Systemic Inflammation and Oxidative Stress in Adults with Bronchiectasis: Association with Clinical and Functional Features

Abstract

OBJECTIVES: To compare the inflammatory and oxidative stress (OS) states of adults with bronchiectasis with those of healthy controls and correlate inflammatory and OS levels with lung function and physical capacity. METHODS: This study used a cross-sectional design. Seventy-four adults with bronchiectasis (age: 49±15 years, forced expiratory volume in 1 second [FEV1]: 52.5±25.6%) and 42 healthy controls (age: 44±17 years, FEV1: 95.9±14.0%) performed cardiopulmonary exercise tests and incremental shuttle walking tests. Their physical activity in daily life, inflammatory cytokine, and antioxidant levels in plasma were measured. RESULTS: Compared to that of the controls, the levels of interleukin (IL)-6 ( p <0.001), IL-10 ( p <0.001), carbonylated proteins ( p =0.001), and superoxide anions ( p =0.046) were significantly increased in adults with bronchiectasis. Catalase activity was also reduced in this group ( p <0.001). The inflammatory markers IL-1β, IL-6, and tumor necrosis factor-α correlated negatively with aerobic capacity (r=-0.408, r=-0.308, and r=-0.207, respectively). We observed similar correlations with OS markers (thiobarbituric acid and carbonyls; r=-0.290 and r=0.379, respectively), and these markers also significantly correlated with the aerobic capacity. CONCLUSIONS: Adults with bronchiectasis presented an increased systemic inflammatory response that correlated negatively with physical capacity.

Do Redox Balance and Inflammatory Events Take Place in Mild Bronchiectasis? A Hint to Clinical Implications

“…In the present study, a rise in plasma MDA-protein adducts was also detected for the first time among patients with stable bronchiectasis. Similarly, an increase in reactive carbonyls and superoxide anion levels was also reported in a cohort of bronchiectasis patients with moderate-to-severe airway obstruction [10]. In this study, however, disease severity was not assessed in the study patients.…”

“…Moreover, the investigation focused mainly on the assessment of patients with mild and very mild disease, in whom a significant rise in plasma inflammatory and oxidative stress balance was already observed. Other series, however, have reported significant changes in patients with more advanced and larger extension bronchiectasis [ 10 , 45 ]. Furthermore, future investigations with a larger cohort of patients will have to address further questions such as whether the profile of bronchial infection including those with no bacterial predominance (normal flora) may determine variations in the systemic patterns of inflammation and redox balance in patients with mild bronchiectasis.…”

“…Oxidative stress modifies key cellular structures as a result of the action of oxidants on proteins, DNA, and lipids [ 8 ]. Inflammatory molecules through the action of cytokines may amplify the response to several insults in the lungs and airways of patients [ 9 , 10 ]. Most studies have focused on the examination of either antioxidant or prooxidant markers [ 10 ].…”

“…Inflammatory molecules through the action of cytokines may amplify the response to several insults in the lungs and airways of patients [ 9 , 10 ]. Most studies have focused on the examination of either antioxidant or prooxidant markers [ 10 ]. Increased oxidative stress levels are important players in the pathophysiology of skeletal muscle dysfunction and mass loss and nutritional abnormalities in patients with chronic obstructive pulmonary disease (COPD), especially those with more severe disease [ 11 , 12 , 13 , 14 ].…”

“…In patients with mild-to-moderate COPD, the effects of systemic inflammation and/or redox imbalance are barely seen [ 13 , 16 , 17 ]. Likewise, in patients with bronchiectasis, greater systemic levels of inflammation are directly related to impaired lung function, quality of life, exercise tolerance, and higher scores of disease severity [ 10 , 18 , 19 , 20 , 21 ]. Whether patients with very mild bronchiectasis, localized extension, and preserved lung function as measured by several disease scores may also exhibit high levels of systemic inflammation and redox imbalance remains to be elucidated.…”