title: Chronic obstructive pulmonary disease patient journey: hospitalizations as window of opportunity for extra-pulmonary intervention.
abstract: OBJECTIVE
  Hospitalizations due to exacerbation of chronic obstructive pulmonary disease (COPD) are a major burden for patient and healthcare system. Extra-pulmonary needs and resulting interventions are poorly investigated.
  
  
  RESULTS
  COPD induces nutritional issues, body composition changes and limits patient exercise capacity. The COPD patient journey can be accelerated through exacerbations during which disease-related detrimental factors such as systemic inflammation, hypoxia, inactivity, and glucocorticosteroid treatment converge and intensify, which acutely and often irreversibly worsens patient condition. Specific needs during exacerbations reach beyond the respiratory system, thus clinicians should comprehensively evaluate patients and identify potent and feasible metabolic and anabolic intervention targets. General and specific nutritional support appear feasible and with potential to cover for the changed bodily requirements during exacerbation. Adjunctive physical exercise or neuromuscular electrical stimulation may prevent the muscle loss.
  
  
  CONCLUSIONS
  Hospitalizations should be considered as a window of opportunity for detailed patient assessment and implementation of tailored extra-pulmonary adjunctive strategies with long-term implications. Nutritional assessment and support as well as physical exercise appear promising but should be investigated in adequately designed and conducted trials.
authors.affiliation: Division of Cardiology, University Clinic of Pulmonary and Allergic Diseases Golnik, Golnik, Slovenia. mitja.lainscak@guest.arnes.si
authors.forename: Mitja
authors.initials: M
authors.lastname: Lainscak
authors.forename: Harry R
authors.initials: HR
authors.lastname: Gosker
authors.forename: Annemie M W J
authors.initials: AM
authors.lastname: Schols
mesh_terms: D045930:Anabolic Agents / Q000378:metabolism; D001823:Body Composition; D015444:Exercise; D006760:Hospitalization; D006801:Humans; D007249:Inflammation / Q000473:pathology / Q000628:therapy; D008168:Lung / Q000473:pathology; D044342:Malnutrition / Q000150:complications / Q000628:therapy; D018529:Nutritional Support / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000473:pathology / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic
chemical_list: D045930:Anabolic Agents