Effects of a high-intensity pulmonary rehabilitation program on the minute ventilation/carbon dioxide output slope during exercise in a cohort of patients with COPD undergoing lung resection for non-small cell lung cancer

Abstract

Objective: Preoperative functional evaluation is central to optimizing the identification of patients with non-small cell lung cancer (NSCLC) who are candidates for surgery. The minute ventilation/carbon dioxide output (VE/VCO2) slope has proven to be a predictor of surgical complications and mortality. Pulmonary rehabilitation programs (PRPs) could influence short-term outcomes in patients with COPD undergoing lung resection. Our objective was to evaluate the effects of a PRP on the VE/VCO2 slope in a cohort of patients with COPD undergoing lung resection for NSCLC. Methods: We retrospectively evaluated 25 consecutive patients with COPD participating in a three-week high-intensity PRP prior to undergoing lung surgery for NSCLC, between December of 2015 and January of 2017. Patients underwent complete functional assessment, including spirometry, DLCO measurement, and cardiopulmonary exercise testing. Results: There were no significant differences between the mean pre- and post-PRP values (% of predicted) for FEV1 (61.5 ± 22.0% vs. 62.0 ± 21.1%) and DLCO (67.2 ± 18.1% vs. 67.5 ± 13.2%). Conversely, there were significant improvements in the mean peak oxygen uptake (from 14.7 ± 2.5 to 18.2 ± 2.7 mL/kg per min; p < 0.001) and VE/VCO2 slope (from 32.0 ± 2.8 to 30.1 ± 4.0; p < 0.01). Conclusions: Our results indicate that a high-intensity PRP can improve ventilatory efficiency in patients with COPD undergoing lung resection for NSCLC. Further comprehensive prospective studies are required to corroborate these preliminary results.

COVID-19 and the elderly: insights into pathogenesis and clinical decision-making

“…Early in-hospital pulmonary rehabilitation should be considered as a minimum of clinical stability is achieved. Prolonged physical activities in home-based settings after patients discharge would be potentially beneficial [114][115][116][117][118]. Finally, despite optimized medical treatment, some patients with end-stage COVID-19 pneumonia progress to irreversible loss of lung function [119].…”

Implications of the Adiponectin System in Non-Small Cell Lung Cancer Patients: A Case-Control Study

“…Evidence from studies of thiazolidinediones, fenofibrate, renin-angiotensin inhibitors, and mineralocorticoid receptor blockers have documented positive correlations with adiponectin serum level expression. In addition, as adipokines homeostasis appears to be modulated by physical training and pulmonary rehabilitation, this should also be explored in NSCLC cohorts [15,26,[46][47][48][49]. The down-regulation of T-cadherin in lung cancer tissues has been reported to be associated with an up-regulation of T-cadherin in the vasculature that could partially determine a reduction in Acrp30 production by the local infiltrating adipose tissue; this decrease of local Acrp30 in turn determines AdipoR1 up-regulation.…”

“…Evidence from studies of thiazolidinediones, fenofibrate, renin-angiotensin inhibitors, and mineralocorticoid receptor blockers have documented positive correlations with adiponectin serum level expression. In addition, as adipokines homeostasis appears to be modulated by physical training and pulmonary rehabilitation, this should also be explored in NSCLC cohorts [ 15 , 26 , 46 , 47 , 48 , 49 ].…”

Elderly with COPD: comoborbitidies and systemic consequences

“…Smokers with mild and moderate air flow obstruction, DLCO < 80% predicted or CT detected emphysema, have a particular risk for development of lung cancer and could represent the right target for a screening program. Lung functional parameters are also crucial in the pre-surgical evaluation of patients undergoing lung resection for lung cancer 95,96 . The United States Preventive Services Task Force (USPSTF) recommends low-dose CT since 2014 97 .…”