Effectiveness of Pulmonary Rehabilitation in Patients With Chronic Obstructive Pulmonary Disease With Different Degrees of Static Lung Hyperinflation

Objective

To evaluate the effect of pulmonary rehabilitation (PR) on exercise performance and quality of life in patients with chronic obstructive pulmonary disease (COPD) with different degrees of static lung hyperinflation (LH).

Associations between BODE Index and Systemic Inflammatory Biomarkers in COPD

Background: COPD is a multicomponent disease and systemic inflammation represents one of the possible mechanisms responsible for its systemic manifestations, including skeletal muscle weakness and cachexia. Fat-free mass index (FFMI) that reflects the skeletal muscle mass, has been shown to be associated with both dyspnoea and exercise capacity. We hypothesized that the multidimensional BODE index, that reflects the multicomponent nature of COPD, might be related to biomarkers of systemic inflammation. We further evaluated associations between FFMI and systemic inflammation. Methods: BODE index and FFMI were calculated in 222 stable COPD patients and 132 smokers or ex-smokers with normal lung function. Systemic inflammation was evaluated with the measurement of leptin, adiponectin, CRP, IL-6, and TNF-α in serum samples of COPD patients. Results: In patients with COPD, both BODE index and FFMI presented significant positive and negative associations respectively with leptin levels (R² 0.61 and 0.65, respectively), whereas FFMI presented an additional negative association with the levels of TNF-α (R² 0.38). No significant associations were observed in smokers or ex-smokers with normal lung function. Conclusions: Both BODE index and FFMI, are related to the circulating levels of leptin in patients with COPD, suggesting a possible role for leptin in the systemic component of COPD. The additional association of FFMI with TNF-α may further support a role of systemic inflammation in muscle wasting in COPD.     

北京市儿童青少年体成分的分析

目的了解北京市儿童、青少年体成分的状况,分析其年龄和性别变化特点。方法利用3项在北京城区或北京郊区的儿童、青少年中开展的横断面研究,选取8、9、10、13、14、15岁男女生共947人。测量身高、体重,计算体质指数;采用双能X线吸收法测量全身及手臂、腿部和躯干的体成分,计算身体脂肪含量指数(FMI)、去脂体重指数(FFMI)、体脂百分比(%BF)和躯干/四肢脂肪比。结果随年龄增长,女生的FMI从4.8 kg/m2增加到7.6 kg/m2,%BF、FFMI和骨矿物质含量均相应增加;男生FMI从13岁开始下降,%BF则从8岁的23.9%下降到15岁的14.7%,但FFMI和骨矿物质含量均相应增加。各年龄段女生的FMI和%BF均高于同龄男生,且脂肪均主要分布于四肢;女生FFMI均低于同龄男生,8~15岁男生的增长总量接近女生的2倍,且瘦体重主要分布于躯干;男女生间骨矿物质含量差异无统计学意义。结论儿童青少年在生长过程中,各种体成分的含量、比例和分布不断变化,且存在性别差异。     

Six-minute walking-induced systemic inflammation and oxidative stress in muscle-wasted COPD patients

BACKGROUND: Systemic inflammation and oxidative stress are potential mechanisms for muscle wasting in COPD patients. Six-minute walking testing (6MWT) has been suggested as simple and valid exercise test in COPD that is well tolerated, and reflective of activities of daily living. The present study investigated physiologic and systemic immunologic responses to a 6MWT in muscle-wasted patients with COPD and compared them with maximal cardiopulmonary exercise testing (CPET). METHODS: Ten patients with muscle-wasted COPD were included (fat-free mass index [FFMI]: men, < 16 kg/m2; women, < 15 kg/m2). 6MWT and CPET were performed in random order. The physiologic response was followed by a mobile oxycon. Arterial blood was obtained at rest and after exercise to measure blood gases and markers of systemic inflammation and oxidative stress. RESULTS: In these patients (FEV1 55 +/- 4% of predicted [mean +/- SE]), the 6MWT was a submaximal, albeit intense, exercise as reflected by oxygen uptake (VO2), minute ventilation, heart rate, and lactate values. Leukocytosis was less intense after 6MWT compared to CPET. Contrary, the increase in interleukin-6, free radical release by neutrophils, oxidation of proteins and lipids, and the reduction in antioxidant capacity were similar after both exercises. FFMI was inversely related to 6MWT-induced increases in protein and lipid peroxidation. CONCLUSIONS: This study shows that a 6MWT induces a systemic immunologic response in muscle-wasted patients with COPD, which is comparable to CPET-induced responses. The correlation between systemic oxidative stress and the degree of muscle wasting supports a possible causal relation between systemic inflammation, oxidative stress, and muscle wasting.