Acute exacerbation of COPD during pulmonary rehabilitation: outcomes and risk prediction

Bertrand Herer,¹ Thierry Chinet<sup>2

1</sup>Pulmonary Rehabilitation Unit, Pulmonary Department, Centre Hospitalier De Bligny, Briis sous Forges, France; ²Pneumology Unit, Hôpital A. Paré, Boulogne-Billancourt, France

Purpose: This study was performed to examine acute exacerbation of COPD (AECOPD) during pulmonary rehabilitation (PR) and the usefulness of multidimensional indices (MIs) to predict AECOPD at enrolment in PR.
Patients and methods: A 4-week PR program (PRP) was implemented for 125 consecutive patients with COPD. At baseline and PRP completion, we recorded the FEV₁, 6-minute walk test, peak work rate at cardiopulmonary testing, modified Medical Research Council score, and COPD Assessment Test (CAT) score. The risk of AECOPDs at baseline was assessed using the body mass index, airway obstruction, dyspnea, Exercise capacity (BODE), dyspnea, obstruction, smoking, exacerbation (DOSE), and score to predict short-term risk of COPD exacerbations (SCOPEX) MIs.
Results: Thirty-two episodes of AECOPD occurred. The COPD status was worse in patients with than without AECOPD at baseline (lower FEV₁, 6-minute walk test, and peak work rate; higher modified Medical Research Council and CAT scores). The sensitivities of the BODE, DOSE, and SCOPEX MIs to predict the occurrence of AECOPD during PRP were 78.1%, 21.9%, and 84.4%, and the specificities were 73.6%, 87.1%, and 51.6%, respectively.
Conclusion: The BODE and SCOPEX MIs help to predict the exacerbation risk during PR.

Keywords: COPD, rehabilitation, exacerbation, multidimensional indices