The effects of pulmonary rehabilitation on endothelial function and arterial stiffness in patients with chronic obstructive pulmonary disease

Abstract

Objectives Cardiovascular disease is a major cause of mortality in chronic obstructive pulmonary disease (COPD) and endothelial dysfunction may enhance the mortality risk. Exercise training has shown to be beneficial for improvement of endothelial function in patients with cardiovascular disease, but this remains unclear in COPD. Thus, this study aimed to assess the effect of exercise‐based pulmonary rehabilitation (PR) on endothelium function, arterial stiffness and plasma nitrite levels in patients with COPD. Methods Patients with COPD engaged a 48‐session PR program. Reactive hyperaemia index (RHI), augmentation index (AIx), and heart rate (HR) assed by peripheral arterial tonometry (PAT), plasma nitrite levels, systemic blood pressure, functional capacity (six‐minute walk test) and the BODE index were assessed at baseline and after 24 and 48 sessions of PR. Plasma nitrite levels were also assessed before and after the first session of PR. Results Twenty‐one subjects were included and completed 24 PR sessions, and 16 subjects completed 48 sessions. It was observed that a poorer AIx adjusted for HR in frequent COPD exacerbators (4.67 ± 16.5 vs. 20.9 ± 12.9; p = .02). PR improved functional capacity (380 ± 107 m vs. 442 ± 115 m; p < .001) and the BODE index (6 [2.8] vs. 4 [3]; p = .001), but did not change HR, systemic arterial pressure, RHI, AIx, and plasma nitrite levels during the follow‐up. Plasma nitrite levels reduced after the first session of PR (0.074 [0.079] μM vs. 0.061 [0.04] μM; p = .027). The acute change in plasma nitrite levels correlated with RHI in patients with preserved endothelial function (r = 0.71; p = .01). Conclusions Although exercise‐based PR improved functional capacity and the BODE index, it did not change endothelial function and arterial stiffness in patients with COPD.

Analysis of retinal blood vessel diameters in patients with COPD undergoing a pulmonary rehabilitation program

“…These studies focused on endothelial function in COPD and showed conflicting findings. [26][27][28] Differences in baseline patient characteristics (age, disease severity) and possibly varying exercise intensities or durations may explain these differences.…”

The Role of Rehabilitation in Arterial Function Properties of Convalescent COVID-19 Patients

“…Cardiopulmonary rehabilitation has been advocated to improve the functional status of patients with respiratory and cardiovascular diseases [ 11 , 12 ]. Moreover, rehabilitation in patients with chronic pulmonary disease may improve vascular function parameters [ 13 ]. Additionally, scarce evidence in post-COVID-19 patients suggests that endothelium-dependent vasodilation may be ameliorated after cardiopulmonary rehabilitation [ 14 , 15 ].…”

The CT pulmonary vascular parameters and disease severity in COPD patients on acute exacerbation: a correlation analysis

“…Pulmonary vascular change is an important pathophysiological characteristic of COPD. On the one hand, COPD causes the destruction of the lung parenchyma, which leads to the loss of the attachment of the alveoli and the small airways and the reduction of the elasticity of the lungs [10]. Previous studies [11][12][13] have shown that pulmonary vascular parameters of high-resolution computed tomography (HRCT) of the chest, such as the ratio of the cross-sectional area of small pulmonary vessels to the total area of the lung field (%crosssectional area, CSA), the ratio of pulmonary artery and aorta(PA/A) cross-sectional diameter are potentially related to the pulmonary function indexes.…”