Changes in Cycle-Ergometer Performance during Pulmonary Rehabilitation Predict COPD Exacerbation.

Early diagnosis of COPD exacerbations is vital. Exacerbations are characterised by an increase in dyspnoea that could be affect physical capacity. Changes in the physical capacity of patients with COPD during pulmonary rehabilitation could provide a predictive indication regarding the occurrence of exacerbation. This was a retrospective study of forty for patients with COPD who participated in a pulmonary rehabilitation programme between January 2015 and October 2018. Patients to have experienced at least one exacerbation during their pulmonary rehabilitation programme are included. The performance variable and dyspnoea on the cycle ergometer and the treadmill were collected during the five sessions prior to the exacerbation and the three sessions following the exacerbation. Seventy exacerbations were analysed. We found a significant decrease in the performance on the cycle ergometer during the last session before exacerbation compared with previous sessions (mean difference: 74.5% (95%CI 12.6-136.5); p < 0.01). The optimal threshold value was a 17% decrease in performance compared to the previous training session. Sensitivity was 0.46 (95%CI 0.34-0.59), specificity was 0.83 (95%CI 0.72-0.91) and the area under the curve was 0.65 (95%CI 0.56-0.74) (p < 0.01). The analysis of performance data from cycle ergometer is a potentially useful method to predict the occurrence of exacerbation.

Advanced telehealth technology improves home-based exercise therapy for people with stable chronic obstructive pulmonary disease: a systematic review.

QUESTIONS: How effective is home-based exercise therapy delivered using advanced telehealth technology (ATT-ET) for people with chronic obstructive pulmonary disease (COPD) compared with: no exercise therapy (ET), in/outpatient ET, and home-based ET without ATT? DESIGN: Systematic review and meta-analysis of randomised trials. PARTICIPANTS: People with stable COPD referred for ET. INTERVENTION: ATT-ET. OUTCOME MEASURES: Exercise capacity, quality of life, functional dyspnoea, cost-effectiveness and various secondary outcomes. RESULTS: Fifteen eligible trials involved 1,522 participants. Compared with no ET, ATT-ET improved exercise capacity (four studies, 6-minute walk test MD 15 m, 95% CI 5 to 24) and probably improved quality of life (four studies, SMD 0.22, 95% CI 0.00 to 0.43) and functional dyspnoea (two studies, Chronic Respiratory Questionnaire-Dyspnoea MD 2, 95% CI 0 to 4). ATT-ET had a similar effect as in/outpatient ET on functional dyspnoea (two studies, SMD -0.05, 95% CI -0.39 to 0.29) and a similar or better effect on quality of life (two studies, SMD 0.23, 95% CI -0.04 to 0.50) but its relative effect on exercise capacity was very uncertain (three studies, 6-minute walk test MD 6 m, 95% CI -26 to 37). ATT-ET had a similar effect as home-based ET without ATT on exercise capacity (three studies, 6-minute walk test MD 2 m, 95% CI -16 to 19) and similar or better effects on quality of life (three studies, SMD 0.79, 95% CI -0.04 to 1.62) and functional dyspnoea (two studies, Chronic Respiratory Questionnaire-Dyspnoea MD 2, 95% CI 0 to 4). ATT-ET had effects on most secondary outcomes that were similar to or better than each comparator. CONCLUSION: ATT-ET improves exercise capacity, functional dyspnoea and quality of life compared with no ET, although some benefits may be small. Its benefits are generally similar to in/outpatient ET and similar to or better than home-based ET without ATT. REGISTRATION: PROSPERO CRD42020165773.