The effects of pulmonary rehabilitation on inflammatory biomarkers in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis

INTRODUCTIONChronic obstructive pulmonary disease (COPD) is associated with elevated levels of proinflammatory biomarkers which may contribute to pathophysiological changes in both the respiratory and extrapulmonary systems. Pulmonary rehabilitation (PR) is an effective intervention for symptom management in people with COPD. The impact of PR on systemic inflammation is currently unknown.MATERIALS AND METHODSUsing the search terms "chronic obstructive pulmonary disease," "pulmonary rehabilitation" and "inflammatory biomarkers," 5 databases were searched from inception. Studies were eligible if they included: (1) participants with COPD undergoing PR with an exercise component of at least 4 weeks in length and (2) a systemic inflammation measurement pre- and post-PR. Our primary outcomes of interest were interleukin-6 (IL-6), fibrinogen and c-reactive protein (CRP) concentrations. A meta-analysis was performed using weighted mean difference and 95% confidence intervals.RESULTSA total of 1339 participants were enrolled across all 18 eligible studies. A meta-analysis of the 5 randomized controlled trials (RCTs) found that CRP (MD -1.19, 95% CI -1.78 to -0.60, I2 = 86%) showed a greater response to PR than usual care. No difference between groups was noted for IL-6 (MD -3.38, 95% CI -13.03 to 6.28, I2 = 98%). Fibrinogen was not reported among included RCTs.CONCLUSIONA PR program with at least 4 weeks of exercise appears to reduce CRP levels but not IL-6 or fibrinogen in people with COPD. These results are based on small sample sizes and low-quality evidence and the impact of PR on systemic inflammation is uncertain. INTRODUCTIONLa maladie pulmonaire obstructive chronique (MPOC) est associ & eacute;e & agrave; des niveaux & eacute;lev & eacute;s de biomarqueurs pro-inflammatoires qui peuvent contribuer & agrave; des changements physiopathologiques dans les syst & egrave;mes respiratoire et extrapulmonaires. La r & eacute;adaptation pulmonaire est une intervention efficace pour la prise en charge des sympt & ocirc;mes chez les personnes atteintes de MPOC. L'effet de la r & eacute;adaptation pulmonaire sur l'inflammation syst & eacute;mique est actuellement inconnuMAT & Eacute;RIEL ET M & Eacute;THODESEn utilisant les termes de recherche << maladie pulmonaire obstructive chronique >>, << r & eacute;adaptation pulmonaire >> et << biomarqueurs inflammatoires >>, cinq bases de donn & eacute;es ont & eacute;t & eacute; consult & eacute;es d & egrave;s le d & eacute;but de l'& eacute;tude. Les & eacute;tudes & eacute;taient admissibles si elles comprenaient : (1) des participants atteints de MPOC ayant suivi une r & eacute;adaptation pulmonaire incluant un programme d'exercice d'au moins quatre semaines et (2) une mesure de l'inflammation syst & eacute;mique avant et apr & egrave;s la r & eacute;adaptation pulmonaire. Nos principaux r & eacute;sultats d'int & eacute;r & ecirc;t & eacute;taient les concentrations d'interleukine-6 (IL-6), de fibrinog & egrave;ne et de prot & eacute;ine c-r & eacute;active. Une m & eacute;ta-analyse a & eacute;t & eacute; r & eacute;alis & eacute;e & agrave; l'aide d'une diff & eacute;rence de moyenne pond & eacute;r & eacute;e et d'intervalles de confiance & agrave; 95 %.R & Eacute;SULTATSAu total, 1 339 participants issus des 18 & eacute;tudes admissibles ont & eacute;t & eacute; inclus dans l'& eacute;tude. Une m & eacute;ta-analyse des cinq essais contr & ocirc;l & eacute;s randomis & eacute;s a r & eacute;v & eacute;l & eacute; que la prot & eacute;ine c-r & eacute;active (DM -1,19, IC & agrave; 95 % -1,78 & agrave; -0,60, I2 = 86 %) a montr & eacute; une plus grande r & eacute;ponse & agrave; la r & eacute;adaptation pulmonaire que les soins habituels. Aucune diff & eacute;rence entre les groupes n'a & eacute;t & eacute; observ & eacute;e pour l'IL-6 (DM -3,38, IC & agrave; 95 % -13,03 & agrave; 6,28,I2 = 98 %). Le fibrinog & egrave;ne n'a pas & eacute;t & eacute; signal & eacute; parmi les essais contr & ocirc;l & eacute;s randomis & eacute;s inclus.CONCLUSIONUn programme de r & eacute;adaptation pulmonaire comprenant au moins quatre semaines d'exercice semble r & eacute;duire les niveaux de prot & eacute;ine c-r & eacute;active, mais pas l'IL-6 ou le fibrinog & egrave;ne chez les personnes atteintes de MPOC. Ces r & eacute;sultats sont bas & eacute;s sur des & eacute;chantillons de petite taille et des preuves de faible qualit & eacute;, ce qui rend l'effet de la r & eacute;adaptation pulmonaire sur l'inflammation syst & eacute;mique incertain.