Aug 2026· International Journal of COPD· Vol 21, pp. 1-9· 0 citations· 30 references
Medicine
TL;DR
A « High Functional Disability » (HFD) phenotype defined by HAQ-DI ≥ 1 (n = 20), and characterized by COPD poor prognosis markers and severe disease burden is identified, which could benefit from personalised management such as pulmonary rehabilitation and psychological support.
Abstract
Purpose Chronic Obstructive Pulmonary Disease (COPD) is characterized by a progressive limitation of exercise capacity and functional disability, induced by both airway obstruction, skeletal muscle dysfunction and comorbidities, contributing to the disease burden. The Health Assessment Questionnaire – Disability Index (HAQ-DI), a validated tool assessing functional disability in rheumatologic diseases, with higher scores reflecting more severe disability, may be of interest in COPD. This study aimed to assess functional disability in COPD using the HAQ-DI and its association with disease severity and burden. Patients and Methods Mild to very severe COPD patients were included in the RINNOPARI prospective cohort (NCT02924818). Pulmonary function tests and 6-minute walking test (6MWT) results, HRCT emphysema quantification, and patient-reported outcomes, including mMRC, CAT, SGRQ, EQ-5D and SF-36, were recorded. Functional disability was assessed using the French version of the HAQ-DI. Results A total of 117 patients were included, with a median HAQ-DI score of 0.38 [0.0–0.75]. HAQ-DI scores were significantly higher in COPD GOLD 3–4 (0.50 [0.13–0.75] vs 0.25 [0–0.63] in COPD GOLD 1–2, p = 0.015). HAQ-DI was associated with cardiovascular and depression comorbidities (p < 0.05), COPD clinical features (number of exacerbations, p = 0.015; mMRC dyspnea score, CAT score and 6MWT distance, all p < 0.001), and COPD burden as assessed by SF-36, SGRQ and HAD anxiety and depression scores, p < 0.001 for all. Multivariate analysis identified the 6MWT distance, CAT, SGRQ, and HAD-Depression scores as independent factors associated with HAQ-DI. We further identified a « High Functional Disability » (HFD) phenotype defined by HAQ-DI ≥ 1 (n = 20), and characterized by COPD poor prognosis markers and severe disease burden. Conclusion The HAQ-DI is a feasible tool for screening functional disability in COPD. It allowed the identification of a « high-risk, high burden » phenotype, which could benefit from personalised management such as pulmonary rehabilitation and psychological support.
Pakistan patients with COPD experienced marked symptom burden and HRQoL impairment, supporting multidimensional assessment beyond spirometry alone, and CAT, FEV₁, and probable depression remained independently associated with HRQoL.
Zarish Younas, Ashar Yousaf, Adden Anis Khan et al.· Journal of Health and Rehabi...· 0 citations
Abstract Introduction: Chronic obstructive pulmonary disease (COPD) is characterized by limited airflow that generates impacts on the respiratory and musculoskeletal system, and on quality of life, which can be treated by exercises. Objective: To evaluate the effects of functional training on peripheral muscle strength, mobility and balance and quality of life in patients with COPD. Methods: Quasi experimental, prospective, non-randomized study with convenience sample. Patients with COPD were submitted to a 12-week functional training composed of 10 exercises similar to the activities of daily life. Anthropometric varia-bles and pulmonary function tests were assessed at baseline. Quality of life (Saint George Questionnaire), muscular strength (handgrip and lumbar strength test), mobility and balance capacities (Incremental Shuttle Walking, Stair Climb, Time Up and Go and BERG balance scale) tests were evaluated before and after the training. Statistical tests by comparison were used (p < 0.05). Results: Fourteen patients, 10 (71%) females, with a mean age of 61.71 ± 10.07 years, forced expiratory volume in first second and forced vital capacity relation of 58.78 ± 7.54 participated in this study. There was an improvement in quality of life [symptoms:73.90 (38.02-87.98) to 28.91 (23.50-32.23); activity: 21.40 ± 5.72 to 27.96 ± 7.47; total: 78.33 [36.39-82.99) to 20.22 [15.94-34.33] with maintenance of functional and musculoskeletal conditions. Conclusion: Functional training may be an alternative for maintaining health conditions and improving the quality of life of patients with COPD. New therapeutic proposals with an increased training volume, duration, and periodicity may promote functional, and musculoskeletal repercussions.
Daniel de Carvalho Kanashiro, B. Martinelli, A. R. P. Ambrozin· Fisioterapia em Movimento· 0 citations
Aims: Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous condition with variable clinical presentation and disease progression. This study aimed to investigate the distribution of patients across defined COPD phenotypes and to compare their clinical, radiological, and functional characteristics.
Methods: This cross-sectional descriptive study included 96 patients diagnosed with COPD. Patients were classified into four phenotype groups: asthma–COPD overlap syndrome (ACOS), non-exacerbator (NE), frequent exacerbator with emphysema (FEE), and frequent exacerbator with chronic bronchitis (FECB). Demographic, clinical, and pulmonary function parameters were analyzed and compared among groups. Forced expiratory volume in one second (FEV1), body mass index (BMI), COPD Assessment Test (CAT), diffusing capacity for carbon monoxide (DLCO), and inspiratory capacity/total lung capacity (IC/TLC) ratio were evaluated.
Results: Of the patients, 83 (86.5%) were male and 13 (13.5%) were female, with a mean age of 65.22±7.85 years. The distribution of phenotypes was as follows: ACOS (9%), NE (53%), FEE (19%), and FECB (19%). The mean annual exacerbation rate was 1.27±1.2, and the mean FEV1 was 50.21±16.56%. The ACOS phenotype was characterized by a higher proportion of female patients, younger age, history of asthma and atopy, better clinical status, and relatively preserved lung function. In contrast, the FEE phenotype demonstrated a higher exacerbation frequency, poorer quality of life, and more severe airflow limitation. Patients in the FEE group had lower FEV1 and BMI, higher CAT scores, increased lung volumes and airway resistance, lower DLCO and partial pressure of oxygen (pO2), and an IC/TLC ratio below 25%.
Conclusion: Distinct COPD phenotypes, particularly ACOS and FEE, exhibit significant differences in clinical and functional characteristics. Recognition of these phenotypes may help guide individualized management strategies, including pulmonary rehabilitation, nutritional support, and optimization of pharmacological and interventional treatments.
Duygu Acar Karagül, S. Saryal· Journal of Pulmonology and I...· 0 citations
The AE non CB and AE-CB phenotypes were found to have the most significant impact on HR-QoL among COPD patients, suggesting that individuals with the AE-CB phenotype notably require a tailored treatment approach that specifically addresses both the frequent exacerbations and the chronic bronchitis component to improve their overall QoL.
Naresh Bhagora, S. Meena, Pushpendra Bairwa et al.· Journal of Clinical and Diag...· 0 citations
Background: Chronic obstructive pulmonary disease (COPD) is characterized by persistent airway obstruction and systemic manifestations, leading to symptoms such as dyspnea and fatigue, which contribute to a typical behavior of physical inactivity and high sedentary time in daily life. However, it is still unclear whether disease knowledge has any correlation with this behavior. Aim: To identify whether the level of knowledge and disease self-management in individuals with COPD are correlated with higher levels of sedentary behavior, physical inactivity, or both. Methods: This is a cross-sectional study including individuals with COPD who underwent assessment of physical activity in daily life over seven consecutive days using an accelerometer. Additionally, pulmonary function was assessed by spirometry, and disease knowledge was evaluated using the Understanding COPD (UCOPD) and the Pulmonary Rehabilitation Adapted Index of Self-Efficacy (PRAISE) questionnaires. Results: 34 individuals with COPD were analyzed (17 men, 69±6 years, FEV 1 48±19% predict). Only weak or non-existing and not statistically significant correlations were observed between time spent/day in activities of moderate-to-vigorous intensity (MVPA) and the PRAISE and UCOPD questionnaires (r = 0.25 and 0.10, respectively, p > 0.05 for both), as well as between sedentary time and the same instruments (r = -0.05 and 0.25, respectively, p >0.05 for both). Conclusion: In individuals with COPD, the level of physical inactivity and sedentary behavior are not well correlated with the knowledge and self-management of the disease
Heloisa Krokoch, Thais Moçatto Tofoli, L. Santin et al.· Brazilian Journal of Respira...· 0 citations
Physical activity levels are reduced in people with chronic obstructive pulmonary disease (COPD). The factors underpinning this, and its impact on individuals’ health, are complex. Our aim was to investigate whether within-person changes in physical activity are associated with subsequent health outcomes, encompassing six-minute walk distance, quadriceps strength, lung function, perceived fatigue (FACIT-F), and symptom burden (CAT).
In this multicentre cohort study, 565 individuals with COPD (37% female; age 68±8 years; FEV
1
54±21%pred) were followed over two years, with study visits every six months. Physical activity was assessed using wearable devices (Axivity AX6 or DynaPort MoveMonitor MM+), capturing daily step count and movement intensity during walking. Linear mixed-effects models assessed the longitudinal changes in physical activity and health outcomes, and the associations of within-person changes in physical activity and subsequent health outcomes.
Participants showed a significant annual decline of 229 (95%CI 132–326) steps/day. Correcting for baseline PA, each 1000-step annual decline was associated with a 5.13 m (95%CI 3.20–7.06) lower six-minute walk distance, 0.37%pred (95%CI 0.08–0.66) lower FEV
1
, and 0.47-point (95%CI 0.20–0.75) lower FACIT-F at the end of that year. Similar associations were observed for movement intensity as exposure. Only movement intensity was associated with functional quadriceps strength, with each 0.1 m·s
−2
decline resulting in a 0.18 s (95%CI 0.35–0.01) slower five-times sit-to-stand performance. No associations were found with the CAT.
Within-person decline in physical activity is associated with lower lung function, reduced exercise capacity, increased fatigue symptoms and lower functional quadriceps strength.
Paulien Mellaerts, H. Demeyer, C. Becker et al.· ERJ Open Research· 0 citations
