View Abstract

A2160 - Short and Long Term Effects of Exacerbations on Functional Status in Patients with COPD - A Systematic Review
Author Block: C. Burtin, M. Barusso, J. De Brandt, M. A. Spruit; BIOMED-REVAL, Hasselt University, Diepenbeek, Belgium.
Rationale. COPD is characterized by exacerbations, which are defined as an acute worsening of respiratory symptoms that result in additional therapy. The frequency of severe exacerbations is associated with a faster lung function decline and increased mortality. Furthermore, literature suggests that (repeated) exacerbations influence functional status in daily life. The onset of deconditioning and muscle dysfunction might have a role in this. This review aims to systematically summarize the scientific evidence regarding the impact of exacerbations of COPD on functional status. This work provides a comprehensive and nuanced view on the detrimental impact of exacerbations. Methods. An electronic literature search was performed on PubMed from inception until September 2017. The following search strategy was used: (COPD [title/abstract] OR chronic obstructive pulmonary disease[MeSH]) AND (hospital*[title] OR exacerbation[title/abstract]). Prospective studies that assessed functional status (functional performance test, exercise test, muscle function test or subjective measures assessing functional status, health-related quality of life (HRQoL) and symptoms related to activities of daily life (ADL) at baseline (in a stable disease phase) and after a period of follow-up were included. Two researchers independently performed title, abstract and full text screening and consensus was reached. Results. The search strategy resulted in 5962 possibly eligible articles. After comprehensive screening, 16 articles were withheld for data extraction. Eleven studies evaluated the impact of exacerbation onset or frequency on functional status during a generally long-term follow-up period (typically one to three years). Nine studies reported that exacerbation frequency is related to changes in symptoms and HRQoL related to ADL. Four studies investigated the impact on performance-driven measures. Conflicting results were found with regards to impact of repeated exacerbations on six-minute walking distance. One study suggested an impact of exacerbations on fat-free mass but not on muscle strength. Five studies assessed the direct effect of an exacerbation on functional status. In summary, these studies show that symptoms, exercise tolerance, muscle strength and physical activity levels worsen during exacerbations. Recovery of symptoms and exercise tolerance is only partial in the few trials performing long-term follow-up. Conclusion. Scientific literature investigating the impact of exacerbations of COPD on functional status clearly reveals the detrimental short- and/or long-term impact on symptoms and HRQoL related to ADL. The long-term impact of (repeated) exacerbations on exercise tolerance, muscle strength and physical activity levels is less studied and/or conflicting evidence is existing. Further prospective research is required to draw firm conclusions on these aspects.