Modeling the decline of physical activity preceding acute exacerbations of COPD

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Introduction: COPD is often associated with a reduced exercise tolerance triggering disease deterioration. In a recent study, we showed a significant negative correlation between physical activity (PA) and the evolution of the COPD Assessment Test (CAT) score. Real-world data typically show a decrease of PA before an acute exacerbation of COPD (AECOPD) confering PA the potential to predict AECOPD. The aim of the current study was to investigate the patterns of PA decrease prior to AECOPD. Material and Methods: 42 patients with COPD were equipped with an activity tracking wearable and their daily PA was telemonitored for one year. AECOPD were monitored and classified into severe, moderate and mild. The decrease of PA preceding an exacerbation was modeled using 4-parameter nonlinear regression logistic models. Results: Among 42 patients, 14 experienced at least one exacerbation within a 1-year follow-up. The median number of AECOPD per exacerbating patient was 4 [range: 1 to 18]. Overall 69 AECOPD were monitored including 8 severe, 34 moderate and 27 mild. A sensitivity analysis showed that the drop of PA 8 days prior to AECOPD gives the best time-window to predict AECOPD. The steepest drop of 3'500 steps per day was observed in patients having a moderate AECOPD. A drop of 1'500 steps per day was observed in patients having a mild AECOPD. Patients who experienced severe AECOPD already had low PA levels 8 days prior AECOPD and only showed a minor drop of PA. Conclusion: Patients with COPD experiencing AECOPD had a significant drop of PA starting 8 days prior to AECOPD. The drop of PA differed according to the severity of AECOPD. Real-world PA monitoring can complement standard COPD management.

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