Função endotelial em pacientes com doença pulmonar obstrutiva crônica exacerbada: discriminação de fenótipo exacerbador, capacidade funcional como determinante e proposta de intervenção precoce e acessível

Abstract

Severe acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with worse health outcomes, which include an increased risk for cardiovascular (CV) events and exercise intolerance. In view of this gap, the first study investigated the association between exercise capacity and endothelial function in patients with AECOPD and demonstrated that the greater distance covered in the six-minute walk test reflects in greater endothelial function assessed by flow-mediated dilation (FMD). In addition, some cutoff values for FMD have already been able to distinguish healthy individuals from those with risk factors or CV diseases, however, the ability of endothelial function to differentiate COPD phenotypes has not yet been investigated. Thus, the second study was developed, which aimed to discriminate the severe exacerbator phenotype in AECOPD and to evaluate clinical and functional features according to the cut-off point. Additionally, physical exercise has been shown to be beneficial for endothelial function, but there is still a lack of evidence regarding its benefit in Pulmonary Rehabilitation and even more specifically in AECOPD. In this sense, the third study was conducted and investigated the effect of early low-cost PR with elastic bands on endothelial function in patients with exacerbated COPD during hospitalization, which resulted in better endothelial function in those patients who received the proposed early PR. In conclusion, it was demonstrated that exercise capacity is associated with endotelial function in patients with severe AECOPD. In addition, a cut-off point was identified for FMD discriminatory for severe exacerbating and non-exacerbating phenotypes in COPD. Moreover, the implementation of early resistance trainning with elastic bands during hospitalization resulted in better endotelial function in severe exacerbation of COPD patients. Therefore, CV diseases are relevant in COPD with the need for integrative and accessible perspectives for the management of this disease.