The effect of pulmonary rehabilitation on oxidative stress after acute exacerbation in COPD

Abstract

Introduction: Oxidative stress plays an important role in the pathogenesis of COPD and in acute exacerbation of the disease (AECOPD). Pulmonary rehabilitation (PR) has maintenance effect on exercise physiologic parameters in COPD.

Aims: The aim of our study was to investigate the effect of early PR on lung function, exercise physiologic variables and oxidative stress after AECOPD.

Methods: 18 AECOPD patients (FEV₁: 45±17, TLCO: 41±16 %pred) were enrolled, 10 patients completed a 6 week standardized PR and 8 patients served as controls (C). Body plethysmography, diffusion capacity and cardio-pulmonary exercise test were carried out and MDA levels in sputum and plasma were measured in a longitudional manner (at the onset of AECOPD (V1), before PR (V2), after PR (V3), at 3 months after PR(V4)).

Results: Lung function parameters did not change significantly in PR and C group. The effect of PR was manifested in WR (V2:52±12 vs. V3:67±5* vs. V4:62±22), VO2/kg (V2:12,1±2,4 vs. V3: 14,1±1,1* vs. V4:13,7±4,5 mL/kg/min., *p<0,05), VO2/HR (V2:7,97±0,85 vs. V3: 8,83±0,70* vs. V4:8,10±2,99, *p<0,05). Sputum MDA was significantly lower after PR compared to C group and it was further reduced at 3 months after PR (PR V3:91±29 vs. V4:71±12*, C V3:154±56 vs. V4:229±31nmol/l, *p<0,05). Plasma MDA was lower after PR compared to C group and was stable at 3 months after PR (PR V3: 93±20 vs. V4: 102±39; C V3: 145±51 vs. V4: 127±23 nmol/l).

Conclusion: Early pulmonary rehabilitation after AECOPD results in favourable exercise physiologic effects that are sustained for at least 3 months after completion of the program. Effective PR may stabilize oxidative stress at a lower level following treatment of AECOPD.