Changes in systemic inflammation after pulmonary rehabilitation in patients with COPD and severe physical inactivity – an exploratory study

Abstract

Background: Severe physical inactivity (SPI) in patients with COPD is associated with a poor prognosis. It is unknown whether there is a link between SPI and systemic inflammation, and if systemic inflammation in SPI changes following pulmonary rehabilitation (PR). Methods: A prospective, observational study of patients referred for at least 7 weeks of PR comprising 2 h of exercise therapy and education twice weekly. At baseline and after PR, daily physical activity level (PAL) was measured with a validated activity monitor, SenseWear ® as well as systemic inflammation: b-eosinophils, p-fibrinogen, p-CRP, s-IL-6 and s-CD 163. SPI was defined as PAL <1.4. Results: At baseline, SPI was present in 31 of the 57 patients included, and 23% (7/31) improved to non-SPI after PR. We observed no differences between patients with SPI and non-SPI, except baseline plasma fibrinogen level was slightly yet significantly higher in patients with SPI (median 13.3 [6.2–23.6] vs 11.2 [6.5–16.7] µmol/l) but change in fibrinogen levels differed insignificantly between patients who improved to non-SPI at follow-up compared to patients with persistent SPI (−0.6 [−16.9–9.9] vs −0.4 [−11.2–1.2] µmol/l). Conclusion: SPI in COPD appears not to be associated with a distinct inflammatory profile compared to less sedentary COPD patients attending pulmonary rehabilitation. Currently biomarkers have no role in the detection of SPI in COPD.

What every clinician should know about inflammation in COPD

“…The relationship between dysbiosis and inflammation is also of interest and forms the basis of some pathophysiological hypotheses in COPD. Local and/or systemic inflammation may also be augmented by lifestyle factors such as smoking/smoke exposure, poor nutritional status, low levels of physical activity level, and obesity [72,73]. Epigenetic alterations are likely to be involved in the sequelae of inflammation in COPD and can modulate treatment effects and the natural course of the disease.…”

Impacto de las exacerbaciones en la enfermedad pulmonar obstructiva crónica Exacerbaciones en la EPOC

“…Los autores recomiendan la rehabilitación pulmonar temprana supervisada en estos pacientes. 41 La rehabilitación en pacientes con EPOC debe abarcar tanto aspectos físicos como pulmonares, ya que se ha demostrado que esto puede disminuir los biomarcadores de inflamación sistémica. Por lo tanto, la promoción de actividad física de leve a moderada intensidad debe ser considerada un aspecto tratable de la enfermedad y debe ser fomentada en cada evaluación de un caso.…”