A Longitudinal Study Evaluating the Effect of Exacerbations on Physical Activity in Patients with Chronic Obstructive Pulmonary Disease

Ehsan, Mohsin; Khan, Rana; Wakefield, Dorothy; Qureshi, Asher; Murray, Lindsey; ZuWallack, Richard; Leidy, Nancy Kline

doi:10.1513/annalsats.201304-100oc

Cited by 46 publications

(42 citation statements)

References 31 publications

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“…Weight loss and wasting of muscle and bone tissue may be induced or accelerated during severe acute exacerbations requiring hospitalisation, due to convergence of different catabolic stimuli including malnutrition [58], physical inactivity [59], hypoxia, inflammation [60] and systemic glucocorticoids [61]. Moreover, this may be a time when energy intake may be compromised by practical difficulties in providing adequate nutrition due to breathlessness or other treatments such as noninvasive ventilation.…”

Section: Acute Exacerbationsmentioning

confidence: 99%

Nutritional assessment and therapy in COPD: a European Respiratory Society statement

et al. 2014

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Nutrition and metabolism have been the topic of extensive scientific research in chronic obstructive pulmonary disease (COPD) but clinical awareness of the impact dietary habits, nutritional status and nutritional interventions may have on COPD incidence, progression and outcome is limited. A multidisciplinary Task Force was created by the European Respiratory Society to deliver a summary of the evidence and description of current practice in nutritional assessment and therapy in COPD, and to provide directions for future research. Task Force members conducted focused reviews of the literature on relevant topics, advised by a methodologist. It is well established that nutritional status, and in particular abnormal body composition, is an important independent determinant of COPD outcome. The Task Force identified different metabolic phenotypes of COPD as a basis for nutritional risk profile assessment that is useful in clinical trial design and patient counselling. Nutritional intervention is probably effective in undernourished patients and probably most when combined with an exercise programme. Providing evidence of costeffectiveness of nutritional intervention is required to support reimbursement and thus increase access to nutritional intervention. Overall, the evidence indicates that a well-balanced diet is beneficial to all COPD patients, not only for its potential pulmonary benefits, but also for its proven benefits in metabolic and cardiovascular risk. @ERSpublications Metabolism and nutrition: shifting paradigms in COPD management

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Section: Acute Exacerbationsmentioning

confidence: 99%

Nutritional assessment and therapy in COPD: a European Respiratory Society statement

et al. 2014

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“…This was somewhat unexpected, since in our analysis reporting directly measured physical activity outcome, clinically reported, and EXACT-only exacerbations had the same negative impact on physical activity, 6 and a recent study showed similar negative effects on health status. 23 Our study has several important limitations.…”

Section: Discussionmentioning

confidence: 59%

“…6 A review of wrist actigraphy suggests that this method is useful in the estimation of TST, sleep percentage, and wake after sleep onset; however, it is less consistent in the estimation of sleep latency. 16 …”

Section: Sleep Variablesmentioning

confidence: 99%

A longitudinal assessment of sleep variables during exacerbations of chronic obstructive pulmonary disease

et al. 2015

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Although sleep disturbance is common in chronic obstructive pulmonary disease (COPD), relatively little is known on the effect of the exacerbation on sleep quality. Accordingly, we longitudinally assessed sleep variables during exacerbations and clinical stability. This is a sub-study of a larger observational analysis. Inclusion criteria were clinically stable COPD and two or more clinical exacerbations in the preceding 12 months. Patients were followed for approximately 6 months and during this time the following were recorded daily: (1) COPD exacerbations, which were determined in two ways, clinically and symptom defined using the exacerbations of chronic pulmonary disease tool (EXACT); (2) daytime sleepiness, which was measured using the Stanford Sleepiness Scale; (3) subjective awakenings, which was measured from a sleep diary; and (4) sleep duration, efficiency, and objective awakenings, which was measured from actigraphy. These variables for exacerbation and non-exacerbation days were compared. Seventeen patients (9 male, age 63 + 12 years, forced expiratory volume in 1 second 52 + 20%) entered data over 135 + 18 days. During this time, 15 patients had 27 symptom-defined exacerbations and 8 had 9 clinically reported exacerbations. Symptom-defined exacerbation days were 26% of the total study days. More daytime sleepiness, decreased total sleep time (TST), and decreased sleep efficiency (SE) were present during exacerbations compared with clinical stability (p < 0.001). These disturbances tended to be greater during clinically reported exacerbations than during unreported events (p < 0.05). Increased daytime sleepiness, less TST, and poorer SE are present during COPD exacerbations.

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“…Indeed, lower physical activity levels are seen in COPD 133. Physical inactivity is associated with advanced disease stage,134, 135, 136 exacerbations,137, 138 and degree of emphysema 139. In addition, lung volume‐reduction surgery in patients with severe emphysema improved exercise performance due to reduced lung hyperinflation, less dyspnoea severity, and less cost of breathing 140.…”

Section: Putative Mechanisms Involved In a Disturbed Energy Balance Imentioning

confidence: 99%

Cachexia in chronic obstructive pulmonary disease: new insights and therapeutic perspective

Sanders¹,

Kneppers²,

Bool³

et al. 2015

Journal of Cachexia, Sarcopenia and Muscle

115

101

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Cachexia and muscle wasting are well recognized as common and partly reversible features of chronic obstructive pulmonary disease (COPD), adversely affecting disease progression and prognosis. This argues for integration of weight and muscle maintenance in patient care. In this review, recent insights are presented in the diagnosis of muscle wasting in COPD, the pathophysiology of muscle wasting, and putative mechanisms involved in a disturbed energy balance as cachexia driver. We discuss the therapeutic implications of these new insights for optimizing and personalizing management of COPD‐induced cachexia.

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A Longitudinal Study Evaluating the Effect of Exacerbations on Physical Activity in Patients with Chronic Obstructive Pulmonary Disease

Abstract: Physical activity decreased significantly during exacerbations. Reduction in activity occurs early during an exacerbation and persists for about 2 weeks after symptomatic recovery.

Cited by 46 publications

References 31 publications

Nutritional assessment and therapy in COPD: a European Respiratory Society statement

Nutritional assessment and therapy in COPD: a European Respiratory Society statement

A longitudinal assessment of sleep variables during exacerbations of chronic obstructive pulmonary disease

Cachexia in chronic obstructive pulmonary disease: new insights and therapeutic perspective

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