Pulmonary rehabilitation and endothelial function in patients with chronic obstructive pulmonary disease: A prospective cohort study

Pasquale Ambrosino; Matteo Nicola Dario Di Minno; Silvestro Ennio D'Anna; Roberto Formisano; Nicola Pappone; Costantino Mancusi; Antonio Molino; Andrea Motta; Mauro Maniscalco

doi:10.1016/j.ejim.2023.06.015

Pulmonary rehabilitation and endothelial function in patients with chronic obstructive pulmonary disease: A prospective cohort study

Eur J Intern Med. 2023 Oct:116:96-105. doi: 10.1016/j.ejim.2023.06.015. Epub 2023 Jun 20.

Authors

Pasquale Ambrosino¹, Matteo Nicola Dario Di Minno², Silvestro Ennio D'Anna³, Roberto Formisano⁴, Nicola Pappone⁵, Costantino Mancusi⁶, Antonio Molino², Andrea Motta⁷, Mauro Maniscalco⁸

Affiliations

¹ Istituti Clinici Scientifici Maugeri IRCCS, Directorate of Telese Terme Institute, Italy.
² Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
³ Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, Italy.
⁴ Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation Unit of Telese Terme Institute, Italy.
⁵ Istituti Clinici Scientifici Maugeri IRCCS, Neuromotor Rehabilitation Unit of Telese Terme Institute, Italy.
⁶ Department of Advanced Biomedical Science, Federico II University, Naples, Italy.
⁷ Institute of Biomolecular Chemistry, National Research Council, Pozzuoli, Italy.
⁸ Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Pulmonary Rehabilitation Unit of Telese Terme Institute, Italy. Electronic address: mauro.maniscalco@icsmaugeri.it.

PMID: 37349204
DOI: 10.1016/j.ejim.2023.06.015

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is associated with subclinical atherosclerosis and endothelial dysfunction, thereby leading to increased cardiovascular risk. In the present study, we evaluated the changes in endothelium-dependent flow-mediated dilation (FMD) in a cohort of severe COPD patients undergoing pulmonary rehabilitation.

Methods: Consecutive COPD patients referred to our Pulmonary Rehabilitation Unit were screened for inclusion. All study procedures were performed at hospital admission and discharge.

Results: Of 78 patients screened for eligibility, a total of 40 participants (67.5% males, median age 72.5 years) were included. After pulmonary rehabilitation, a significant improvement in functional parameters, exercise capacity, and measures of disability and quality of life were documented. FMD changed from 3.25% (IQR: 2.31-4.26) to 4.95% (IQR: 3.57-6.02), corresponding to a 52.3% increase of its median value (P < 0.001). Significantly lower changes in FMD were documented in COPD patients with hypercholesterolemia as compared to those without (+0.33% ± 1.61 vs. +1.62% ± 1.59, P = 0.037). Changes in FMD (ΔFMD) were positively associated with changes in forced expiratory volume in 1 s (FEV₁), when expressed both as absolute values (ΔFEV₁) (r = 0.503, P = 0.002) and as percentages of predicted values (ΔFEV₁%) (r = 0.608; P < 0.001). In multiple linear regressions, after adjusting for major cardiovascular risk factors, ΔFEV₁ (β=0.342; P = 0.049) and ΔFEV₁% (β=0.480; P = 0.015) were both confirmed as independent predictors of ΔFMD.

Conclusions: Results of our study suggest that endothelial function may improve in COPD after pulmonary rehabilitation. The potential beneficial effect in terms of cardiovascular risk prevention should be evaluated in ad hoc designed studies.

Keywords: Chronic obstructive pulmonary disease; Disability; Endothelial function; Exercise; Occupational medicine; Outcome; Pulmonary rehabilitation.