Different Training-Induced Skeletal Muscle Adaptations in COPD Patients with and without Alpha-1 Antitrypsin Deficiency

Jarosch, Inga; Gehlert, Sebastian; Jacko, Daniel; Koczulla, Rembert; Wencker, Marion; Welte, Tobias; Bloch, Wilhelm; Janciauskiene, Sabina; Kenn, Klaus

doi:10.1159/000449509

Cited by 21 publications

(22 citation statements)

References 32 publications

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“…Recently, an unfavorable muscle response to exercise has been shown in a small number of AATD patients, compared with usual COPD,90 suggesting that evidence about PR might not be wholly generalizable to AATD either. This is backed up by a study of a 5-week PR program pretransplantation, where AATD patients were observed to have a smaller improvement in 6-min walking test distance compared with usual COPD (47.9 vs 60.6 m) 91.…”

Section: Discussionmentioning

confidence: 99%

Treatment of lung disease in alpha-1 antitrypsin deficiency: a systematic review

Edgar¹,

Patel²,

Bayliss³

et al. 2017

COPD

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BackgroundAlpha-1 antitrypsin deficiency (AATD) is a rare genetic condition predisposing individuals to chronic obstructive pulmonary disease (COPD). The treatment is generally extrapolated from COPD unrelated to AATD; however, most COPD trials exclude AATD patients; thus, this study sought to systematically review AATD-specific literature to assist evidence-based patient management.MethodsStandard review methodology was used with meta-analysis and narrative synthesis (PROSPERO-CRD42015019354). Eligible studies were those of any treatment used in severe AATD. Randomized controlled trials (RCTs) were the primary focus; however, case series and uncontrolled studies were eligible. All studies had ≥10 participants receiving treatment or usual care, with baseline and follow-up data (>3 months). Risk of bias was assessed appropriately according to study methodology.ResultsIn all, 7,296 studies were retrieved from searches; 52 trials with 5,632 participants met the inclusion criteria, of which 26 studies involved alpha-1 antitrypsin augmentation and 17 concerned surgical treatments (largely transplantation). Studies were grouped into four management themes: COPD medical, COPD surgical, AATD specific, and other treatments. Computed tomography (CT) density, forced expiratory volume in 1 s, diffusing capacity of the lungs for carbon monoxide, health status, and exacerbation rates were frequently used as outcomes. Meta-analyses were only possible for RCTs of intravenous augmentation, which slowed progression of emphysema measured by CT density change, 0.79 g/L/year versus placebo (P=0.002), and associated with a small increase in exacerbations 0.29/year (P=0.02). Mortality following lung transplant was comparable between AATD- and non-AATD-related COPD. Surgical reduction of lung volume demonstrated inferior outcomes compared with non-AATD-related emphysema.ConclusionIntravenous augmentation remains the only disease-specific therapy in AATD and there is evidence that this slows decline in emphysema determined by CT density. There is paucity of data around other treatments in AATD. Treatments for usual COPD may not be as efficacious in AATD, and further studies may be required for this disease group.

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Section: Discussionmentioning

confidence: 99%

Treatment of lung disease in alpha-1 antitrypsin deficiency: a systematic review

Edgar¹,

Patel²,

Bayliss³

et al. 2017

COPD

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“…Im Hinblick auf die optimale Dauer und Trainingsfrequenz einer pulmonalen Rehabilitation besteht im internationalen Schrifttum kein Konsens [40]. Bei den COPD-Patienten deuten zumindest erste Biopsiedaten eine messbare Strukturverbesserung der Muskulatur bereits nach 3-wöchiger Trainingsphase an [41]. Prinzipiell steigt die Wirksamkeit der pneumologischen Rehabilitation mit dessen Dauer an.…”

Section: Dauer Der Rehabilitationunclassified

Rehabilitation nach stationärer COPD

et al. 2018

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ZusammenfassungEine pneumologische Rehabilitationsmaßnahme kann bei COPD-Patienten, insbesondere nach Exazerbationen, die Zahl der Rehospitalisierungen reduzieren und sogar die Mortalität verringern. Diese Effekte stehen jedoch in einem direkten Zusammenhang mit der Qualität der Rehabilitation, was diese komplex macht. Neben der Erfassung des medizinischen Status, der Leistungsfähigkeit sowie relevanter Komorbiditäten ist eine spezifische Diagnostik und zielgerichtete Therapie notwendig. Das schließt neben der medikamentösen Therapie, inklusive Training der Inhalationstechniken, unter Umständen auch endoskopische Therapien (z. B. Bronchialtoilette) ein. Auch die nicht-invasive Beatmung erhält eine wachsende Bedeutung im rehabilitativen Setting. Dies setzt neben der notwendigen fachlichen Expertise die Erfahrung und den Mut voraus, diese Patienten auch konkret in die Reha-Trainingsprogramme einzuschließen, die mit NIV durchgeführt werden können – wie Fahrradergometer-Therapien oder Laufbandtraining – mit dem Ziel, die Patienten einem höheren Trainingsstimulus zuzuführen, welcher die weitere Prognose des COPD-Patienten beeinflusst. Ein wichtiger Punkt in der Arzt-Patienten-Interaktion ist die Festlegung realistischer Patientenziele, um letztendlich zu einer dauerhaft aktiveren gesundheitsorientierteren Lebensweise zu gelangen.

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“…Although the Nrf2-dependent antioxidant response in skeletal muscle decreases with age (Done et al, 2016; Sachdeva et al, 2014), exercise training induces expression of two Nrf2 target genes, namely mitochondrial transcription factor (TFAM) and nuclear respiratory factor 1 (NRF-1) in mouse skeletal muscle (Merry and Ristow, 2016). Pulmonary rehabilitation exercises improve the adaptation of oxidative phosphorylation in skeletal muscles in patients with chronic obstructive pulmonary disease via induction of TFAM and PGC1α (Jarosch et al, 2016). The report of Jarosch et al (2016) and many others highlight the fact that mitochondrial signaling plays a functional role in promoting exercise efficiency.…”

Section: Muscle Metabolism In Agingmentioning

confidence: 99%

“…Pulmonary rehabilitation exercises improve the adaptation of oxidative phosphorylation in skeletal muscles in patients with chronic obstructive pulmonary disease via induction of TFAM and PGC1α (Jarosch et al, 2016). The report of Jarosch et al (2016) and many others highlight the fact that mitochondrial signaling plays a functional role in promoting exercise efficiency. Both NRF-1 and PGC1α stimulate human telomere transcription in response to exercise via AMPK activation, connecting telomere protection in aging with metabolism (Diman et al, 2016).…”

Section: Muscle Metabolism In Agingmentioning

confidence: 99%

Influence of anaerobic and aerobic exercise on age-related pathways in skeletal muscle

Navas-Enamorado

Bernier

Brea-Calvo

et al. 2017

Ageing Research Reviews

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Different Training-Induced Skeletal Muscle Adaptations in COPD Patients with and without Alpha-1 Antitrypsin Deficiency

Cited by 21 publications

References 32 publications

Treatment of lung disease in alpha-1 antitrypsin deficiency: a systematic review

Treatment of lung disease in alpha-1 antitrypsin deficiency: a systematic review

Rehabilitation nach stationärer COPD

Influence of anaerobic and aerobic exercise on age-related pathways in skeletal muscle

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