Abstract
BackgroundThe burden of symptoms and risk of exacerbations are the main drivers of the overall assessment of the Chronic Obstructive Pulmonary Disease (COPD) and the adequate treatment approaches per current Global Initiative for Chronic Obstructive Lung Disease (GOLD). Physical activity has emerged as both functional outcome and non-pharmacological intervention in COPD patients, despite the lack of standardized measures or guidelines in clinical practice. This study aimed to explore in more depth the 24-h respiratory symptoms, the physical activity level (PAL) and the relationship between these two determinants in stable COPD patients.MethodsThis was a multinational, multicenter, observational, cross-sectional study conducted in ten European countries and Israel. Dedicated questionnaires for each part of the day (morning, daytime, night) were used to assess respiratory symptoms. PAL was evaluated with self- and interview-reported tools [EVS (exercise as vital sign) and YPAS (Yale Physical Activity Survey)], and physician’s judgement. Patients were stratified in ABCD groups by 2013 and 2017 GOLD editions using the questionnaires currently recommended: modified Medical Research Council dyspnea scale and COPD Assessment Test.ResultsThe study enrolled 2190 patients (mean age: 66.9 years; male: 70.0%; mean % predicted FEV1: 52.6; GOLD groups II-III: 84.5%; any COPD treatment: 98.9%). Most patients (> 90%) reported symptoms in any part of the 24-h day, irrespective of COPD severity. PAL evaluations showed discordant results between patients and physicians: 32.9% of patients considered themselves completely inactive, while physicians judged 11.9% patients as inactive. By YPAS, the overall study population spent an average of 21.0 h/week performing physical activity, and 68.4% of patients were identified as sedentary. In any GOLD ABCD group, the percentage of inactive patients was high. Our study found negative, weak correlations between respiratory symptoms and self-reported PAL (p < 0.001).ConclusionsDespite regular treatment, the majority of stable COPD patients with moderate to severe disease experienced daily variable symptoms. Physical activity level was low in this COPD cohort, and yet overestimated by physicians. With evidence indicating the negative consequences of inactivity, its adequate screening, a more active promotion and regular assessment of physical activity are urgently needed in COPD patients for better outcomes.Trial registrationNCT03031769, retrospectively registered, 23 Jan 2017.
Highlights
The burden of symptoms and risk of exacerbations are the main drivers of the overall assessment of the Chronic Obstructive Pulmonary Disease (COPD) and the adequate treatment approaches per current Global Initiative for Chronic Obstructive Lung Disease (GOLD)
In line with other studies performed in a similar population of patients, our results indicate that symptom variability is higher than expected in stable COPD patients [7, 8, 12]
Data in the literature indicate that daily PAL in COPD patients is impaired by comorbidities, irrespective of their type and independent of the level of airflow obstruction [47]. These findings show that other dimensions of physical activity such as comorbidities, environmental factors and previous history of physical activity [44] should be explored, combined with symptoms, to better understand and address the low physical activity level in COPD patients
Summary
The burden of symptoms and risk of exacerbations are the main drivers of the overall assessment of the Chronic Obstructive Pulmonary Disease (COPD) and the adequate treatment approaches per current Global Initiative for Chronic Obstructive Lung Disease (GOLD). Physical activity has emerged as both functional outcome and non-pharmacological intervention in COPD patients, despite the lack of standardized measures or guidelines in clinical practice. In 2011, the Global Initiative for Obstructive Lung Disease (GOLD) [2] added symptom burden tothe multidimensional assessment, to classify the patients into four quadrants (GOLD ABCD), combining it with the risk of exacerbations based on pulmonary function and history of exacerbations. Physical activity (PA) has emerged as an important functional outcome in COPD patients, based on its association with mortality and exacerbations [13]. Recognizing the patients at risk for low physical activity is crucial for clinicians and many methods are available for the assessment of PA, no measure or guidance is standardized [17,18,19,20]
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