalized due to COPD exacerbation and to assess the physical and functional impact of hospitalization at a 1-month follow-up in patients with severe COPD.
METHODS:
This was a prospective observational study on a sample of 52 subjects hospitalized due to COPD exacerbation. The assessments were performed at baseline, discharge, and 1-month follow-up. The outcome measures were dyspnea, muscle strength, functional capacity, and postural steadiness.
RESULTS:
Quadriceps strength [1.036 (P = .043) kg mean difference] and the one-leg stance test [1.04 (P = .02) and 0.73 (P = .032) s mean difference right and left leg] showed significant impairment during hospitalization. Dyspnea perception improved significantly (P = .004) during hospitalization. Additionally, strength in the upper and lower limbs [4.04 (P = .002) and 1.23 (P = .038) kg mean difference], functional capacity [3.0 number of steps mean difference (P = .032)], and the one-leg stance test [2.12 (P = .006) and 0.53 (P = .047) s mean difference right and left leg] showed significant impairment 1-month follow-up.
CONCLUSIONS:
Hospitalization due to COPD exacerbation leads to physical and functional impairment in patients; impairment is greater at 1-month follow-up. It would be interesting to conduct physical therapy interventions to prevent the impairment.
MurrayCJ, LopezAD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet, 1997; 349(9064):1498–1504.
2.
Rodriguez-RoisinR. Toward a consensus definition for COPD exacerbations. Chest, 2000; 117(5 Suppl 2):398S–401S.
3.
MiravitllesM, GuerreroT, MayordomoC, Sánchez-AgudoL, NicolauF. Factors associated with increased risk of exacerbation and hospital admission in a cohort of ambulatory COPD patients: a multiple logistic regression analysis: the EOLO Study Group. Respiration, 2000; 67(5):495–501.
4.
SpencerS, CalverleyPM, BurgePS, JonesPW. Impact of preventing exacerbations on deterioration of health status in COPD. Eur Respir J, 2004; 23(5):698–702.
5.
Soler-CataluñaJJ, Martínez-GarcíaMA, Román SánchezP, SalcedoE, NavarroM, OchandoR. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax, 2005; 60(11):925–931.
6.
GroenewegenKH, ScholsAM, WoutersE. Mortality and mortality-related factors after hospitalization for acute exacerbation of COPD. Chest, 2003; 124(2):459–467.
Martínez-LlorensaJM, Orozco-LeviM, MasdeuMJ, CoronellC, Ramírez-SarmientoA, SanjuasC, et al. Disfunción muscular global durante la exacerbación de la EPOC: un estudio de cohortes [Global muscle dysfunction and exacerbation of COPD: a cohort study]. Med Clin (Barc), 2004; 122(14):521–527.
9.
SeemungalTA, DonaldsonGC, PaulEA, BestallJC, JeffriesDJ, WedzichaJA. Effect of exacerbations on quality of life in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 1998; 157(5):1418–1422.
10.
KimHC, MofarrahiM, HussainSN. Skeletal muscle dysfunction in patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis, 2008; 3(4):637–658.
11.
ForsterAJ, MurffHJ, PetersonJF, GandhiTK, BatesDW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med, 2003; 138(3):161–167.
12.
Dal NegroR. Optimizing economic outcomes in the management of COPD. Int J Chron Obstruct Pulmon Dis, 2008; 3(1):1–10.
13.
SeemungalTA, DonaldsonGC, BhowmikA, JeffriesDJ, WedzichaJA. Time course and recovery of exacerbations in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2000; 161(5):1608–1613.
14.
PittaF, TroostersT, ProbstVS, SpruitMA, DecramerM, GosselinkR. Physical activity and hospitalization for exacerbation of COPD. Chest, 2006; 129(3):536–544.
15.
InouyeSK, WagnerDR, AcamporaD, HorwitzRI, CooneyLMJr., TinetiiME. A controlled trial of a nursing-centered intervention in hospitalized elderly medical patients: the Yale Geriatric Care Program. J Am Geriatr Soc, 1993; 41(12):1353–1360.
American Thoracic Society. Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 1995; 152(5 Pt 2):S77–S121.
18.
RabeKF, HurdS, AnzuetoA, BarnesPJ, BuistSA, CalverleyP, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med, 2007; 176(6):532–555.
19.
Torres-SánchezI, ValenzaMC, Sáez-RocaG, Cabrera-MartosI, López-TorresI, Rodríguez-TorresJ. Results of a multimodal program during hospitalization in obese COPD exacerbated patients. COPD. 2016; 13(1):19–25.
20.
CharlsonME, PompeiP, AlesKL, MacKenzieCR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis, 1987; 40(5):373–383.
21.
MahoneyFI, BarthelDW. Functional evaluation: the Barthel index. Md State Med J, 1965; 14:61–65.
22.
JonesPW. St. George's Respiratory Questionnaire: MCID. COPD, 2005; 2(1):75–79.
23.
WatzH, WaschkiB, MeyerT, MagnussenH. Physical activity in patients with COPD. Eur Respir J, 2009; 33(2):262–272.
24.
PatelSA, BenzoRP, SlivkaWA, SciurbaFC. Activity monitoring and energy expenditure in COPD patients: a validation study. COPD, 2007; 4(2):107–112.
BorgGA. Psychophysical basis of perceived exertion. Med Sci Sports Exerc, 1982; 14(5):377–381.
27.
MartinHJ, YuleV, SyddallHE, DennisonEM, CooperC, Aihie SayerA. Is hand-held dynamometry useful for the measurement of quadriceps strength in older people? a comparison with the gold standard Biodex dynamometry. Gerontology, 2006; 52(3):154–159.
28.
ShephardRJ, MontelpareW, PlyleyM, McCrackenD, GoodeRC. Handgrip dynamometry, Cybex measurements and lean mass as markers of the ageing of muscle function. Br J Sports Med, 1991; 25(4):204–208.
MichikawaT, NishiwakiY, TakebayashiT, ToyamaY. One-leg standing test for elderly populations. J Orthop Sci, 2009; 14(5):675–685.
31.
SpruitMA, GosselinkR, TroostersT, KasranA, Gayan-RamirezG, BogaertsP, et al. Muscle force during an acute exacerbation in hospitalised COPD patients and its relationship with CXCL8 and IGF-1. Thorax, 2003; 58(9):752–756.
32.
ViegiG, PistelliF, SherrillDL, MaioS, BaldacciS, CarrozziL. Definition, epidemiology and natural history of COPD. Eur Respir J, 2007; 30(5):993–1013.
33.
OgaT, NishimuraK, TsukinoM, SatoS, HajiroT, MishimaM. Longitudinal deteriorations in patient reported outcomes in patients with COPD. Respir Med, 2007; 101(1):146–153.
34.
PeruzzaS, SergiG, VianelloA, PisentC, TiozzoF, ManzanA, CoinA, InelmenEM, EnziG. Chronic obstructive pulmonary disease (COPD) in elderly subjects: impact on functional status and quality of life. Respir Med, 2003; 97(6):612–617.
35.
Martín-SalvadorA, Torres-SánchezI, Sáez-RocaG, López-TorresI, Rodríguez-AlzuetaE, ValenzaMC. Age group analysis of psychological, physical and functional deterioration in patients hospitalized for pneumonia. Arch Bronconeumol, 2015; 51(10):496–501.
36.
Osuna-PozoCM, Ortiz-AlonsoJ, VidánM, FerreiraG, Serra-RexachJA. Review of functional impairment associated with acute illness in the elderly. Rev Esp Geriatr Gerontol, 2014; 49(2):77–89.
37.
TudoracheE, OanceaC, AvramC, Fira-MladinescuO, PetrescuL, TimarB. Balance impairment and systemic inflammation in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2015; 10:1847–1852.
38.
BarnesDE, MehtaKM, BoscardinWJ, FortinskyRH, PalmerRM, KirbyKA. Prediction of recovery, dependence or death in elders who become disabled during hospitalization. J Gen Intern Med, 2013; 28(2):261–268.
39.
CovinskyKE, PalmerRM, CounsellSR, PineZM, WalterLC, ChrenMM. Functional status before hospitalization in acutely ill older adults: validity and clinical importance of retrospective reports. J Am Geriatr Soc, 2000; 48(2):164–169.
40.
BoydCM, RicksM, FriedLP, GuralnikJM, XueQL, XiaJ. Functional decline and recovery of activities of daily living in hospitalized, disabled older women: the Women's Health and Aging Study I. J Am Geriatr Soc, 2009; 57(10):1757–1766.
