Systemic Inflammatory Markers and Disease Severity in Chronic Obstructive Pulmonary Disease—The Effect of Acute Exercise and Pulmonary Rehabilitation

Amani I. El Gammal^1*, Rob O’Farrell¹, Liam O’Mahony³, Fergus Shanahan², Kieran Killian⁴, Terence M. O’Connor¹

¹Department of Respiratory Medicine, Mercy University Hospital, Cork, Ireland.
²Alimentary Pharmabiotic Centre, University College Cork, Cork, Ireland.
³Swiss Institute of Allergy and Asthma Research, University of Zurich, Davos, Switzerland.
⁴Department of Respiratory Medicine, McMaster University, Hamilton, Ontario, Canada.

DOI: 10.4236/ojrd.2015.51003                

Abstract

Background: Decreased physical capacity and increased systemic inflammatory response are frequently observed in patients with chronic obstructive pulmonary disease (COPD). The relationship between the inflammatory response and disease severity and the immunological response to exercise were addressed in COPD. Objective: The first objective was to identify systemic biomarkers and their relationship with COPD severity. The second objective was to examine the effect of both acute exercise and pulmonary rehabilitation on these biomarkers. Methods: Forty subjects participated in the study. Thirty-two patients with moderate or severe COPD and 8 healthy non-smokers completed the study. Spirometry was preformed. Physical capacity was determined by a progressive symptom-limited cycle ergo meter (incremental) test. Blood samples were analyzed for C-reactive protein (CRP), pro-inflammatory cytokines (IL-6, TNF-α), pro-fibrotic cytokines (TGF-β) and oxidative burst in circulating leukocytes before and after exercise, and before and after pulmonary rehabilitation. Results: IL-6, CRP, WCC and TGF-β were higher in COPD (p < 0.05) than eight healthy controls. WCC, IL-6, TNF-α, CRP and TGF-β were negatively related to forced expiratory volume in 1 s (FEV₁) (r = 0.4054, 0.3221, 0.1528, 0.1846 and 0.1187, respectively). Acute exercise increased circulating leucocytes and oxidative stress in both groups (p = 0.000, 0.0049 respectively), while IL-6 was increased in COPD group ((p = 0.0115) and circulating TNF-α in healthy control (p = 0.0369). Pulmonary rehabilitation didn’t modify the levels of inflammatory mediators. Conclusions: Reduced lung function is associated with increased levels of systemic inflammatory markers and acute exercise can further increase this inflammatory response. However pulmonary rehabilitation is unlikely to exacerbate systemic inflammation in COPD.

Keywords

Systemic Inflammation, COPD, Oxidative Stress, Pulmonary Rehabilitation

Conflicts of Interest

The authors declare no conflicts of interest.

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