Exhaled nitric oxide and exercise tolerance in severe COPD patients.
To answer the question as to whether pulmonary rehabilitation programs (PRP) induced increase in exercise tolerance (ET) is associated with increased levels of exhaled nitric oxide (eNO) in COPD patients of different degrees of severity, we designed a prospective and controlled study. Forty-seven stable COPD patients underwent an 8-week outpatient multidisciplinary PRP including supervised incremental exercise. Fractional eNO concentration (FE(NO)) and peak work-rate (W(peak) were assessed baseline (T-1), atthe end of 1-month run-in period (T0), and after (T1) the PRP. Lung function, walking test, health-related quality of life (HRQL) were also recorded. Patients were divided into three groups according to disease severity: 17 severe [FEV1 35 (5)% pred] COPD patients, seven of them with cor pulmonale; 15 mild [FEV1 78 (6)% pred], and 15 moderate [FEV1 56 (6)% pred] COPD patients. FE(NO) did not differ at T-1 and T0 (mean absolute change (SD): 0.03 (0.09) 95% CI-0.01, 0.16, 0.06 (1.03) 95% CI 0.03, 0.75 and 0.05 (0.06) 95% CI 0.02, 0.11 ppb in mild, moderate and severe patients, respectively). As compared to T0, both W(peak) (by 17,15 and 10%, respectively) and FE(NO) (by 29, 24 and 16%, respectively) significantly increased in all groups, but not in patients with cor pulmonale. A significant correlation between pre- and post-PRP changes in Wpeak and FE(NO) was found both in mild to moderate (r = 0.79, P < 0.00001) and severe (r = 0.76, P < 0.001) COPD patients. After a PRP, improvement in ET is associated with an increase in eNO also in most severe COPD patients, but not in those with cor pulmonale.
Fondazione CdC Villa Pineta-Gaiato, MO, Italy.
E
E
Clini
L
L
Bianchi
K
K
Foglio
M
M
Vitacca
N
N
Ambrosino
D000368:Aged; D000704:Analysis of Variance; D000886:Anthropometry; D015415:Biomarkers / Q000032:analysis; D001944:Breath Tests / Q000379:methods; D005080:Exercise Test; D005081:Exercise Therapy; D017079:Exercise Tolerance; D006801:Humans; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology* / Q000534:rehabilitation; D012720:Severity of Illness Index; D016896:Treatment Outcome
D015415:Biomarkers; D009569:Nitric Oxide