Timely management of COPD exacerbations is associated with limited acute deterioration and early recovery: a prospective observational study.

Acute exacerbations of COPD (AECOPDs) are critical events often associated with prolonged and incomplete recovery. Early recognition and prompt treatment of AECOPDs, which is rarely achieved in routine outpatient care, may influence the acute course and recovery trajectory. This study aimed to characterize the clinical course and recovery trajectory of AECOPDs detected early and treated immediately.In this prospective, observational study, COPD patients were enrolled in a closely supervised, 4-week, inpatient pulmonary rehabilitation (PR) program. Patients who developed a pulmonologist-confirmed AECOPD during PR received same-day guideline-based therapy with systemic corticosteroids and/or antibiotics. Clinical, inflammation (C-reactive protein [CRP]), lung function (forced expiratory volume in 1 s [FEV₁]), and patient-reported outcomes (COPD Assessment Test [CAT]) were assessed at PR admission (pre-AECOPD), AECOPD day 1, day 5, and post-AECOPD (PR discharge). Functional performance outcomes, including 6-minute walk distance (6MWD) and muscle strength (quadriceps and handgrip), were also assessed at baseline and post-AECOPD.Among 355 patients undergoing inpatient PR, 57 (16%) developed an AECOPD and were included in the analysis. At AECOPD onset (day 1), CRP increased significantly to 20.8 ± 41.8 mg/L (p = 0.032) and FEV₁ declined by 113 ± 220 mL (p < 0.001) compared to pre-AECOPD at baseline, while CAT scores showed no significant changes (p = 0.41). By day 5, CRP and FEV₁ were no longer significantly different from baseline. At PR discharge which occurred 13 ± 8 days after AECOPD onset, CAT scores were significantly better (23.6 ± 7.2 vs. 21.6 ± 7.8; p < 0.01), 6MWD increased (294 ± 105 m to 313 ± 126 m; p < 0.001), and quadriceps and handgrip strength improved (all p < 0.05) compared to pre-AECOPD baseline levels. No severe adverse events beyond the AECOPD occurred.In this observational cohort, episodes of AECOPD detected and treated on the day of onset during inpatient PR were characterized by short-term deterioration, normalization of inflammatory and lung function parameters within days, and subsequent improvements in patient-reported outcomes and functional performance. These findings suggest that early recognition, immediate treatment, and continued adapted physical activity may be associated with better short-term recovery trajectories following an AECOPD.Clinical trial registration ClinicalTrials.gov identifier: NCT04140097.