Metabolomics of COPD Pulmonary Rehabilitation Outcomes via Exhaled Breath Condensate.

Mauro Maniscalco,Annabella Tramice,Salvatore Fuschillo,Paola Cuomo,Andrea Motta,Letizia Palomba,Debora Paris,Pasquale Ambrosino

doi:10.3390/cells11030344

Mauro Maniscalco, Annabella Tramice + Show 6 more

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https://doi.org/10.3390/cells11030344

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Abstract

Chronic obstructive pulmonary disease (COPD) is characterized by different phenotypes and clinical presentations. Therefore, a single strategy of pulmonary rehabilitation (PR) does not always yield the expected clinical outcomes as some individuals respond excellently, others discreetly, or do not respond at all. Fifty consecutive COPD patients were enrolled. Of them, 35 starting a 5-week PR program were sampled at admission (T0), after 2 (T2W) and 5 (T5W) weeks, while 15 controls not yet on PR were tested at T0 and T5W. Nuclear magnetic resonance (NMR) profiling of exhaled breath condensate (EBC) and multivariate statistical analysis were applied to investigate the relationship between biomarkers and clinical parameters. The model including the three classes correctly located T2W between T0 and T5W, but 38.71% of samples partially overlapped with T0 and 32.26% with T5W, suggesting that for some patients PR is already beneficial at T2W (32.26% overlapping with T5W), while for others (38.71% overlapping with T0) more time is required. Rehabilitated patients presented several altered biomarkers. In particular, methanol from T0 to T5W decreased in parallel with dyspnea and fatigue, while the walk distance increased. Methanol could be ascribed to lung inflammation. We demonstrated that the metabolic COPD phenotype clearly evolves during PR, with a strict relationship between clinical and molecular parameters. Methanol, correlating with clinical parameters, represents a useful biomarker for monitoring personalized outcomes and establishing more targeted protocols.

Highlights

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide [1]
chronic obstructive pulmonary disease (COPD) patients undergoing pulmonary rehabilitation (PR) were enrolled as cases, while those not yet on PR served as controls
Twenty of them were excluded for protocol adherence, 15 because of exacerbations and/or change in the therapy during the study, while five refused to sign the informed consent

Summary

Introduction

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide [1]. Given the rising social and economic costs, COPD prevention and treatment have received growing attention [2], and pulmonary rehabilitation (PR), underused [3], has become essential for COPD management. PR is a multidisciplinary approach based on exercise training and pharmacological and nonpharmacological (e.g., physical, psychological, educational, and nutritional) interventions [4]. Expected PR outcomes are improvement in dyspnea, quality of life, exercise tolerance, and a reduction in hospitalization [4]. COPD remains a disease with a wide spectrum of clinical presentations, with different phenotypes even in patients with a comparable degree of airflow limitation [5]. The individual response to PR is highly variable and sometimes unpredictable [6], because “there is currently no standardized way to assess which model would best suit which patient (and vice versa)” [3]

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