ACE and response to pulmonary rehabilitation in COPD: two observational studies.
BACKGROUND
Skeletal muscle impairment is an important feature of chronic obstructive pulmonary disease (COPD). Renin-angiotensin system activity influences muscle phenotype, so we wished to investigate whether it affects the response to pulmonary rehabilitation.


METHODS
Two studies are described; in the first, the response of 168 COPD patients (mean forced expiratory volume in one second 51.9% predicted) to pulmonary rehabilitation was compared between different ACE insertion/deletion polymorphism genotypes. In a second, independent COPD cohort (n=373), baseline characteristics and response to pulmonary rehabilitation were compared between COPD patients who were or were not taking ACE inhibitors or angiotensin receptor antagonists (ARB).


RESULTS
In study 1, the incremental shuttle walk distance improved to a similar extent in all three genotypes; DD/ID/II (n=48/91/29) 69(67)m, 61 (76)m and 78 (78)m, respectively, (p>0.05). In study 2, fat free mass index was higher in those on ACE-I/ARB (n=130) than those who were not (n=243), 17.8 (16.0, 19.8) kg m-2vs 16.5 (14.9, 18.4) kg/m2(p<0.001). However change in fat free mass, walking distance or quality of life in response to pulmonary rehabilitation did not differ between groups.


CONCLUSIONS
While these data support a positive association of ACE-I/ARB treatment and body composition in COPD, neither treatment to reduce ACE activity nor ACE (I/D) genotype influence response to pulmonary rehabilitation.
NIHR Respiratory Biomedical Research Unit , Royal Brompton and Harefield NHS Foundation Trust and Imperial College , London , UK.
Samantha S C
SS
Kon
Department of Respiratory Medicine , King's College Hospital , London , UK.
Caroline J
CJ
Jolley
NIHR Respiratory Biomedical Research Unit , Royal Brompton and Harefield NHS Foundation Trust and Imperial College , London , UK.
Dinesh
D
Shrikrishna
Institute for Human Health and Performance University College , London , UK.
Hugh E
HE
Montgomery
Institute for Human Health and Performance University College , London , UK.
James R A
JR
Skipworth
Department of Respiratory Medicine , King's College Hospital , London , UK.
Zudin
Z
Puthucheary
NIHR Respiratory Biomedical Research Unit , Royal Brompton and Harefield NHS Foundation Trust and Imperial College , London , UK.
John
J
Moxham
NIHR Respiratory Biomedical Research Unit , Royal Brompton and Harefield NHS Foundation Trust and Imperial College , London , UK.
Michael I
MI
Polkey
NIHR Respiratory Biomedical Research Unit , Royal Brompton and Harefield NHS Foundation Trust and Imperial College , London , UK.
William D-C
WD
Man
NIHR Respiratory Biomedical Research Unit , Royal Brompton and Harefield NHS Foundation Trust and Imperial College , London , UK.
Nicholas S
0000-0003-3235-0454
NS
Hopkinson
COPD Pathology; Pulmonary Rehabilitation