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Effect of pulmonary rehabilitation on systemic cardiovascular and inflammatory manifestations of COPD

Researchers

  • N S Gale
  • C E Bolton (Respiratory Medicine, Cardiff University)
  • A Prossor (Adult CF Centre, Llandough Hospital, Penarth, Wales)
  • Dr Stephanie Enright
  • R I Ketchell (Adult CF Centre, Llandough Hospital, Penarth, Wales)
  • D J Shale (Respiratory Medicine, Cardiff University)

Chronic Obstructive Pulmonary Disease (COPD) causes significant morbidity and mortality. The main aetiological factor is smoking, though genetic and other environmental influences are important. Previously clinical and research endeavour has concentrated on the airways disease, comprising airways inflammation and obstruction and their link to reduced exercise tolerance and disability. More recently the presence of extra-pulmonary manifestations have been identified and are considered to have an important additional effect on morbidity and mortality. Systemic involvement in COPD includes chronically increased circulating inflammatory mediators (IL-6, TNF-α and soluble receptors, CRP), catabolic intermediary metabolism, skeletal muscle mass (SMM) loss and functional impairment, bone thinning leading to osteoporosis, insulin resistance and diabetes mellitus and coronary heart disease. Originally such research was carried out in subjects with severe airways obstruction and complications were considered a problem of late stage disease. However, there is evidence that changes, such as bone demineralisation occurs in mild severity lung disease and remains undiagnosed. We have performed a cross-sectional pilot study in 75 patients with COPD and compared with 42 age, gender and mean arterial pressure matched smoking controls. In the patients mean (SD) aortic PWV was 11.4 (2.7) m/s compared with 8.9 (1.7) m/s in controls, p<0.001 (22).

Several, but not all, studies have shown beneficial effects of aerobic exercise on arterial stiffness with associated gene expression of vaso-regulatory agents such as eNOS and prostaglandin (23-27). Collectively, studies concentrating on endurance rather than strength have been more beneficial. Thus maintenance of physical activity from early in the disease may have a beneficial cardioprotective effect in COPD. This study therefore aims to investigate the role of early exercise intervention on arterial stiffness and the systemic manifestations of COPD in patients with moderate disease.