The effectiveness of short-term pulmonary rehabilitation program in patients with comorbid asthma, chronic obstructive pulmonary disease and obesity.

The effectiveness of pulmonary rehabilitation (PR) has not yet been established in patients with asthma - chronic obstructive pulmonary disease overlap (ACO) depending on their nutritional status. We aimed to evaluate the effectiveness of a short-term PR program in patients with comorbid asthma, chronic obstructive pulmonary disease (COPD), and obesity. We included 40 ACO patients and divided them into 3 groups according to body mass index (BMI) and then subdivided them into PR (n=21) and control (n=19) groups. The COPD Assessment Test (CAT), the Asthma Control Test (ACT), and the modified Medical Research Council dyspnea scale (mMRS) were used to evaluate symptoms levels. BODE index (body mass index, forced expiratory volume in one second, dyspnoea, and 6-min walk distance) was used to evaluate the effectiveness of pulmonary rehabilitation. In addition, spirometry and bioimpedansometry were performed. All measurements were done before and after a 6-month PR program. A significantly lower decline in the BODE index was observed in overweight patients (decreased by 43.6% compared to baseline and lower by 40.7% compared to the control group). The six-minute walking test (6MWT) significantly increased in all groups (p<0.001). There was a decrease in total CAT score by 25.4% and by 31.2% in the overweight group (p<0.001). The BMI decreased more in the obese group (by 9.4% compared to baseline). Our study result showed that early use of PR program significantly improves functional capacity and BODE index, leads to dyspnea and CAT scores reduction and improvement in pulmonary function, cause a decrease in BMI, body fat percentage, and visceral fat level, and an increase in muscle mass in overweight and obese patients with ACO.

«OBESITY PARADOX¼ IN COMORBID STABLE ISCHEMIC HEART DISEASE AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS.

OBJECTIVE: The aim: Was to find the possible relationship between spirometry tests, the BODE index (body mass index (BMI), airflow obstruction, dyspnea, and exercise tolerance) with bioimpedance parameters in overweight and class I obese patients. PATIENTS AND METHODS: Materials and methods: 47 patients with stable ischemic heart disease (IHD) (I-II functional class), chronic obstructive pulmonary disease (COPD) (GOLD II, III, IV; groups B, C, D) were divided into 3 groups: G1: 15 normal-weight patients, G2: 15 overweight subjects, and G3: 17 class I obese patients. Spirometry tests, bioimpedance parameters, 6MWT (6-minute walk test) were measured. RESULTS: Results: FEV1 was significantly higher in overweight (p = 0.033) and class I obese (p = 0.049) subjects, the BODE index was lower in overweight (p = 0.033) and class I obese (p = 0.037) patients, compared with normal-weight subjects. The statistically significant positive relationship was between BMI and FEV1 and the negative correlation was between BMI and the BODE index in all groups of patients (p < 0.05). CONCLUSION: Conclusions: In our study, we found better FEV1, 6MWT, the BODE index, the statistically significant association between FEV1 and the BODE index with BMI in overweight and class I obese patients. That's why we can suppose the presence of the "obesity paradox" in comorbid overweight or class I obese stable IHD, COPD patients.

The Role of MDR1 (C3435T) Gene Polymorphism in Patients with Chronic Obstructive Pulmonary Disease Associated with Type 2 Diabetes Mellitus.

Chronic obstructive pulmonary disease is a multifactorial disease characterized by gene-gene interaction as well as environmental effects. The incidence of type 2 diabetes mellitus is proved to be higher in the presence of chronic obstructive pulmonary disease than in the case of its absence. We aimed to study the genotypes of MDR1 (C3435T) gene polymorphism and its relationship with clinical, instrumental, and laboratory parameters in chronic obstructive pulmonary disease associated with type 2 diabetes mellitus. All the patients were divided into two groups. The first group included 53 patients with chronic obstructive pulmonary disease, and the second group included 49 patients with chronic obstructive pulmonary disease with comorbid type 2 diabetes mellitus. The COPD assessment test (CAT), 6-minute walk test, BODE integral index, spirometry, and bioimpedansometry were used for examination. Lipid spectrum, carbohydrate metabolism, endothelial functional status, leptin, adiponectin, and serum levels were also determined by means of enzyme immunoassay. Our study results showed no significant difference between the genotypes of the control group of healthy individuals and patients with chronic obstructive pulmonary disease and comorbid type 2 diabetes mellitus. Though, a certain association of this gene polymorphism with clinical findings by CAT-test, specific parameters of carbohydrate (fasting glucose) and lipid metabolism (total cholesterol and low-density cholesterol lipoproteins), endothelial functional state (nitrate/nitrite level) with the minor allele T available was found.