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Effects of Pulmonary Rehabilitation on Systemic Inflammation and Exercise Capacity in Bronchiectasis: A Randomized Controlled Trial

  • PULMONARY REHABILITATION AND BRONCHIECTASIS
  • Published:
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Abstract

Introduction

Bronchiectasis is a chronic condition that is becoming a global health concern.

Objective

To examine the effects of pulmonary rehabilitation (PR) on systemic inflammation, exercise capacity, and quality of life in participants with bronchiectasis.

Methods

Participants were randomized to receive PR (outpatient, three weekly sessions for 3 months) or control intervention (usual care + airway clearance therapy + breathing exercises). Data on laboratory (fibrinogen level) and patient-centered outcomes such as physical fitness [6-min walk test (6MWT)] and quality of life were collected.

Results

A total of 41 participants were evaluated (20 in the intervention group and 21 in the control group). The magnitude of change between baseline and the end of study was greater in the PR group than in the control group—the 6MWT distance increased by a mean of 54 m (54 vs 12 m; p < 0.01), fibrinogen showed a significant reduction (fibrinogen − 92.8 versus − 47.1 mg/dl; p < 0.01), and quality of life improved according to Saint George’s Respiratory Questionnaire (SGRQ) (− 7.5 vs 3.2; p < 0.01), which exceeded the minimal clinically important difference of 4 points.

Conclusion

PR effectively improved physical fitness, quality of life, and the degree of systemic inflammation, as reflected by changes in 6 MWT, fibrinogen levels and SGRQ scores. This study supports the inclusion of people with bronchiectasis in supervised PR programs.

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References

  1. Chalmers JD, Elborn JS (2015) Reclaiming the name ‘bronchiectasis’. Thorax 70:399–400. https://doi.org/10.1136/thoraxjnl-2015-206956

    Article  PubMed  Google Scholar 

  2. Polverino E, Goeminne PC, McDonnell MJ et al (2017) European Respiratory Society guidelines for the management of adult bronchiectasis. Eur Respir J 50:1–23. https://doi.org/10.1183/13993003.02990-2020

    Article  CAS  Google Scholar 

  3. Pereira MC, Athanazio RA, Dalcin PTR et al (2019) Brazilian consensus on non-cystic fibrosis bronchiectasis. Braz J Pulmonol 45:1–24. https://doi.org/10.1590/1806-3713/e20190122

    Article  Google Scholar 

  4. Lee AL, Gordon CS, Osadnik CR (2021) Exercise training for bronchiectasis. Cochrane Database Syst Rev 6(4):CD013110. https://doi.org/10.1002/14651858.CD013110.pub2

    Article  Google Scholar 

  5. Henkle E, Chan B, Curtis JR et al (2018) Bronchiectasis patient characteristics and healthcare utilization history in US medicare enrollees with prescription drug plans 2006–2014. Chest 154:1311–1320. https://doi.org/10.1016/j.chest.2018.07.014

    Article  PubMed  Google Scholar 

  6. Joish V, Spilsbury-Cantalupo M, Operschall E et al (2013) Economic burden of non-cystic fibrosis bronchiectasis in the first year after diagnosis from a US health plan perspective. Appl Health Econ Health Policy 11:299–304. https://doi.org/10.1016/j.chest.2018.07.014

    Article  PubMed  Google Scholar 

  7. Seitz AE, Olivier KN, Adjemian J et al (2012) Trends in bronchiectasis among medicare beneficiaries in the United States, 2000 to 2007. Chest 142:432–439. https://doi.org/10.1378/chest.11-2209

    Article  PubMed  PubMed Central  Google Scholar 

  8. Cakmak A, Inal-Ince D, Sonbahar-Ulu H et al (2020) Physical activity of patients with bronchiectasis compared with healthy counterparts: a cross-sectional study. Heart Lung 49:99–104. https://doi.org/10.1016/j.hrtlng.2019.09.004

    Article  PubMed  Google Scholar 

  9. Rached S, Castro RAS, Camargo AA et al (2018) Exercise capacity can predict exacerbations and hospitalizations in a 1-year follow up in non-cystic fibrosis bronchiectasis adults. Eur Respir J 52:PA86. https://doi.org/10.1183/13993003

    Article  Google Scholar 

  10. Hsieh MH, Fang YF, Chung FT et al (2017) Distance-saturation product of the 6-minute walk test predicts mortality of patients with non-cystic fibrosis bronchiectasis. J Thorac Dis 9:3168–3176. https://doi.org/10.21037/jtd.2017.08.53

    Article  PubMed  PubMed Central  Google Scholar 

  11. Wang X, Balaña-Corberó A, Martínez-Llorens J et al (2022) Respiratory and peripheral muscle weakness and body composition abnormalities in non-cystic fibrosis bronchiectasis patients: gender differences. Biomedicines 10:334. https://doi.org/10.3390/biomedicines10020334

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Spruit MA, Singh SJ, Garvey C et al (2013) ATS/ERS task force on pulmonary rehabilitation. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 188:e13–e64. https://doi.org/10.1164/rccm.201309-1634ST

    Article  PubMed  Google Scholar 

  13. McCarthy B, Casey D, Devane D et al (2015) Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2:CD03793. https://doi.org/10.1002/14651858.CD003793.pub3

    Article  Google Scholar 

  14. Patel S, Cole AD, Nolan CM et al (2019) Pulmonary rehabilitation in bronchiectasis: a propensity-matched study. Eur Respir J 53:1801264. https://doi.org/10.1183/13993003.01264-2018

    Article  PubMed  Google Scholar 

  15. Annoni S, Bellofiore A, Repossini E et al (2020) Effectiveness of chest physiotherapy and pulmonary rehabilitation in patients with non-cystic fibrosis bronchiectasis: a narrative review. Monaldi Arch Chest Dis 90:43–57. https://doi.org/10.4081/monaldi.2020.1107

    Article  Google Scholar 

  16. Olveira C, García-Escobar E, Doña E et al (2020) Oxidative and inflammatory effects of pulmonary rehabilitation in patients with bronchiectasis. A prospective, randomized study. Nutr Hosp 37:6–13. https://doi.org/10.20960/nh.02763

    Article  CAS  PubMed  Google Scholar 

  17. Mandal P, Sidhu MK, Kope L et al (2012) A pilot study of pulmonary rehabilitation and chest physiotherapy versus chest physiotherapy alone in bronchiectasis. Respir Med 106:1647–1654. https://doi.org/10.1016/j.rmed.2012.08.004

    Article  CAS  PubMed  Google Scholar 

  18. Jenkins AR, Holden NS, Gibbons LP et al (2020) Clinical outcomes and inflammatory responses of the frequent exacerbator in pulmonary rehabilitation: a prospective cohort study. COPD 17:253–260. https://doi.org/10.1080/15412555.2020.1753669

    Article  PubMed  Google Scholar 

  19. Graham BL, Steenbruggen I, Miller MR et al (2019) Standardization of spirometry 2019 update. An official American Thoracic Society and European Respiratory Society technical statement. Am J Respir Crit Care Med 200:e70–e88. https://doi.org/10.1164/rccm.201908-1590ST

    Article  PubMed  PubMed Central  Google Scholar 

  20. American Thoracic Society/European Respiratory Society (2002) ATS/ERS statement on respiratory muscle testing. Am J Respir Critic Care Med 166:518–624. https://doi.org/10.1164/rccm.166.4.518

    Article  Google Scholar 

  21. Holland AE, Spruit MA, Troosters T et al (2014) An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J 44:1428–1446. https://doi.org/10.1183/09031936.00150314

    Article  PubMed  Google Scholar 

  22. Lee AL, Hill CJ, Cecins N et al (2014) Minimal important difference in field walking tests in non-cystic fibrosis bronchiectasis following exercise training. Respir Med 108:1303–1309. https://doi.org/10.1016/j.rmed.2014.07.006

    Article  CAS  PubMed  Google Scholar 

  23. De La Rosa CD, Athanazio R, Girón MRM et al (2018) The annual prognostic ability of FACED and E-FACED scores to predict mortality in patients with bronchiectasis. Eur Respir J Open Res 4:00139–02017. https://doi.org/10.1183/23120541.00139-2017

    Article  Google Scholar 

  24. Athanazio R, Pereira MC, Gramblicka G et al (2017) Latin America validation of FACED score in patients with bronchiectasis: an analysis of six cohorts. BMC Pulm Med 17:73–75. https://doi.org/10.1186/s12890-017-0417-3

    Article  PubMed  PubMed Central  Google Scholar 

  25. Ozalp O, Inal-Ince D, Calik E et al (2012) Extrapulmonary features of bronchiectasis: muscle function, exercise capacity, fatigue, and health status. Multidiscip Respir Med 7:3. https://doi.org/10.1186/2049-6958-7-3

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kovelis D, Segretti NO, Probst VS et al (2008) Validation of the modified pulmonary functional status and dyspnea questionnaire and the medical research council scale for use in Brazilian patients with chronic obstructive pulmonary disease. Braz J Pulmonol 34:1008–1018. https://doi.org/10.1590/s1806-37132008001200005

    Article  Google Scholar 

  27. Wilson CB, Paul WJ, O’Leary CJ et al (1997) Validation of the St. George’s respiratory questionnaire in bronchiectasis. Am J Respir Crit Care Med 156:536–541. https://doi.org/10.1164/ajrccm.156.2.9607083

    Article  CAS  PubMed  Google Scholar 

  28. Sami R, Zohal M, Khanali F et al (2021) Quality of life and its determinants in patients with noncystic fibrosis bronchiectasis. J Res Med Sci 26:27. https://doi.org/10.4103/jrms.JRMS_665_20

    Article  PubMed  PubMed Central  Google Scholar 

  29. Krupp LB, LaRocca G, Muir-Nash J et al (1989) The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 46:1121–1123. https://doi.org/10.1001/archneur.1989.00520460115022

    Article  CAS  PubMed  Google Scholar 

  30. Ong HK, Lee AL, Hill CJ et al (2011) Effects of pulmonary rehabilitation in bronchiectasis: a retrospective study. Chron Respir Dis 8:21–30. https://doi.org/10.1177/1479972310391282

    Article  CAS  PubMed  Google Scholar 

  31. Zanini A, Aiello M, Adamo D et al (2015) Effects of pulmonary rehabilitation in patients with non-cystic fibrosis bronchiectasis: a retrospective analysis of clinical and functional predictors of efficacy. Respiration 89:525–533. https://doi.org/10.1159/000380771

    Article  CAS  PubMed  Google Scholar 

  32. Martín-Valero R, Jimenez-Cebrian AM, Moral-Munoz JA et al (2020) The efficacy of therapeutic respiratory muscle training interventions in people with bronchiectasis: a systematic review and meta-analysis. J Clin Med 9:231. https://doi.org/10.3390/jcm9010231

    Article  PubMed Central  Google Scholar 

  33. Newall C, Stockley RA, Hill SL (2005) Exercise training and inspiratory muscle training in patients with bronchiectasis. Thorax 60:943–948. https://doi.org/10.1136/thx.2004.028928

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Martínez-García MA, Olveira C, Máiz L et al (2019) Bronchiectasis: a complex, heterogeneous disease. Arch Bronconeumol 55:427–433. https://doi.org/10.1016/j.arbres.2019.02.024

    Article  PubMed  Google Scholar 

  35. Ora J, Prendi E, Ritondo BL et al (2022) Pulmonary rehabilitation in noncystic fibrosis bronchiectasis. Respiration 101:97–105. https://doi.org/10.1159/000517527

    Article  CAS  PubMed  Google Scholar 

  36. Hester KLM, Macfarlane JG, Tedd H et al (2011) Fatigue in bronchiectasis. QJM 105:235–240. https://doi.org/10.1093/qjmed/hcr184

    Article  PubMed  Google Scholar 

  37. O’Leary CJ, Wilson CB, Hansell DM et al (2002) Relationship between psychological well-being and lung health status in patients with bronchiectasis. Respir Med 96:686–692. https://doi.org/10.1053/rmed.2002.1330

    Article  PubMed  Google Scholar 

  38. Lee AL, Hill CJ, Cecins N et al (2014) The short and long term effects of exercise training in non-cystic fibrosis bronchiectasis—a randomised controlled trial. Respir Res 15:44. https://doi.org/10.1186/1465-9921-15-44

    Article  PubMed  PubMed Central  Google Scholar 

  39. Duvoix A, Dickens J, Haq I et al (2013) Blood fibrinogen as a biomarker of chronic obstructive pulmonary disease. Thorax 68:670–676. https://doi.org/10.1136/thoraxjnl-2012-201871

    Article  PubMed  Google Scholar 

  40. Saleh AD, Chalmers JD, De Soyza A et al (2017) The heterogeneity of systemic inflammation in bronchiectasis. Respir Med 127:33–39. https://doi.org/10.1016/j.rmed.2017.04.009

    Article  PubMed  Google Scholar 

  41. Bohannon RW, Crouch R (2017) Minimal clinically important difference for change in 6-minute walk test distance of adults with pathology: a systematic review. J Eval Clin Pract 23:377–381. https://doi.org/10.1111/jep.12629

    Article  PubMed  Google Scholar 

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Funding

This study received financial support from the Brazilian Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES, Office for the Advancement of Higher Education; Funding Code 001). This study received financial support from the National Council for Scientific and Technological Development (CNPq) (Funding code 307328/2018-0).

Author information

Authors and Affiliations

  1. Department of Surgery, Federal University of Ceara, Fortaleza, Ceará, Brazil

    Amanda Souza Araújo & Mara Rúbia Figueiredo

  2. Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, CE, Brasil

    Amanda Souza Araújo & Mara Rúbia Figueiredo

  3. Department of Medicine, Federal University of Ceara, Fortaleza, Ceará, 60140000, Brazil

    Isabella Lomonaco & Eanes Delgado Barros Pereira

  4. Hospital Otávio de Freitas, Recife, PE, Brasil

    Fernando Lundgren

  5. Department of Physiotherapy, Federal University of Ceara, Fortaleza, Ceará, Brazil

    Rafael Mesquita

Authors
  1. Amanda Souza Araújo
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  2. Mara Rúbia Figueiredo
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  3. Isabella Lomonaco
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  4. Fernando Lundgren
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  5. Rafael Mesquita
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  6. Eanes Delgado Barros Pereira
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Contributions

EP: Writing—original draft, Writing—review & editing, formal analysis. IL: Conceptualization, Methodology, supervision, ASA: original draft, formal analysis. MRFdF: Methodology, supervision, RM: Writing—review & editing. FL: Methodology, Writing—review & editing. All authors agree to take responsibility and be accountable for the contents of this article and to share responsibility to resolve any questions raised about the accuracy or integrity of the published work.

Corresponding author

Correspondence to Eanes Delgado Barros Pereira.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical Approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Universidade Federal do Ceará (No. 1.844.662).

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Informed consent was obtained from all individual participants included in the study.

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Araújo, A.S., Figueiredo, M.R., Lomonaco, I. et al. Effects of Pulmonary Rehabilitation on Systemic Inflammation and Exercise Capacity in Bronchiectasis: A Randomized Controlled Trial. Lung 200, 409–417 (2022). https://doi.org/10.1007/s00408-022-00540-3

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  • DOI: https://doi.org/10.1007/s00408-022-00540-3

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