Postural balance in COPD with obstructive sleep apnoea: a cross-sectional study.

Objective: The aim of this study was to assess the postural balance in COPD patients with obstructive sleep apnoea (OSA). Physical activity, anxiety and depression symptoms, mood, and falls were also assessed in this population. Methods: Moderate to severe COPD patients were assessed for laboratory and clinical postural balance (force platform and mini-balance evaluation systems test (Mini-BESTest)), physical activity (accelerometry), OSA (polysomnography), sleep quality (Pittsburgh Sleep Quality Index), sleepiness (Epworth Sleepiness Scale), anxiety and depression symptoms (Hospital Anxiety and Depression Scale), dyspnoea (modified Medical Research Council), clinical status (COPD Assessment Test) and mood (Brunel Mood Scale). Self-reported falls were recorded for 6 months via phone calls. Results: COPD patients (n=70) were divided according to the polysomnography findings into the no OSA (n=30), mild OSA (n=25), and moderate to severe OSA (n=15) groups. Compared to patients with no OSA, those with moderate to severe OSA (msOSA group) presented median (interquartile range) increased path length (30.5 (23.9-34.5) cm versus 39.0 (30.6-52.6) cm, anteroposterior displacement (1.89 (1.39-2.31) cm versus 2.54 (2.06-2.83) cm and postural adjustment velocity (1.02 (0.80-1.15) cm·s-1 versus 1.30 (1.02-1.76) cm·s-1) (p<0.05). No differences were observed in the Mini-BESTest scores among the groups. The msOSA group presented a greater number of recurrent fallers in the first follow-up trimester. No association was observed between postural balance and age and pulmonary function. Conclusion: Individuals with COPD and moderate to severe OSA present changes in postural balance, including broader oscillation, faster postural adjustments and a greater risk of falls than those with no OSA. Physical activity, anxiety and depression symptoms, and mood are similar between COPD patients with and without OSA.

Effects of constant-load exercise and high-intensity interval training on reliever medication consumption and peak expiratory flow in individuals with asthma: a randomised controlled trial.

Introduction: The effect of aerobic training on reliever medication consumption (short-acting ß2-agonist (SABA)) and peak expiratory flow (PEF) in participants with asthma is poorly known. The comparison between constant-load exercise (CLE) and high-intensity interval training (HIIT) in these outcomes has never been tested. The purpose of the present study was to compare the effects of CLE or HIIT in SABA consumption and PEF improvement during an exercise programme in subjects with asthma. Methods: Clinically stable participants were randomised into CLE (n=27; 70-85% of the maximal load (Wmax)) or HIIT (n=28; 80-140% Wmax). The programme lasted 12 weeks (two sessions per week, 40 min per session), and the intensity was based on cardiopulmonary exercise testing (CPET). PEF was assessed before and after each exercise session. SABA was used if PEF was <70%. Clinical control (Asthma Control Questionnaire (ACQ)-6), CPET and aerobic fitness were also assessed before and after the intervention. Results: Both groups were similar at baseline. CLE and HIIT reduced SABA consumption throughout the intervention (p<0.05). Before training, 14 patients required SABA before exercising, but only one needed it after the intervention. Changes in post-exercise PEF were lower in the CLE group than in the HIIT group (1.6±25.3 versus 10.3±13.7%). Both groups improved aerobic fitness (10.1±12.8% versus 5.7±15.6%) and clinical asthma control; however, only the HIIT group achieved a minimal clinically important difference in the ACQ-6 post-intervention (-0.23±1.06 versus -0.52±0.73 Δ score). Conclusion: CLE and HIIT reduced SABA consumption; however, only HIIT increased PEF and asthma clinical control after the intervention. These results reinforce the importance of exercise training in moderate-to-severe asthma.

Elastic tape reduces dyspnea and improves health status in the short term in nonobese COPD males: A randomized controlled trial.

INTRODUCTION AND OBJECTIVES: The elastic tape (ET) is a novel intervention that acutely improves exercise capacity in laboratory tests; however, its effect on a patient's daily life remains unknown. This randomized controlled trial evaluated the effects of ET on daily life physical activity (DLPA), dyspnea symptoms, health status, and health-related quality of life (HRQoL) in individuals with COPD. METHODS: Fifty males with moderate to very severe COPD were randomly assigned to an intervention group (ETG, n = 25), receiving ET on the chest wall and abdomen, or a control group (CG, n = 25). The intervention was for 14 days. DLPA (accelerometry; steps per day, and sedentary time), dyspnea symptoms (transition dyspnea index, TDI; and modified Medical Research Council, mMRC), health status (COPD assessment test, CAT), and health-related quality of life (HRQoL, CRQ) were evaluated at baseline and on Day 21 after the intervention. RESULTS: No change in the DLPA was observed in between-group comparison. CG presented a reduction in step counts after 21days (-707,p <0.05) while ETG. maintained (-114,p > 0.94). However, ET reduced dyspnea symptoms in all TDI domains (functional, task, and effort) and on the mMRC scale after 14 days compared with CG (p < 0.01). Also, the ETG improved CAT score compared to the CG, reaching minimal clinical important difference (MCID) (-4.4 score, p <0.01). The ETG also improved in most CRQ domains reaching MCID after 21 days. CONCLUSIONS: ET does not modify DLPA but reduces dyspnea and improves health status and HRQoL in nonobese males with moderate to very severe COPD in the short term. This novel and low-cost intervention improves COPD symptoms.

Identifying the Characteristics of Responders and Nonresponders in a Behavioral Intervention to Increase Physical Activity Among Patients With Moderate to Severe Asthma: Protocol for a Prospective Pragmatic Study.

BACKGROUND: Previous research has suggested that most adults improve their asthma control after a short-term behavioral intervention program to increase physical activity in daily life (PADL). However, the characteristics of individuals who respond and do not respond to this intervention and the medium-term response remain unknown. OBJECTIVE: This study aims to (1) identify the characteristics of adult responders and nonresponders with asthma to a behavioral intervention to increase physical activity and (2) evaluate the functional and clinical benefits in the medium term. METHODS: This prospective pragmatic study will include adults with moderate to severe asthma who enroll in a behavioral intervention. All individuals will receive an educational program and an 8-week intervention to increase PADL (1 time/wk; up to 90 min/session). The educational program will be conducted in a class setting through group discussions and video presentations. Behavioral interventions will be based on the transtheoretical model using counseling, incentives, and individual feedback aiming to increase participation in physical activity. Motivational interviewing and guidelines for overcoming barriers will be used to stimulate individuals to reach their goals. Pre- and postintervention assessments will include the following: PADL (triaxial accelerometry), body composition (octopolar bioimpedance), barriers to PADL (questionnaire), clinical asthma control (Asthma Control Questionnaire), quality of life (Asthma Quality of Life Questionnaire), anxiety and depression levels (Hospital Anxiety and Depression Scale), and exacerbations. "Responders" to the intervention will be defined as those who demonstrate an increase in the number of daily steps (≥2500). RESULTS: In December 2021, the clinical trial registration was approved. Recruitment and data collection for the trial is ongoing, and the results of this study are likely to be published in late 2024. CONCLUSIONS: The intervention will likely promote different effects according to the clinical characteristics of the individuals, including asthma control, age, anxiety and depression levels, obesity, and several comorbidities. Identifying individuals who respond or do not respond to behavioral interventions to increase PADL will help clinicians prescribe specific interventions to adults with asthma. TRIAL REGISTRATION: ClinicalTrials.gov NCT05159076; https://clinicaltrials.gov/ct2/show/NCT05159076. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/49032.

Increased physical activity reduces sleep disturbances in asthma: A randomized controlled trial.

BACKGROUND AND OBJECTIVE: Individuals with asthma are more likely to develop sleep-disordered breathing. Exercise training improves sleep; however, the effect of physical activity (PA) on improving sleep quality remains unknown. This study had two objectives: (i) to evaluate the effect of a behavioural intervention to increase physical activity in daily living (PADL) on sleep quality in adults with asthma; (ii) to verify the association between a change in sleep quality, quality of life, anxiety, depression and asthma symptoms. METHODS: This randomized controlled clinical trial included adults physically inactive with asthma. Participants were randomized into the control (CG; n = 25) and intervention groups (IG; n = 24). IG was submitted to a behavioural intervention to increase PADL, and CG received the usual care. Pre- and post-intervention assessments of sleep quality (by actigraphy and questionnaire), PADL level (by accelerometry), asthma control, health-related quality of life and anxiety and depression levels were conducted. RESULTS: Both groups were similar at baseline. After the intervention, IG increased daily steps and moderate to vigorous PA levels. IG also improved sleep efficiency and latency as well as increased asthma-symptom-free days compared to CG. In addition, a greater proportion of participants in the IG had improved sleep quality after the intervention. Lastly, IG presented clinical improvement in the asthma-related quality of life questionnaire and a reduction in anxiety symptoms. CONCLUSION: Our results demonstrate that a behavioural intervention can increase PA, enhance behavioural sleep quality, efficiency and quality of life and reduce asthma and anxiety symptoms.

2021 Brazilian Thoracic Association recommendations for the management of severe asthma.

Advances in the understanding that severe asthma is a complex and heterogeneous disease and in the knowledge of the pathophysiology of asthma, with the identification of different phenotypes and endotypes, have allowed new approaches for the diagnosis and characterization of the disease and have resulted in relevant changes in pharmacological management. In this context, the definition of severe asthma has been established, being differentiated from difficult-to-control asthma. These recommendations address this topic and review advances in phenotyping, use of biomarkers, and new treatments for severe asthma. Emphasis is given to topics regarding personalized management of the patient and selection of biologicals, as well as the importance of evaluating the response to treatment. These recommendations apply to adults and children with severe asthma and are targeted at physicians involved in asthma treatment. A panel of 17 Brazilian pulmonologists was invited to review recent evidence on the diagnosis and management of severe asthma, adapting it to the Brazilian reality. Each of the experts was responsible for reviewing a topic or question relevant to the topic. In a second phase, four experts discussed and structured the texts produced, and, in the last phase, all experts reviewed and approved the present manuscript and its recommendations.

Identification of asthma phenotypes based on extrapulmonary treatable traits.

Asthma is a heterogeneous and complex disease, and a description of asthma phenotypes based on extrapulmonary treatable traits has not been previously reported.The objective of this study was to identify and characterise clusters based on clinical, functional, anthropometrical and psychological characteristics in participants with moderate-to-severe asthma.This was a cross-sectional multicentre study involving centres from Brazil and Australia. Participants (n=296) with moderate-to-severe asthma were consecutively recruited. Physical activity and sedentary time, clinical asthma control, anthropometric data, pulmonary function and psychological and health status were evaluated. Participants were classified by hierarchical cluster analysis and the clusters compared using ANOVA, Kruskal--Wallis and Chi-squared tests. Multiple logistic and linear regression models were performed to evaluate the association between variables.We identified four clusters: 1) participants with controlled asthma who were physically active; 2) participants with uncontrolled asthma who were physically inactive and more sedentary; 3) participants with uncontrolled asthma and low physical activity, who were also obese and experienced anxiety and/or depression symptoms; and 4) participants with very uncontrolled asthma who were physically inactive, more sedentary, obese and experienced anxiety and/or depression symptoms. Higher levels of sedentary time, female sex and anxiety symptoms were associated with increased odds of exacerbation risk, while being more active showed a protective factor for hospitalisation. Asthma control was associated with sex, the occurrence of exacerbation, physical activity and health status.Physical inactivity, obesity and symptoms of anxiety and/or depression were associated with worse asthma outcomes, and closely and inextricably associated with asthma control. This cluster analysis highlights the importance of assessing extrapulmonary traits to improve personalised management and outcomes for people with moderate and severe asthma.

Effects of elastic tape on thoracoabdominal mechanics, dyspnea, exercise capacity, and physical activity level in nonobese male subjects with COPD.

Subjects with severe and very severe chronic obstructive pulmonary disease (COPD) present thoracoabdominal asynchrony (TAA) that reduces ventilatory efficiency and exercise capacity. However, no therapeutic intervention has focused on reducing TAA. The purpose of this study was to evaluate the effects of elastic tape (ET) on thoracoabdominal mechanics, dyspnea symptoms, exercise capacity, and physical activity level in nonobese male subjects with severe-to-very severe COPD. This crossover, randomized trial included nonobese males with severe to very severe COPD. ET was placed on the chest wall and abdomen to reduce TAA. Subjects were evaluated at three hospital visits, each 7 days apart. At visit 1, thoracoabdominal kinematic and pulmonary ventilation were evaluated by optoelectronic plethysmography and electrical impedance tomography, respectively, both at rest and during isoload exercise testing. At visit 2, a cardiopulmonary exercise test (CPET; 10 W/min) was performed until exhaustion. Between the visits, subjects used a physical activity monitor (PAM) (at least 5 days of measurement; 10 h/day). At visit 3, all the tests were repeated in the opposite order of the previous randomization. During the isoload exercise, subjects with ET presented lower tidal and minute volumes (P = 0.01) and reduced TAA (P = 0.02) and dyspnea (P = 0.04). During the CPET, subjects with ET presented an increase in peak oxygen consumption (V̇o2peak; L/min and mL·kg-1·min-1; P = 0.01), test duration (P = 0.009), and maximal load (P = 0.03). Moderate and vigorous physical activity (MVPA), which was evaluated by the PAM, was also increased in subjects with ET (P = 0.01). ET reduced TAA and dyspnea and increased exercise capacity and the duration of MVPA in nonobese male subjects with severe-to-very severe COPDNEW & NOTEWORTHY Elastic tape can be used as a new and low-cost intervention to reduce thoracoabdominal asynchrony and sedentary behavior as well as improve exercise capacity and physical activity level in nonobese male subjects with severe-to-very severe chronic obstructive pulmonary disease.

Provision of inhaled corticosteroids is associated with decrease in hospital admissions in Brazil: A longitudinal nationwide study.

OBJECTIVE: To describe trends of hospital admissions due to asthma from 2008 to 2015 and to evaluate their relationship with trends of inhaled corticosteroids (ICS) provision by the government in Brazil. METHODS: We used Brazilian Government data to calculate hospital admission rates due to asthma, number of physicians, number of hospital beds, number of subjects that received ICS per 100,000 inhabitants in Brazil and in each of its municipalities for each year of the study. We performed Poisson Multilevel Regression Analyses to evaluate the relationship between the trends of hospital admission rates due to asthma with the trends of the number of subjects that had been receiving ICS during the study period. The analyses were adjusted for the number of physicians and hospital beds. FINDINGS: The number of patients who received ICS/100,000 inhabitants increased from 2008 to 2015 (943.9-1988.5). Hospital admissions/100,000 inhabitants decreased in patients aged 5-14 years (148.3-110.9) and in patients aged 15-39 years (59.9-32.3); the reduction was greater in municipalities in which ICS provision increased. The number of physicians/100,000 inhabitants increased and the number of hospital beds/100,000 inhabitants decreased in the study period. The increase in the number of physicians and in the number of subjects that received ICS were associated with reduction in hospital admissions. CONCLUSION: We found that provision of ICS by the Brazilian Government was associated with a decrease of hospital admissions for asthma in the municipalities and country levels from 2008 to 2015.

2020 Brazilian Thoracic Association recommendations for the management of asthma.

The pharmacological management of asthma has changed considerably in recent decades, as it has come to be understood that it is a complex, heterogeneous disease with different phenotypes and endotypes. It is now clear that the goal of asthma treatment should be to achieve and maintain control of the disease, as well as to minimize the risks (of exacerbations, disease instability, accelerated loss of lung function, and adverse treatment effects). That requires an approach that is personalized in terms of the pharmacological treatment, patient education, written action plan, training in correct inhaler use, and review of the inhaler technique at each office visit. A panel of 22 pulmonologists was invited to perform a critical review of recent evidence of pharmacological treatment of asthma and to prepare this set of recommendations, a treatment guide tailored to use in Brazil. The topics or questions related to the most significant changes in concepts, and consequently in the management of asthma in clinical practice, were chosen by a panel of experts. To formulate these recommendations, we asked each expert to perform a critical review of a topic or to respond to a question, on the basis of evidence in the literature. In a second phase, three experts discussed and structured all texts submitted by the others. That was followed by a third phase, in which all of the experts reviewed and discussed each recommendation. These recommendations, which are intended for physicians involved in the treatment of asthma, apply to asthma patients of all ages.

Exploratory analysis of requests for authorization to dispense high-cost medication to COPD patients: the São Paulo "protocol".

OBJECTIVE: A resolution passed by the government of the Brazilian state of São Paulo established a protocol for requesting free COPD medications, including tiotropium bromide, creating regional authorization centers to evaluate and approve such requests, given the high cost of those medications. Our objective was to analyze the requests received by an authorization center that serves cities in the greater metropolitan area of (the city of) São Paulo between 2011 and 2016. METHODS: Data regarding the authorization, return, or rejection of the requests were compiled and analyzed in order to explain those outcomes. Subsequently, the clinical and functional data related to the patients were evaluated. RESULTS: A total of 7,762 requests for dispensing COPD medication were analyzed. Requests related to male patients predominated. Among the corresponding patients, the mean age was 66 years, 12% were smokers, 88% had frequent exacerbations, and 84% had severe/very severe dyspnea. The mean FEV1 was 37.2% of the predicted value. The total number of requests decreased by 24.5% from 2012 to 2013 and was lowest in 2015. Most (65%) of the requests were accepted. The main reasons for the rejection/return of a request were a post-bronchodilator FEV1/FVC ratio > 0.7, a post-bronchodilator FEV1 > 50% of the predicted value, and failure to provide information regarding previous use of a long-acting ß2 agonist. During the study period, the total number of requests returned/rejected decreased slightly, and there was improvement in the quality of the data included on the forms. CONCLUSIONS: Here, we have identified the characteristics of the requests for COPD medications and of the corresponding patients per region served by the authorization center analyzed, thus contributing to the improvement of local public health care measures.

Effects of weight loss on dynamic hyperinflation in obese women asthmatics.

Obese adults with asthma are more likely to develop dynamic hyperinflation (DH) and expiratory flow limitation (EFL) than nonobese asthmatics, and weight-loss seems to improve the breathing mechanics during exercise. However, studies evaluating the effect of weight loss on DH in obese adults with asthma have not been performed. We sought to evaluate the effect of a weight loss program on DH in obese adults with asthma. Forty-two asthma patients were enrolled in a weight loss program (diet, psychological support, and exercise) and were subsequently divided into two groups according to the percentage of weight loss: a ≥5% group ( n = 19) and a <5% group ( n = 23). Before and after the intervention, DH and EFL (constant load exercise), health-related quality of life (HRQoL), asthma control, quadriceps muscle strength and endurance, body composition, and lung function were assessed. Both groups exhibited a decrease of ≥10% in inspiratory capacity (DH) before intervention, and only the ≥5% group showed clinical improvement in DH compared with the <5% group postintervention (-9.1 ± 14.5% vs. -12.5 ± 13.5%, respectively). In addition, the ≥5% group displayed a significant delay in the onset of both DH and EFL and a clinically significant improvement in HRQoL and asthma control. Furthermore, a correlation was observed between reduced waist circumference and increased inspiratory capacity ( r = -0.45, P = 0.05) in the ≥5% group. In conclusion, a weight-loss of ≥5% of the body weight improves DH, which is associated with waist circumference in obese adults with asthma. In addition, the group with greater weight-loss showed a delayed onset of DH and EFL during exercise and improved asthma clinical control and HRQoL. NEW & NOTEWORTHY This is the first study to evaluate dynamic hyperinflation (DH) after a weight loss program in obese patients with asthma. Our results demonstrate that moderate weight loss can improve DH in obese patients with asthma that is associated with a decrease in abdominal fat. Moreover, a minimum of 5% in weight loss delays the onset of DH and expiratory flow limitation besides inducing a clinical improvement in asthma quality of life and clinical control.

Spirometry in patients screened for coronary artery disease: is it useful?

OBJECTIVE: To determine the prevalence of spirometric abnormalities in patients screened for coronary artery disease (CAD) and the risk factors for lung function impairment. METHODS: Patients referred for cardiac CT underwent spirometry and were subsequently divided into two groups, namely normal lung function and abnormal lung function. The prevalence of spirometric abnormalities was calculated for the following subgroups of patients: smokers, patients with metabolic syndrome, elderly patients, and patients with obstructive coronary lesions. All groups and subgroups were compared in terms of the coronary artery calcium score and the Duke CAD severity index. RESULTS: A total of 205 patients completed the study. Of those, 147 (72%) had normal lung function and 58 (28%) had abnormal lung function. The median coronary artery calcium score was 1 for the patients with normal lung function and 36 for those with abnormal lung function (p = 0.01). The mean Duke CAD severity index was 15 for the former and 27 for the latter (p < 0.01). Being a smoker was associated with the highest OR for abnormal lung function, followed by being over 65 years of age and having obstructive coronary lesions. CONCLUSIONS: The prevalence of spirometric abnormalities appears to be high in patients undergoing cardiac CT for CAD screening. Smokers, elderly individuals, and patients with CAD are at an increased risk of lung function abnormalities and therefore should undergo spirometry. (ClinicalTrials.gov identifier: NCT01734629 [http://www.clinicaltrials.gov/]).

Spirometry in patients screened for coronary artery disease: is it useful? / Espirometria em pacientes submetidos a investigação para detecção de doença arterial coronariana: é útil?

ABSTRACT Objective: To determine the prevalence of spirometric abnormalities in patients screened for coronary artery disease (CAD) and the risk factors for lung function impairment. Methods: Patients referred for cardiac CT underwent spirometry and were subsequently divided into two groups, namely normal lung function and abnormal lung function. The prevalence of spirometric abnormalities was calculated for the following subgroups of patients: smokers, patients with metabolic syndrome, elderly patients, and patients with obstructive coronary lesions. All groups and subgroups were compared in terms of the coronary artery calcium score and the Duke CAD severity index. Results: A total of 205 patients completed the study. Of those, 147 (72%) had normal lung function and 58 (28%) had abnormal lung function. The median coronary artery calcium score was 1 for the patients with normal lung function and 36 for those with abnormal lung function (p = 0.01). The mean Duke CAD severity index was 15 for the former and 27 for the latter (p < 0.01). Being a smoker was associated with the highest OR for abnormal lung function, followed by being over 65 years of age and having obstructive coronary lesions. Conclusions: The prevalence of spirometric abnormalities appears to be high in patients undergoing cardiac CT for CAD screening. Smokers, elderly individuals, and patients with CAD are at an increased risk of lung function abnormalities and therefore should undergo spirometry. (ClinicalTrials.gov identifier: NCT01734629 [http://www.clinicaltrials.gov/])

RESUMO Objetivo: Determinar a prevalência de alterações espirométricas em pacientes submetidos a investigação para detecção de doença arterial coronariana (DAC) e os fatores de risco de comprometimento da função pulmonar. Métodos: Pacientes encaminhados para TC cardíaca foram submetidos a espirometria e, em seguida, divididos em dois grupos: função pulmonar normal e função pulmonar anormal. A prevalência de alterações espirométricas foi calculada em fumantes, pacientes com síndrome metabólica, idosos e portadores de lesões coronárias obstrutivas. Os grupos e subgrupos foram comparados quanto ao escore de cálcio coronariano e ao índice de gravidade de DAC de Duke. Resultados: Completaram o estudo 205 pacientes. Destes, 147 (72%) apresentaram função pulmonar normal e 58 (28%) apresentaram função pulmonar anormal. A mediana do escore de cálcio coronariano foi 1 nos pacientes com função pulmonar normal e 36 naqueles com função pulmonar anormal (p = 0,01). A média do índice de gravidade de DAC de Duke foi = 15 nos pacientes com função pulmonar normal e 27 nos pacientes com função pulmonar anormal (p < 0,01). O tabagismo apresentou a maior OR de função pulmonar anormal, seguido de idade > 65 anos e lesões coronarianas obstrutivas. Conclusões: A prevalência de alterações espirométricas parece ser alta em pacientes submetidos a TC cardíaca para detecção de DAC. O risco de função pulmonar anormal é maior em fumantes, idosos e pacientes com DAC, os quais, portanto, devem ser submetidos a espirometria. (ClinicalTrials.gov identifier: NCT01734629 [http://www.clinicaltrials.gov/])

Effect of an Exercise Program on Lymphocyte Proliferative Responses of COPD Patients.

Exercise training has been shown to reduce symptoms and exacerbations in COPD patients; however, the exercise effect on patients' immune response is poorly known. We thus verified if an exercise program (EP) impacted on proliferative T cell response of COPD patients. Fourteen non-O2 dependent COPD patients on standard treatment were studied. EP consisted in 24 sessions of aerobic and muscular training. Peripheral blood mononuclear cells were stimulated with the mitogen phytohemagglutinin and antigens from Haemophilus influenzae and cytomegalovirus, and the lymphocyte proliferative response (LPR) was assessed through the expression of Ki67 before and after the EP. The Quality of life [COPD assessment test (CAT)], dyspnea [(modified Medical Research Council scale (mMRC)], and 6-min walk distance were also assessed. The EP program increased significantly the LPR of TCD4+ lymphocytes to phytohemagglutinin and cytomegalovirus and H. influenzae antigens, but with TCD8+ lymphocytes the increase was less marked. Consistent with this, a higher proportion of TCD8+ than TCD4+ cells did not express the costimulatory molecule CD28. The EP also resulted in improvement of the quality of life, dyspnea, and physical capacity. The improvement in TCD4+ cell function may represent an additional mechanism through which the EP results in less exacerbations and hospitalizations.

Exercise Improves Physical Activity and Comorbidities in Obese Adults with Asthma.

INTRODUCTION: Obese adults with asthma have an increased number of comorbidities and reduced daily life physical activity (DLPA), which may worsen asthma symptoms. Exercise is recommended to improve asthma outcomes; however, the benefits of exercise for psychosocial comorbidities and physical activity levels in obese adults with asthma have been poorly investigated. OBJECTIVE: This study aimed to assess the effects of exercise on DLPA, asthma symptoms, and psychosocial comorbidities in obese adults with asthma. METHODS: Fifty-five grade II obese adults with asthma were randomly assigned to either a weight loss program + exercise program (WL + E group, n = 28) or a weight loss program + sham (WL + S group, n = 27). The WL + E group incorporated aerobic and resistance muscle training into the weight loss program (nutrition and psychological therapies), whereas the WL + S group performed breathing and stretching exercises. DLPA, asthma symptoms, sleep quality, and anxiety and depression symptoms were quantified before and after treatment. RESULTS: After 3 months, the WL + E group presented a significant increase in daily step counts (3068 ± 2325 vs 729 ± 1118 steps per day) and the number of asthma symptom-free days (14.5 ± 9.6 vs 8.6 ± 11.4 d·month) compared with the WL + S group. The proportion of participants with improvements in depression symptoms (76.4% vs 16.6%) and a lower risk of developing obstructive sleep apnea (56.5% vs 16.3%) was greater in the WL + E group than that in the WL + S group (P < 0.05). Significant improvements in sleep efficiency (6.6% ± 5.1% vs 1.3% ± 4.7%) and latency (-3.7 ± 5.9 vs 0.2 ± 5.6 min) were also observed in the WL + E group. CONCLUSIONS: Our results strongly suggest that exercise training plus a weight loss program improves DLPA, sleep efficiency, and depression and asthma symptoms in obese adults with asthma.