Oxidative and inflammatory effects of pulmonary rehabilitation in patients with bronchiectasis. A prospective, randomized study.

INTRODUCTION: Background: systemic inflammation and oxidative stress are important factors in the pathogenesis of bronchiectasis. Pulmonary rehabilitation (PR) is recommended for bronchiectasis, but there is no data about its effect on the inflammatory and REDOX status of these patients. Aims: to investigate the effect of PR in non-cystic-fibrosis bronchiectasis (NCFB) patients, and to compare it with the effect of PR plus a hyperproteic oral nutritional supplement (PRS) enriched with beta-hydroxy-beta-methylbutyrate (HMB) on serum inflammatory and oxidative biomarkers. Materials and methods: this was an open randomized, controlled trial. Thirty individuals (65 years old or younger with a body mass index over 18.5, older than 65 years with a body mass index over 20) were recruited from September 2013 to September 2014, and randomly assigned to receive PR or PRS. Total neutrophils, and inflammatory and oxidative biomarker levels were measured at baseline, and then at 3 and 6 months. Results: in the PRS group neutrophil levels were decreased from baseline at 6 months. A significantly different fold change was found between the PR and PRS groups. In the PR group, IL-6 and adiponectin were increased by the end of the study while TNFα levels were decreased from baseline at 6 months. REDOX biomarkers remained stable throughout the study except for 8-isoprostane levels, which were increased from baseline at 6 months in both groups of patients. Conclusions: a PR program induced a pro-oxidative effect accompanied by changes in circulating inflammatory cytokine levels in NCFB patients. Our results would also suggest a possible beneficial effect of the HMB enriched supplement on neutrophil level regulation in these patients. The information provided in this study could be useful for choosing the right therapeutic approach in the management of bronchiectasis.

INTRODUCCIÓN: Introducción: la inflamación sistémica y el estrés oxidativo son factores importantes en la patogénesis de la bronquiectasia. La rehabilitación pulmonar (PR) está recomendada en los sujetos con bronquiectasias, pero no hay datos sobre sus posibles efectos sobre el estado inflamatorio y REDOX de estos pacientes. Objetivos: investigar el efecto de la PR en pacientes con bronquiectasias no asociadas a fibrosis quística (NCFB) sobre los biomarcadores oxidativos e inflamatorios, y compararlo con los efectos de la PR junto con la suplementación oral de un suplemento hiperproteico (PRS) enriquecido con beta-hidroxi-beta-metilbutirato (HMB). Material y métodos: ensayo clínico abierto, aleatorizado y controlado. Treinta pacientes (de 65 años o menos con un índice de masa corporal por encima de 18,5, y mayores de 65 años con un índice de masa corporal de más de 20) se aleatorizaron para recibir PR o PRS. Los niveles circulantes de neutrófilos totales y los de biomarcadores de estado inflamatorio y oxidativo se determinaron al inicio del estudio y a los 3 y 6 meses. Resultados: los niveles de neutrófilos en el grupo de PRS se redujeron desde el inicio a los 6 meses, presentando una tasa de cambio significativamente diferente según el tratamiento. En el grupo de PR, la IL-6 y la adiponectina aumentaron al final del estudio, mientras que los niveles de TNFα disminuyeron desde el inicio a los 6 meses. Los biomarcadores de estrés oxidativo se mantuvieron estables durante todo el estudio excepto por los niveles de 8-isoprostano, que aumentaron desde el inicio a los 6 meses en ambos grupos de pacientes. Conclusión: el programa de PR indujo un efecto pro-oxidativo acompañado de cambios en los niveles de citoquinas inflamatorias circulantes en pacientes con NCFB. Nuestros resultados también sugieren un posible efecto beneficioso del suplemento nutricional sobre la regulación de los niveles de neutrófilos de estos pacientes.

Pulmonary Rehabilitation Only Versus With Nutritional Supplementation in Patients With Bronchiectasis: A RANDOMIZED CONTROLLED TRIAL.

PURPOSE: Pulmonary rehabilitation (PR) is recommended for bronchiectasis, but there is little evidence of its efficacy in these patients. The aim of this study was to assess the effect of PR in normally nourished patients with noncystic fibrosis bronchiectasis compared with the effect of PR plus an oral nutritional supplement (PRONS). METHODS: A single-center randomized controlled trial, parallel treatment design in which participants were randomly assigned to receive PR for 12 wk or PR plus a high-protein nutritional supplement enriched with beta-hydroxy-beta-methylbutyrate. Outcome assessments were performed at baseline, 12 and 24 wk including cardiopulmonary exercise testing, health-related quality of life (HRQOL), bronchorrhea, dyspnea, psychological symptoms, spirometry, and exacerbations. RESULTS: Thirty patients were randomized into 2 groups of 15 participants. In both groups, cardiopulmonary exercise testing, HRQOL, dyspnea, and spirometry parameters significantly increased from baseline at 3 and/or 6 mo. CONCLUSION: PR improved exercise capacity, HRQOL, and respiratory parameters. The use of PRONS did not have a significant effect on the results.

Oral supplement enriched in HMB combined with pulmonary rehabilitation improves body composition and health related quality of life in patients with bronchiectasis (Prospective, Randomised Study).

BACKGROUND & AIMS: Pulmonary Rehabilitation (PR) is recommended for bronchiectasis but there is no data about its effect on body composition. The aim of this study is to assess the effect of Pulmonary Rehabilitation (PR) for 12 weeks in normally-nourished non-cystic-fibrosis bronchiectasis patients compared with the effect of PR plus a hyperproteic oral nutritional supplement enriched with beta-hydroxy-beta-methylbutyrate (HMB) on body composition, muscle strength, quality of life and serum biomarkers. METHODS: single center randomized controlled trial, parallel treatment design: Participants were randomly assigned to receive PR for 12 weeks or PR plus ONS (PRONS) (one can per day). Outcome assessments were performed at baseline, 12 weeks and 24 weeks: body composition (Dual-energy X-Ray Absorptiometry (DEXA), mid-arm muscle circumference (MAMC), phase angle by Bio-impedance), health related quality of life (Spanish QOL-B-V3.0, Physical Functioning Scale), handgrip strength, diet questionnaire, and plasma levels of prealbumin, myostatin and somatomedin-c. RESULTS: Thirty patients were randomized (15 per group) without differences in clinical and respiratory variables. In the PRONS group bone mineral density (BMD), mean and maximum handgrip dynamometry, MAMC, QOLB and prealbumin were significantly increased from baseline at 12 and 24 weeks and Fat free Mass (FFM) and FFM index, at 12 weeks. In the PR group only mean handgrip dynamometry and prealbumin were significantly increased at 12 and 24 weeks. In both groups plasma myostatin was reduced at 12 weeks (without significant differences). CONCLUSION: The addition of a hyperproteic ONS enriched with HMB to Pulmonary Rehabilitation could improve body composition, BMD, muscle strength and health related quality of life in bronchiectasis patients. Clinical Trials Number NCT02048397.

Conversion of chemical scrubbers to biotrickling filters for VOCs and H2S treatment at low contact times.

The purpose of this work was to evaluate the technical and economical feasibility of converting three chemical scrubbers in series to biotrickling filters (BTFs) for the simultaneous removal of H2S and volatile organic compounds (VOCs). The conversion of the full-scale scrubbers was based on previous conversion protocols. Conversion mainly required replacing the original carrier material and recycle pumps as well as modifying the controls and operation of the reactors. Complete removal of H2S and VOCs on a routine basis was reached at neutral pH in a longer period of time compared to previous conversions reported. Biotrickling filters operated at a gas contact time of about 1.4 s per reactor and at pH controlled between 6.5 and 6.8. Inlet average concentrations below 10 ppmv of H2S and below 5 ppmv for VOCs were often completely removed. The first and second bioreactors played a primary role in H2S removal. Year-round operation of the biotrickling filters proved the ability of the system to handle progressive load increases of H2S and VOCs. However, fast, sudden load changes often lead to reduced removal efficiencies. Odor analyses showed average removal efficiencies above 80%. Gas chromatography-mass spectrometry of selected samples showed that outlet odor concentration was due to limited removal of VOCs. The conversion showed was economically viable taking into account the theoretical consumption of chemicals needed for the absorption and oxidation of both H2S and VOCs.

Inventory and treatment of compost maturation emissions in a municipal solid waste treatment facility.

Emissions of volatile organic compounds (VOCs) from the compost maturation building in a municipal solid waste treatment facility were inventoried by solid phase microextraction and gas chromatography-mass spectrometry. A large diversity of chemical classes and compounds were found. The highest concentrations were found for n-butanol, methyl ethyl ketone and limonene (ppmv level). Also, a range of compounds exceeded their odor threshold evidencing that treatment was needed. Performance of a chemical scrubber followed by two parallel biofilters packed with an advanced packing material and treating an average airflow of 99,300 m(3) h(-1) was assessed in the treatment of the VOCs inventoried. Performance of the odor abatement system was evaluated in terms of removal efficiency by comparing inlet and outlet abundances. Outlet concentrations of selected VOCs permitted to identify critical odorants emitted to the atmosphere. In particular, limonene was found as the most critical VOC in the present study. Only six compounds from the odorant group were removed with efficiencies higher than 90%. Low removal efficiencies were found for most of the compounds present in the emission showing a significant relation with their chemical properties (functionality and solubility) and operational parameters (temperature, pH and inlet concentration). Interestingly, benzaldehyde and benzyl alcohol were found to be produced in the treatment system.