Expiratory Muscle Strength, Peak Oxygen Consumption and Hyperinflation Predicts Severe Exacerbation in Chronic...

To explore the predictive ability of physiological and clinical parameters, including respiratory muscle strength, peak oxygen consumption, exercise capacity assessed by the six-minute walk distance (6MWD), pulmonary function, and arterial blood gas for identifying patients with chronic obstructive pulmonary disease (COPD) who are at risk of frequent severe acute exacerbations.

This retrospective, observational study analyzed data from 265 patients who were hospitalized for severe exacerbations between January 1^st, 2018 to February 28^th,, 2024. Patients were classified as infrequent or frequent exacerbators based on the annual frequency of severe exacerbations. Binary logistic regression models were used to identify independent predictors, adjusting for clinically relevant covariates.

In adjusted multivariate analysis, maximal expiratory pressure [odds ratio (OR): 0.989; 95% confidence interval (CI): 0.980-0.998; P = 0.014], 6MWD (OR: 0.997; 95% CI: 0.994-1.000; P = 0.028), 6MWD% (OR: 0.985; 95% CI: 0.970-0.999; P = 0.041), peak oxygen consumption (OR: 0.874; 95% CI: 0.776-0.986; P = 0.028), residual volume (OR: 1.006; 95% CI: 1.001-1.011; P = 0.017), and functional residual capacity (OR: 1.008; 95% CI: 1.001-1.014; P = 0.028) emerged as significant predictors of frequent severe exacerbations.

Expiratory muscle weakness, reduced peak oxygen consumption, diminished exercise capacity, and pulmonary hyperinflation are independent predictors of frequent severe acute exacerbations in patients with COPD. Incorporating these parameters into routine assessments may enhance risk stratification and goal-directed therapies, and potentially reduce hospitalization rates.