Who are the COPD patients who have reduced exercise capacity during recovery from hospitalization for acute exacerbation of COPD (AECOPD)? A longitudinal observational study

Background: Hospitalized patients with AECOPD may experience physical and functional decline, which may not fully recovery after discharge. Early identification of the most vulnerable patient can guide rehabilitation in this acute setting. Aim: To evaluate the clinical and functional profile of patients with reduced exercise capacity during AECOPD recovery. Methods: 28 patients with AECOPD were evaluated during exacerbation (24-48h from admission) and recovery (30 days-after) and classified according the distance covered in the six-minute walk test (6MWD) during recovery in: lower (lowEC, <317m, n=13) and higher exercise capacity (highEC, ≥317m, n=15). Clinical (age, sex, BMI, FEV₁ and comorbidities) and functional [6MWD, handgrip strength (HS), maximal inspiratory pressure (MIP) and Duke Activity Status Index (DASI)] variables were assessed. Results: Patients in lowEC group were older (71.84±6.16 vs 65.67±7.07yrs, p=0,02) and hypertensive (85 vs 40%, p=0.02), presented shorter 6MWD (198.54±69,97 vs 275,53±95,35m, p=0.02) and lower MIP (32.52±13.93 vs 54.93±24.03mmHg, p=0.012) in exacerbation. Also, LowEC presented lower ∆ recovery of 6MWD (25.38±49.73 vs 108.00±83.87m, p<0.01) and lower HS (18.57±8.44 vs 24.66±5.82Kgf, p=0.04), with lower DASI score (16.89±11.85 vs 27.86±10.54, p=0.02) in recovery moment. Conclusion: Older, hypertensive patients, with lower MIP and shorter 6MWD at the time of AECOPD are more likely to have reduced exercise capacity 30 days after discharge, in addition to greater strength weakness and functional impact in recovery. Support: FAPESP 2015/12763-4; 2015/26501-1; 2021/03493-4 and CAPES