Changes in Microcirculation and Functional Status During Exacerbation of COPD
Keywords
Abstract
Description
Recent findings suggest that patients with chronic obstructive pulmonary disease (COPD) are at increased risk for myocardial infarction and stroke during periods of acute exacerbation. These findings might be related to acute endothelial changes associated to increased systemic inflammation. Changes in the microcirculation can be explored noninvasively by studying retinal blood vessels that are visualized in fundus images. The retinal blood vessels have anatomical and physiological features that are comparable with the coronary circulation.
Patients with COPD experience quadriceps muscle weakness, which worsens during hospitalization by ~1% per day. This is the result of physical inactivity, in combination with increased oxidative stress and systemic inflammation. Physical inactivity is induced by the hospital environment, but is also related to symptoms of dyspnea caused by increased work of breathing and oxygen desaturation.
Muscle weakness and physical inactivity are associated to poor functional status and recurrent hospital admissions, independent of pulmonary impairment, which makes those patients with frequent exacerbations prone to enter a vicious cycle.
Simple functional screening tests during hospital stay might enable us to quantify the impact of a hospitalization on functional status and to identify patients at risk for repeated exacerbations.
Dates
| Last Verified: | 08/31/2017 |
| First Submitted: | 06/20/2017 |
| Estimated Enrollment Submitted: | 08/09/2017 |
| First Posted: | 08/14/2017 |
| Last Update Submitted: | 09/06/2017 |
| Last Update Posted: | 09/07/2017 |
| Actual Study Start Date: | 09/07/2017 |
| Estimated Primary Completion Date: | 06/30/2018 |
| Estimated Study Completion Date: | 06/30/2020 |
Condition or disease
Phase
Arm Groups
| Arm | Intervention/treatment |
|---|---|
| COPD-stable Stable COPD patients at pulmonology consultation in Ziekenhuis Oost-Limburg (ZOL) Genk | |
| COPD-Ex Patients admitted to the respiratory ward of ZOL Genk with a diagnosis of acute exacerbation, based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. |
Eligibility Criteria
| Ages Eligible for Study | 40 Years To 40 Years |
| Sexes Eligible for Study | All |
| Sampling method | Non-Probability Sample |
| Accepts Healthy Volunteers | Yes |
| Criteria | Inclusion Criteria: - Stable COPD (post-bronchodilator forced expiratory volume / forced vital capacity < 0.7), no exacerbations in the previous weeks. COPD patients with diagnosis of acute exacerbation, based on the GOLD criteria. Exclusion Criteria: - Inability to walk without support from others |
Outcome
Primary Outcome Measures
1. Changes in Retinal microcirculation [Stable: Outpatient clinic/ COPD exacerbated: Day 2-3 in hospital; Day 5-7 in hospital; 4 weeks after discharge]
2. Changes in Functional status tests [Stable: Outpatient clinic/ COPD exacerbated: Day 2-3 in hospital; Day 5-7 in hospital; 4 weeks after discharge]
Secondary Outcome Measures
1. Functional exercise tolerance [Stable: Outpatient clinic/ COPD exacerbated: Day 2-3 in hospital; Day 5-7 in hospital; 4 weeks after discharge]
2. Muscle Function [Stable: Outpatient clinic/ COPD exacerbated: Day 2-3 in hospital; Day 5-7 in hospital; 4 weeks after discharge]
3. Changes in Daily physical activity [Stable: Outpatient clinic/ COPD exacerbated: Day 2-3 in hospital; Day 5-7 in hospital; 4 weeks after discharge]
4. Impact of the disease [Stable: Outpatient clinic/ COPD exacerbated: Day 2-3 in hospital; Day 5-7 in hospital; 4 weeks after discharge]
5. Impact of the dyspnea [Stable: Outpatient clinic/ COPD exacerbated: Day 2-3 in hospital; Day 5-7 in hospital; 4 weeks after discharge]
6. Impact of the depression [Stable: Outpatient clinic/ COPD exacerbated: Day 2-3 in hospital; Day 5-7 in hospital; 4 weeks after discharge]
7. Impact of the fatigue [Stable: Outpatient clinic/ COPD exacerbated: Day 2-3 in hospital; Day 5-7 in hospital; 4 weeks after discharge]
8. Body composition [Stable: Outpatient clinic/ COPD exacerbated: Day 2-3 in hospital; Day 5-7 in hospital; 4 weeks after discharge]
9. Cardiovascular parameters [Stable: Outpatient clinic/ COPD exacerbated: Day 2-3 in hospital; Day 5-7 in hospital; 4 weeks after discharge]
10. Continuous assessment of oxygen saturation [COPD exacerbated: Day 5-7 in hospital; 4 weeks after discharge]
11. Continuous assessment of heart rate [COPD exacerbated: Day 5-7 in hospital; 4 weeks after discharge]
