Abstract Background Acute exacerbations of COPD (AECOPD) drive disease progression, hospitalization, and long-term disability. Recovery from an AECOPD is gradual and often takes weeks, with some patients never fully returning to their pre-AECOPD status. Early recognition and prompt pharmacologic treatment may reduce AECOPD severity and improve outcomes. Methods In the observational PACE trial (NCT04140097), COPD patients underwent 3 to 5 weeks of inpatient pulmonary rehabilitation (PR). Comprehensive clinical assessments were performed on admission and discharge. In patients whose symptoms worsened acutely, an AECOPD was immediately diagnosed by a pulmonologist with additional diagnostic evaluations (including CRP) performed on days 1 and 5 of AECOPD. Treatment was started immediately after diagnosis. Results A total of 355 COPD patients were prospectively included, of whom 57 (16%) experienced an AECOPD during PR. These patients were treated with oral corticosteroids (n = 56, 98%) and antibiotics (n = 17, 30%) guided by sputum purulence. AECOPD and non-AECOPD patients were similar in age (67±9 vs. 67±7 years), but the AECOPD group had lower FEV1 at PR admission (34±11% vs. 40±15% predicted). CRP levels were similar between AECOPD and non-AECOPD patients at PR admission (5.2±6.4 mg/L vs. 7.4±12.1 mg/L). In patients who developed an AECOPD, CRP increased markedly at day 1 of AECOPD (20.8±41.8 mg/L) and declined by day 5 (6.9±12.1 mg/L). Fifty-six AECOPD patients (98%) continued PR; only one required transfer to an acute hospital. By PR discharge, AECOPD patients showed comparable FEV1 to PR admission but significant improvements in health status (COPD Assessment Test) and exercise capacity (6-min walk distance) (Figure). Conclusions Early diagnosis and immediate treatment of AECOPD can prevent further deterioration and support rapid recovery. Novel strategies for early detection and management of AECOPD should be further explored in routine clinical care. This abstract is funded by: The PACE study (ID 212667) is a supported, collaborative study funded by GSK.
Gloeckl et al. (Fri,) studied this question.