Effect of exercise on pulmonary inflammation and systemic immune response in patients with moderate or severe persistent asthma

Author(s)

Felipe Augusto Rodrigues Mendes

• Document type: Doctoral Thesis
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Faculdade de Medicina (FM/SBD)
• Defense date: 2013-10-17

Examining board members

Celso Ricardo Fernandes de Carvalho; Simone Dal Corso

• Advisor: Celso Ricardo Fernandes de Carvalho

Abstract

Asthma is a chronic inflammatory disorder of the airway with high prevalence that leads functional impairment to health related quality of life (HRQoL). The pathophysiology of asthma is characterized by intense immunoregulation and exercise can play an important role in this inflammatory response due to its immunoregulatory effects. Objective: To evaluate the effect of an aerobic training program on systemic and pulmonary inflammation, clinical control and HRQoL of adult patients with moderate or severe persistent asthma. Methods: Fifty-eight asthmatic adult patients were randomly assigned to either control (CG, n = 28) or training groups (TG, n = 30) and 16 subjects non-asthmatic (NAG). The CG performed an educational program and breathing exercises, while the TG performed all procedures in the CG and an aerobic training program. The immune response was assessed by plasma levels of Th1 cytokines (tumor necrosis factor, interleukin-6 (IL-6), IL-8, Th2 (IL-4, IL-5), regulatory (IL-10) and chemokines (MCP-1, IP-10, MIG, RANTES), either chronically and after a single bout of exercise. Before and after the intervention all patients performed a pulmonary function test, cardiopulmonary exercise testing, clinical control test, HRQoL questionnaire, fractional exhaled nitric oxide (FeNO), induced sputum and blood sample. The NAG performed only the cardiopulmonary exercise test and plasma levels of cytokines. Results: Patients that performed a aerobic training program decreased plasma of interleukin (IL) 6, IL-8 and monocyte chemotactic protein-1 (MCP-1) (p < 0.005). A single bout session of exercise raises the levels of IL-6, IL-8 and IL-5, and then return to baseline one hour after exercise (p < 0.05). IL-10 has also increased immediately after exercise and its levels remained higher even for one hour (p < 0.05). The pulmonary inflammation reduced only GT patients with high levels of eosinophils and FeNO (p < 0.05). The FSRQV, clinical control and physical capacity also improved only in GT (p < 0.05). Conclusion: Our results show that the improvement of the physical capacity of patients with asthma may have an anti-inflammatory effect and may be relevant for the clinical management of these patients (AU)