Predictors of Acute Exacerbation in Patients With COPD - an Observational Study

Study Overview
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Brief Summary
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Chronic obstructive pulmonary disease (COPD) is a lung disease characterized by respiratory problems and poor airflow with dyspnea and cough being the main symptoms. Acute exacerbations of COPD (AECOPD) are the most important events for patients with COPD that have a negative impact on patients´ quality of life, accelerate disease progression, and can result in hospital admissions and death. It is of major clinical importance to determine predictors of an AECOPD and to identify patients who are at high risk for developing an acute exacerbation and/or to detect the beginning of or prevent an ongoing acute exacerbation as early as possible. Until now, research in the field of AECOPD has gathered and analyzed data only after manifestation of AECOPD until recovery and most of them used a retrospective study design. Therefore, the aim of this prospective trial is to collect clinical data in patients prior to the first visible clinical signs of an AECOPD to investigate potential early predictors of an AECOPD.

Detailed Description
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In total, 355 COPD patients will be included prospectively to this study during a 3-week inpatient pulmonary rehabilitation programme at the Schoen Klinik Berchtesgadener Land, Schoenau am Koenigssee, (Germany). All patients will be closely monitored from admission to the study. Measures of lung function, blood samples, breath sampling, exercise tests, physical activity monitoring, cardiac parameters, quality of life and a symptom diary will be recorded regularly. Prior knowledge from this programme suggest that about 15% of patients will develop an AECOPD during this observational phase. If a patient develops an AECOPD there will be a comprehensive diagnostic assessment to differentiate between cardiac, pulmonary or cardio-pulmonary reasons for the AECOPD and to identify the type of exacerbation. The clinical diagnosis and management of an AECOPD will be determined by a pulmonologist according to criteria of international guidelines within the first 24h after the onset of clinical symptoms suggestive of an exacerbation. Collected clinical data from the days prior to AECOPD will be analyzed comprehensively to identify parameters with high prediction power for AECOPD. Furthermore, patients will perform follow-up measures at 6, 12 and 24 months following the initial observational phase (PR phase). A wide range of predictor screening methods will be applied to identify significant predictors including cross tabulation tables, correlations, generalized linear models, mixed models, generalized estimation equation models and various predictor screening methods based on variable selection algorithms. Study objectives Primary endpoint: To prospectively identify potential early, respiratory and/ or cardiac clinical predictors, laboratory parameters, breath print analyses and/ or changes in lung function and physical activity prior to an AECOPD in COPD patients. Secondary endpoint(s): To identify potential mechanisms explaining the nature and composition of an acute exacerbation in COPD patients To identify and differentiate patterns of acute COPD exacerbation versus cardiac failure in COPD patients To investigate the potential role of an electronic-nose to capture exhaled breath metabolomic profiles for the early detection of an acute exacerbation in COPD patients (COPD pre exacerbation breath print) To identify parameters influencing mortality and other adverse events in the total study cohort at 6, 12 and 24 months follow up

Official Title
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Predictors of Acute Exacerbation in Patients With COPD - an Observational Study (PACE Trial)

Conditions
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COPD, Chronic Obstructive Pulmonary Disease, COPD Exacerbation, COPD Exacerbation Acute

Intervention / Treatment
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* Other: Prospective monitoring of a large variety of parameters


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: confirmed diagnosis of Chronic Obstructive Pulmonary Disease according to Global Association for Obstructive Lung Disease stage II to IV the ability to follow the rehabilitation protocol provided written informed consent Exclusion Criteria: - current primary diagnosis of asthma

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| COPD patients with acute exacerbation<br> | Other: Prospective monitoring of a large variety of parameters<br>* Patients will be recruited during an inpatient pulmonary rehabilitation program. This setting offers a unique opportunity to study the phenomenon of an acute exacerbation of the Chronic Obstructive Pulmonary Disease prior to the first visible clinical sign and further on to have a follow up of the underlying mechanisms. All COPD patients that are referred to the reference center for a rehabilitation program will be included after providing written informed consent. Prospectively, a wide range of measurements will be collected. If a patient develops an acute exacerbation there will be a comprehensive diagnostic assessment to differentiate between pulmonary, cardiac or cardio-pulmonary reasons for the exacerbation. The clinical diagnosis of an AECOPD will be made by a pulmonologist according to criteria of international guidelines within the first 24h of clinical symptoms suggestive of an exacerbation.<br>|
| COPD patients without acute exacerbation<br> | Other: Prospective monitoring of a large variety of parameters<br>* Patients will be recruited during an inpatient pulmonary rehabilitation program. This setting offers a unique opportunity to study the phenomenon of an acute exacerbation of the Chronic Obstructive Pulmonary Disease prior to the first visible clinical sign and further on to have a follow up of the underlying mechanisms. All COPD patients that are referred to the reference center for a rehabilitation program will be included after providing written informed consent. Prospectively, a wide range of measurements will be collected. If a patient develops an acute exacerbation there will be a comprehensive diagnostic assessment to differentiate between pulmonary, cardiac or cardio-pulmonary reasons for the exacerbation. The clinical diagnosis of an AECOPD will be made by a pulmonologist according to criteria of international guidelines within the first 24h of clinical symptoms suggestive of an exacerbation.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change from baseline laboratory parameters at day 21 | following Parameters will be collected: c-reactive protein, cardiac Troponin I, hemoglobin A1c, Interleukin-1 beta, Interleukin-2, Interleukin-6, Interleukin 8, N-terminal probrain natriuretic peptide, Tumor necrosis factor alpha | baseline and day 21 | 
| Change from day 1 of an acute exacerbation in laboratory parameters at day 5 | following Parameters will be collected: c-reactive protein, cardiac Troponin I, hemoglobin A1c, Interleukin-1 beta, Interleukin-2, Interleukin-6, Interleukin 8, N-terminal probrain natriuretic peptide, Tumor necrosis factor alpha | day 1 and 5 in case of an acute exacerbation | 
| Change from baseline lung function at day 21 | following Parameters will be collected: forced expiratory volume in 1 sec, forced vital capacity, total lung capacity, residual volume | baseline and day 21 | 
| Change from day 1 of an acute exacerbation in lung function at day 5 | following Parameters will be collected: forced expiratory volume in 1 sec, forced vital capacity, total lung capacity, residual volume | day 1 and 5 in case of an acute exacerbation | 
| Change from baseline Cardiac Doppler echocardiography at day 21 | Left and right heart echocardiography will be performed | baseline and day 21 | 
| Change from day 1 of an acute exacerbation in Cardiac Doppler echocardiography at day 5 | Left and right heart echocardiography will be performed | day 1 and 5 in case of an acute exacerbation | 
| Change from baseline breath volatile organic compounds Analysis to day 4, 8, 11, 15 and 18 | breath samples will be analyzed by ion-mobility spectrometry and gaschromatography/mass spectrometry | day 1, 4, 8, 11, 15, 18 | 
| Change in baseline exercise Performance at day 21 | following tests will be performed: 6-Minute walk test, sit-to-stand-test, Peak quadriceps and Hand grip force, | day 1 and 21 | 
| Change from baseline Quality of life assessed by Short Form - 36 Questionnaire at days 21, day 180, day360, day 720 | the scale of the physical and mental Health component summary score ranges from 0 to 100 Points with higher scores indicating better Quality of lif | baseline, day 21, day 180, day 360, day 720 | 
| Change from baseline functional status assessed by Modified Medical Research Counsil score at days 21, day 180, day360, day 720 | the score ranges from category 0 to 4 with higher scores indicating higher impairment in function status | baseline, day 21, day 180, day 360, day 720 | 
| Change from baseline anxiety status assessed by Chronic Obstructive Pulmonary Disease Anxiety Questionnaire at days 21, day 180, day360, day 720 | the total score ranges from 0 to 112 Points with higher scores indicating worse anxiety status | baseline, day 21, day 180, day 360, day 720 | 
| Change from baseline Depression status assessed by Patient Health Questionnaire 9 at days 21, day 180, day360, day 720 | the total score ranges from 0 to 27 Points with higher scores indicating worse Depression symptoms | baseline, day 21, day 180, day 360, day 720 | 
| Change from baseline disease specific Quality of life assessed by Chronic Obstructive Pulmonary Disease Assessment Test at days 21, day 180, day360, day 720 | total score ranges from 0 to 40 points with higher scores indicating worse quality of life | baseline, (day 1 and 5 in case of an acute exacerbation), day 21, day 180, day 360, day 720 | 
| Self-reported patient diary | The EXAcerbations of Chronic pulmonary disease Tool will be used | once daily from day 1 to day 21 | 
| physical activity monitoring | Using the Actigraph device following Parameters will be collected: steps per day and physical activity levels | continuous monitoring from day 1 to day 21 | 
| Change in Survival Status from baseline at 6, 12 and 24 months | Survival Status will be assessed by phone calls | baseline, at 6, 12 and 24 months | 
| cough events | Number of nocturnal cough events recorded by NELA sound device (Carepath) | Recording from day 1 to day 21 at night only | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Predictor, Development, Pulmonary Rehabilitation